Application for Permit to Drill - Form 1

Application for Permit to Drill - Form 1 Department of Mineral Resources Oil and Gas Division 600 East Boulevard Dept 474 Bizmark, N.D. 58505 to 0614 S.F.N 4615 (10 to 2014)

Please Read Instructions Before Filling Out Form.

Please Submit the Original and One Copy.

Field: Type of Work

Field: Type of Well

Field: Approximate Date Dirt Work Will Start

Field: Confidential

Field: Operator

Field: Telephone Number

Field: Address

Field: City

Field: State

Field: Zip Code

Field: Name of Surface Owner or Tenant

Field: Address

Field: City

Field: State

Field: Zip Code

Well Information

Checkbox option: Notice has been provided to the owner of any permanently occupied dwelling within 1,320 feet.

Checkbox option: This well is not located within five hundred feet of an occupied dwelling.

Field: Well Name

Field: Well Number

Field: At Surface

Field: Qtr-Qtr

Field: Section

Field: Township

Field: Range

Field: County

Field: If Directional, Top of Pay

Field: Qtr-Qtr

Field: Section

Field: Township

Field: Range

Field: County

Field: Proposed Bottom Hole Location

Field: Qtr-Qtr

Field: Section

Field: Township

Field: Range

Field: County

Field: Latitude of Well Head

Field: Longitude of Well Head

Field: N.A.D Reference

Field: Description of

Field: (Subject to N.D.I.C Approval)

Field: Ground Elevation

Field: Acres in Spacing/Drilling Unit

Field: Spacing/Drilling Unit Setback Requirement

Field: Industrial Commission Order

Field: Feet Above S.L.

Field: Feet

Field: Objective Horizons

Field: Pierre Shale Top

Field: Proposed

Field: Size

Field: Weight

Field: Depth

Field: Cement Volume

Note: Surface hole must be drilled with fresh water and surface casing must be cemented back to surface.

Field: Surface Casing

Field: Lb./Ft

Field: Sacks

Field: Feet

Field: Proposed

Field: Size

Field: Weight(s)

Field: Longstring Total Depth

Field: Cement Volume

Field: Cement Top

Field: Top Dakota Sand

Field: Longstring Casing

Field: Lb./Ft

Field: Feet M.D

Field: Feet T.V.D

Field: Sacks

Field: Feet

Field: Feet

Field: Base of Last Salt (If Applicable)

Field: Estimated Total Depth (feet)

Field: Drilling Mud Type (Vertical Hole - Below Surface Casing)

Field: Feet

Field: Feet M.D

Field: Feet T.V.D

Field: Proposed Logs

Field: Comments

Field: Date

Field: Signature

Field: Printed Name

Field: Title

Field: Email Address(es)

for State Use Only

for State Use Only

Field: Permit and File Number

Field: A.P.I Number 33-

Field: Date Approved

Field: Field

Field: By

Field: Pool

Field: Permit Type

Field: Title

Please See Instructions dmnr dot nd dot gov U.R.L

Application for Permit to Drill - Form 1 S.F.N 4615

1. All applications for permit to drill must be e-filed, except in extenuating circumstances. Operators must file an ePermit authorization form, and email to apd@nd.gov. The Bismarck office will then issue a user-I.D and password to access the online Form 1 or Form 1h.

2. Please refer to Section 43-02-03-16 of the North Dakota Administrative Code (N.D.A.C) regarding an application for permit to drill.

3. Well-site preparation other than surveying and staking is forbidden prior to approval of an application for permit to drill.

4. Verbal approval may be given for site preparation by the Director in extenuating circumstances although no drilling activity shall commence until the application is approved.

5. The application for permit to drill shall be accompanied by a bond pursuant to Section 43-02-03-15 N.D.A.C or the applicant must have previously filed such bond with the Commission, otherwise the application is incomplete.

6. Any incomplete application for permit to drill received by the Commission has no standing and shall not be deemed filed until it is completed.

7. The application for a permit to drill a well shall be accompanied by an accurate plat certified by a registered surveyor showing the location of the proposed well with reference to the nearest lines of a governmental section and referenced to true north. Also, the application must include an accurate pad layout which indicates cut & fill, and the proposed cuttings pit location. In addition, a production pad facilities layout plat is required.

8. The application for permit to drill a directional well shall be accompanied by an accurate plat certified by a registered surveyor showing the internal dimensions of the spacing or drilling unit.

9. The application for permit to drill shall be accompanied by a drilling prognosis which shall include the following: the proposed total depth (including measured depth if appropriate) to which the well will be drilled, the estimated depth to the top of important geological markers, the estimated depth to the top of objective horizons, the proposed mud program, the proposed casing program including size and weight, the proposed depth at which each casing string is to be set, the proposed amount of cement to be used, the estimated top of cement.

10. A Gamma Ray Log must be run to ground level, C.B.L run on the intermediate or production casing and open hole logs are required (unless waived by the director).

11. The application for permit to drill shall be accompanied by the general completion technique.

12. The application for permit to drill shall comply with N.D.I.C-PP (Permit Policy) 1.01, 1.02, 1.03, 1.04, 1.05, 1.06, 2.01, 2.02, 2.03 and 2.04. Also, the application shall include confirmation that a legal street address was requested per N.D.A.C 43-02-03-16.

13. The application for permit to drill shall be accompanied by a permit fee of one hundred dollars.

14. The approved application for permit to drill shall terminate and be of no further force and effect unless a well is drilling, or has been drilled, below surface casing on the first anniversary of the date of issuance or renewal.