Form 7520-1 Permit Review and Issuance

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OMB No. 2040-0042 Form Expires 12/31/18

United States Environmental Protection Agency
Office of Ground Water and Drinking Water
Washington, DC 20460

I. Name and Address of Reporting Agency

UIC Federal Reporting System

Part I: Permit Review and Issuance/
Wells in Area of Review
(This information is solicited under the
authority of the Safe Drinking Water Act)

II. Date Prepared (month, day, year)

III. State Contact (name, telephone no.)

IV. Reporting Period (month, year)
To

From

October 1, 20

Class and Type of Injection Wells
II
Item
V. Permit
Application

Number of Individual
Permits Issued
(One Well)
Permit

Number of area Permits* Issued
B

Permit
Not Issued

D

Modification
Issued

E

HC

2D

2R

2H

III

IV

V

A

Wells
Identified
for C/A

B

Existing
Wells
New
Well Field
Existing
Well Field

Number of Wells in Area Permits

New
Wells

(See B above)

Existing
Wells
Number of Permits Denied/Withdrawn
(after complete technical review)
Number of Major Permit
Modifications Approved

Class II Wells Reviewed

Reviewed

New
Wells

(*See instructions on back)

Number of Rule-Authorized

Wells

VIII.
Area
of
Review
(AOR)

(Multiple Wells)

Issued
C

VII.
Permit
File
Review

ER

Number of Permit Applications Received

A

VI.
Permit
Determination

I

SWD

Number of Wells

Wells
Reviewed
Wells
Deficient
Abandoned
Wells

in Area of Review

Other
Wells

Number of Wells Identified

Abandoned
Wells

for Corrective Action

Other
Wells

1. Number of Wells in AOR with
Casing Repaired/Recemented C/A
Wells
with

C

C/A

2. Number of Active Wells in AOR
Plugged/Abandoned
3. Number of Abandoned Wells
in AOR Replugged
4. Number of Wells in AOR with
"Other" Corrective Action

IX. Remarks/Ad Hoc Report

(Attach additional sheets if necessary)

Certification
I certify that the statements I have made on this form and all attachments thereto are true, accurate, and complete. I acknowledge that any
knowingly false or misleading statement may be punishable by fine or imprisonment or both under applicable law.
Signature and Typed or Printed Name and Title of Person Completing Form

EPA Form 7520-1 (Rev. 12-31-15)

Previous edition is obsolete.

Date

Telephone No.

Instructions and Definitions
All reporting is cumulative over the fiscal year, and includes
activities from October 1 – September 30. All fields should contain
a value. Do not leave blank fields. Enter 0 if there are no wells
affected or no activities that occurred pertaining to the information
requested. Enter NA if the field or section is not applicable to the
submitter (e.g., the well type is not overseen by the submitter).
Enter U if the information is unknown or not captured; fields
designated as U require explanation.

Wells Deficient: For rule authorized Class II wells, enter the
number of reviewed wells that were found deficient (not in
compliance with UIC regulations) and that received corrective
action.

Section V. Permit Application

Section VIII. Area of Review (AoR)

Enter, under each well class, the total number of permit
applications that have been received this year to date. Include all
applications, including incomplete applications, for individual and
area permits. Include all applications regardless of whether they
are for “New Wells” or “Existing Wells.”

All wells that penetrate the injection zone in the AoR of an injection
well/field are reviewed during permit determination or during any
AoR analysis of a rule authorized well file.

A “New Well” is any well that began operation after the effective
date of the State (or EPA) Underground Injection Control Program.

Wells Reviewed: For rule authorized (existing) Class II wells only,
enter the number of wells with permit files reviewed and compliance
status determined this federal fiscal year to date.

Item A: For each well class, enter the number of “Abandoned” and
“Other” wells reviewed in the AoR for each permit application or
file that has been reviewed this federal fiscal year to date.

An “Existing Well” is any injection well that was in existence on
the effective date of the State (or EPA) UIC Program.

“Abandoned” includes any well penetrating the injection zone in the
AoR that has been properly or improperly plugged and/or
abandoned.

A “New Well Field” has only “New Wells” or a combination of
“New Wells” and “Existing Wells.” An “Existing Well Field”
contains only “Existing Wells.”

“Other” includes any producing well, operable injection well, dry
hole, exploratory well, etc., that penetrates the injection zone in the
AoR.

Section VI. Permit Determination
Permit Determinations include the approval, withdrawal, or denial
of UIC permit requests/actions such as: applications for permits,
major modifications to issued permits, revocation and reissuance
of permits, or termination of permits for cause. A complete permit
determination includes a thorough technical evaluation of the
request, public notification or review before issuance, and a final
decision document signed by the regulating authority.
Item A: For each well class, enter the number of individual permits
issued for “New or Existing Wells” this federal fiscal year to date.
Item B: For each well class, enter the number of area permits that
have been issued for “New or Existing Well Fields” this year to
date.
Item C: For each well class, enter the number of “New and
Existing Wells” covered by the Area Permits entered in Item B.
Item D: For each well class, enter the number of permits or major
modifications denied by the UIC primacy program and/or permits
withdrawn by applicants this federal fiscal year to date. The denial
of a permit or major modification should be included as a permit
determination only after there has been a complete technical
review.
Item E: For each well class, enter the number of major modifications approved this federal fiscal year to date. An approved major
modification requires a complete technical review, public
notification or review, and a final decision document signed by the
regulating authority.
Section VII. Permit File Review
A complete technical review of a rule authorized Class II well
record may be conducted to determine whether the well is in
compliance with UIC regulatory requirements in lieu of a permit
determination. The well record (or file) review may include an
evaluation of siting reports, wells in the area of review,
construction, operating, monitoring or other reports. These Class II
wells should be routinely reviewed at least once every five years
during the life of the well.

Corrective Action is required for those wells that penetrate the
injection zone in the AoR that are improperly sealed, completed, or
abandoned.
Item B: For each well class, enter the number of “Abandoned” and
“Other” wells in the AoR that have required corrective action for
each permit application or file reviewed this federal fiscal year to
date.
Item C: For each well class, enter the number of wells in the AoR
which have received corrective action (be specific) for all permit
applications or files that have been reviewed this year to date.
Paperwork Reduction Act Notice
The public reporting and record keeping burden for this
collection of information is estimated to average 4.5 hours per
year. Burden means the total time, effort, or financial resource
expended by persons to generate, maintain, retain, or disclose or
provide information to or for a Federal Agency. This includes the
time needed to review instructions; develop, acquire, install, and
utilize technology and systems for the purposes of collecting,
validating, and verifying information, processing and
maintaining information, and disclosing and providing
information; adjust the existing ways to comply with any
previously applicable instructions and requirements; train
personnel to be able to respond to the collection of information;
search data sources; complete and review the collection of
information; and, transmit or otherwise disclose the information.
An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it
displays a currently valid OMB control number. Send comments
on the Agency’s need for this information, the accuracy of the
provided burden estimates, and any suggested methods for
minimizing respondent burden, including the use of automated
collection techniques to Director, Collection Strategies Division,
U.S. Environmental Protection Agency (2822), 1200
Pennsylvania Ave., NW., Washington, D.C. 20460. Include the
OMB control number in any correspondence. Do not send the
completed forms to this address.
EPA Form 7520-1 (12-31-15) Revised