Class VI Permit Application Templates

Operators applying for Class VI Permits in states where EPA has direct implementation authority must submit application materials to EPA via the Geologic Sequestration Data Tool (GSDT). To reduce the potential for redundancy and to organize permit application components in a manner that facilitates efficient review by the permitting authority, EPA recommends that Class VI permit applicants submit both:

1. A narrative with a characterization of the proposed site, overall strategies for site operations, and other general project information (compiled into a single file and submitted using the Project Information Tracking module of the GSDT).

2. Specific, detailed information required by certain Class VI Rule provisions (submitted using other GSDT modules, which are tailored to the applicable Class VI Rule requirements).

The templates below provide suggested outlines for providing this information as part of the Class VI permit application. Permit applicants are not required to use these templates. These documents do not substitute for promulgated provisions or regulations, nor are they regulations themselves, and do not impose legally-binding requirements on the U.S. Environmental Protection Agency (EPA), states, or the regulated community. Note that references to EPA’s Class VI Rule in the code of federal regulations (CFR) are provided in these templates. States with Class VI primacy have requirements that are at least as stringent as EPA’s. If your Class VI well is in a primacy state, consult your permitting authority about any additional requirements for what must be included in the permit application.

Application Narrative Templates:

Class VI Permit Application Narrative Template (docx) (64.12 KB)

Class VI Pre-Operation Narrative Template (docx) (61.54 KB)

Application Attachment Templates:

Summary of Requirements Template (docx) (35.91 KB)

Area of Review (AoR) and Corrective Action Plan Template (docx) (59.67 KB)

Testing and Monitoring Plan Template (docx) (68.22 KB)

Quality Assurance and Surveillance Plan (QSAP) Template (docx) (85.67 KB)

Plugging Plan Template (docx) (40.23 KB)

Post-injection Site Care (PISC) and Site Closure Plan Template (docx) (70.73 KB)

Emergency and Remedial Response Plan Template (docx) (67.57 KB)

Construction Details Template (docx) (45.01 KB)

Pre-operational Testing Program Template (docx) (40.6 KB)

Financial Assurance Demonstration Template (docx) (32.54 KB)

Stimulation Program Template (docx) (32.88 KB)