INSTRUCTIONS /
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTIONBUREAU OF MINING PROGRAMS
INSTRUCTIONS FOR COMPLETINGBITUMINOUS SURFACE MINE PERMIT APPLICATION
GENERAL INFORMATION
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INSTRUCTIONS
GENERAL INFORMATION
1. This information is provided to assist the applicant in completing the General Information portion of this Application and to provide additional information relating to the Modules contained in this Application. Please read these instructions prior to completing the Application.
2. Complete the Application by typing or printing clearly. If additional space is required to provide information on a specific Module contained in this Application, attach an 8½ x 11" sheet of paper appropriately labeled with the Module number.
3. Four copies of this Application must be completed and submitted to the appropriate DEP District Mining Office. See AppendixA of these instructions for a listing of the names, addresses and telephone numbers of the offices along with the counties for which the office receives and processes these Applications. AppendixA also lists the DEP Bureau of Mining Programs Central Office.
4. One copy of this Application must be completed and submitted to the local public office identified in SectionG. See AppendixB of these instructions for a listing of county public offices.
5. The Application form is available from any of the offices listed in Appendix A and may also be obtained in electronicformat www.elibrary.dep.state.pa.us/dsweb/view/collection-9727.
6. The “Application Date” must be updated with each additional Module submitted.
Section A. Applicant Information
APPLICANT. The person who seeks to obtain a permit to conduct bituminous coal mining activities.
· Applicant Name: The name under which the Application is filed. If the Application is being filed under a registered fictitious name, the name must match the registered name. The name must be identical with the name as shown on the Surface Mining Operator’s License.
· Address and Telephone Number:The legal mailing address of the applicant and daytime telephone number. Do not use abbreviations for the city name.
· Applicant Type. Check appropriate box for type of organization.
· Surface Mining Operator’s License Number. The applicants’ current mining license number. Check the box if the license is currently pending.
· Applicant Contact. Provide the name, title, mailing address and telephone number of the person employed or contracted by the Applicant who has overall responsibility for preparation of this Application and may be contacted by the Department regarding processing this Application.
Section B. Description of Activity
· Application Type. Check appropriate box indicating if this Application is for a new permit, revision to an existing permit or a permit transfer. If a change is proposed to an existing permit, please give the permit number.
· Type of Mining Activity. Check the appropriate box(es) which identify the coal mining activities proposed under this Application.
Section C. Site Information
· Operation/Site Name. Common name used to refer to the mine site.
· Operation/Site Location. Indicate the municipality and county of the proposed mine site along with the name of the United States Geological Survey Topography Map and the latitude and longitude (in degrees, minutes, and seconds) at the center of the proposed permit area.
· Name(s) of receiving stream(s). List the name(s) of the stream(s) which will receive drainage from the proposed mine site. Use stream names as they appear on the United States Geologic Survey Topographic Map.
· MSHA Number. Provide the Federal Mine Safety and Health Administration (MSHA) Identification Number and date of issuance. If an MSHA number has not been issued, indicate such and provide the number when it becomes available.
· Site Contact.Provide the name, title, mailing address and telephone number of the person employed by the Applicant who will have overall responsibility for environmental matters at this mine site.
Extent of Mining. Indicate the acreages to be affected by the mining. If this Application includes a proposal for remining areas with pollution discharges under the provisions of 25 Pa Code SubchapterF, the total acres of abandoned mine land to be affected and the total acres of abandoned underground mines to be daylighted should include such acreage identified in Module 26.1 of the Application. If wetlands will be affected by the mining, indicate the total acres to be affected and total acres to be replaced as addressed in Module 14.
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Section D. Permit Coordination
Check the appropriate boxes.
Section E. Application Fee
Determine the permit application fee for the activities proposed and provide a check payable to the “Commonwealth of Pennsylvania” for the total application fee. Proposals for constructing access roads and temporary road crossings under a Bureau of Mining Programs 25 Pa Code Chapter105 General Permit (BMR-GP-101 or BMR-GP-102) do not require an application fee. However, the Notification Form and related information for operating under these General Permits must accompany this Application. Activities conducted under the authority of these General Permits must conform with the terms and conditions of the specific General Permit.
Section F. Consultant
· Provide details for the person or firm contracted by the Applicant for preparation of this Application.
Section G. Land Use Information
For a project that affects new area, complete this section.
Please answer yes/no to the questions. You may need to contact your local mining office. Consult TGD#0120200001 for more information.
Applicants are encouraged to submit copies of local land use approvals and other evidence of compliance with comprehensive plans and zoning ordinances. This includes plan approvals, building permits, information about whether the site is “grandfathered” as a pre-existing use or a vested right, and any other applicable land use information.
Section H. Additional Related Information
· If the activity is to occur on primary agricultural lands, describe the alternative consideration. For more information, see TGD#0120700002.
· Name and Address of Public Office. Provide the name and address of the public office where a copy of this Application will be available for public inspection in the county where the mining is proposed. The copy of the Application must be available for public review at the public office no later than the first day the applicant’s public notice appears in the local newspaper. See AppendixB of these instructions for a listing of county public offices.
· Newspaper Public Notice. Provide the name of the newspaper in which the public notice advertisement will appear and a copy of the proposed public notice. The public notice should not start until the application is accepted by the DEP District Mining Office. The advertisement must be published once a week for four(4) consecutive weeks in a newspaper of general circulation in the locality of the mine site. Proof of publication must be submitted to the District Mining Office upon completion of the public notice. See AppendixD of these instructions for sample newspaper public notices containing suggested wording and content.
· Reclamation Fee. The Federal Surface Mining Control and Reclamation Act requires a coal operator to pay a reclamation fee of 35cents per ton of surface mined coal and 15cents per ton of underground mined coal to the Federal Office of Surface Mining. Indicate whether these fees required to be paid by the applicant have been made.
· Pre-Application Number. Provide the number assigned by the DEP District Mining Office if this proposed mine site was reviewed through the pre-application process.
· Small Operator Assistance Program Project Number. Provide the number assigned by the Bureau of Mining Programs if assistance was received under this Program for this proposed mine site.
· Notice of Intent to Explore Number. Provide the number assigned by the DEP District Mining Office on the Coal Exploration Notice of Intent to Explore Form for coal exploration related to this proposed mine site.
Section I. Affidavit
List the name, title and address of the person authorized to make this Application for permit. The Application must be attested by a notary public or district justice.
Section J. Certification
Complete the sections as appropriate with signatures and such. A licensed professional must submit the form.
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Additional forms
The following forms referenced in the Application (either to be completed as part of the application submittal or for use following permit application approval) are available from any of the offices listed in Appendix A and may also be obtained in electronic form at www.dep.state.pa.us/elibrary (unless indicated otherwise below):
· Consent of Landowner Form “Supplemental C” (Form 5600-FM-MR0010)
· Water Monitoring Report Cover Sheet (Form 5600-FM-MR0113)
· Consent to Lesser Water Supply Agreement (Form 5600-FM-MR0110)
· Notification Form BMR-GP-101 General Permit for Temporary Road Crossings (Form 5600-FM-MR0054)
· Notification Form BMR-GP-102 General Permit for Access Road Crossings (Form 5600-FM-MR0059)
· Cultural Resource Notice Form (Form 0120-PM-PY0003)
· Individual NPDES Permit associated with Mining Activities (5600-PM-BMP0032)
· Anti-degradation supplement form (5600-PM-MR0007)
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INSTRUCTIONS
APPENDIX A
DEP DISTRICT MINING OFFICES
Cambria District Mining Office286 Industrial Park Road
Ebensburg, PA 15931-4119
814-472-1900
Counties: Adams, Bedford, Blair, Cambria, Cumberland, Franklin, Fulton, Huntingdon, Indiana, Juniata, Mifflin, Perry and Somerset / Moshannon District Mining Office
186 Enterprise Dr
Philipsburg, PA 16866
814-342-8200
Counties: Bradford, Cameron, Centre, Clearfield, Clinton, Lycoming, Potter, Snyder, Sullivan, Tioga and Union.
Greensburg District Mining Office
Armbrust Building, R.D. 2, Box 603-C
8205 Route 819
Greensburg, PA 15601-7515
724-925-5500
Counties: Allegheny, Armstrong, Beaver, Fayette, Greene, Washington and Westmoreland / Knox District Mining Office
White Memorial Building, P.O. Box 669
Knox, PA 16232-0669
814-797-1191
Counties: Butler, Clarion, Crawford, Elk, Erie, Forest, Jefferson, Lawrence, McKean, Mercer, Venango and Warren
CENTRAL OFFICE
Bureau of Mining Programs
Division of Permits
Rachel Carson State Office Building
P.O. Box 8461
Harrisburg, PA 17105-8461
717-783-8845
Application Date:
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APPENDIX B
COUNTY PUBLIC OFFICES
County / Address and Telephone Number / County / Address and Telephone NumberAllegheny / Allegheny County Conservation District
Lexington Tech. Park
Bldg. 1, Suite 102
400 N. Lexington Ste.
Pittsburgh, PA 15208-2521
412-241-7645 / Clarion / Clarion County Conservation District
R.R. 3, Box 265
Mayfield Professional Building
Clarion, PA 16214
814-226-4070
Armstrong / Armstrong County Conservation District
Armsdale Administration Building
R.D. 8, Box 294
Kittanning, PA 16201
724-548-3425/3428 / Clearfield / Clearfield County Conservation District
650 Leonard Street
Clearfield, PA 16830
814-765-2629
Beaver / Beaver County Conservation District
1000 Third Street, Suite 202
Beaver, PA 15009-2026
724-774-7090 / Clinton / Clinton County Conservation District
216 Spring Run Road
Mill Hall, PA 17751-9543
570-726-3798
Bedford / Bedford County Conservation District
Fairlawn Court, Suite 4
702 W. Pitt Street
Bedford, PA 15522
814-623-6706/8099 / Crawford / Crawford County Conservation District
14699 N. Main St. Ext.
Meadville, PA 16335-9441
814-724-1793
Blair / PA Dept. of Environmental Protection
Altoona District Office
615 Howard Avenue
Altoona, PA 16601
814-946-7290 / Elk / Elk County Conservation District
300 Center Street
Ridgway, PA 15853
814-776-5373
Bradford / Bradford County Conservation District
R.R. 5, Box 5030-C
Stoll Nature Res. Center
Towanda, PA 18848
570-265-5539 / Fayette / Fayette County Conservation District
10 Nickman Plaza
Lemont Furnace, PA 15456
724-438-4497
Butler / Butler County Conservation District
122 McCune Drive
Butler, PA 16001-6501
724-284-5270/5271 / Forest / Forest County Conservation District
P.O. Box 456
Courthouse Annex 2nd Floor
Tionesta, PA 16353
814-755-3560
Cambria / Cambria County Conservation District
P.O. Box 187
Ebensburg, PA 15931
814-472-2120 / Fulton / Fulton County Conservation District
216 North Second Street
McConnellsburg, PA 17233-1170
717-485-3547
Cameron / Cameron County Conservation District
416 N. Broad St.
Emporium, PA 15834
814-486-2244 / Greene / Greene County Conservation District
Greene County Office Bldg.
Waynesburg, PA 15370-1839
724-852-5278
Centre / Centre County Conservation District
414 Homes Avenue
Bellefonte, PA 16823
814-355-6817/6818 / Huntingdon / Huntingdon Co. Conservation District
RR 1, Box 7C
Huntingdon, PA 16652-9603
814-627-1627
Application Date:
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APPENDIX B (Continued)
COUNTY PUBLIC OFFICES
County / Address and Telephone Number / County / Address and Telephone NumberIndiana / Indiana County Conservation District
USDA Service Center
1432 Route 286, Hwy. E
Indiana, PA 15701-1467
724-463-8547 Ext. 4 / Sullivan / Sullivan County Conservation District
R.R. 4181
Dushore, PA 18614
570-928-7057
Jefferson / Jefferson County Conservation District
R.R. 5, Box 51
Brookville, PA 15825
814-849-7463 / Tioga / Tioga County Conservation District
29 East Avenue
Wellsboro, PA 16901
717-724-1801
Lawrence / Lawrence County Conservation District
Government Service Center
430 Court Street
New Castle, PA 16101
724-652-4512 / Venango / Venango County Conservation District
R.R. 5, Box 320
Franklin, PA 16323
814-676-2832
Lycoming / Lycoming County Conservation District
542 County Farm Road
Suite 202
Montoursville, PA 17754
570-433-3003 / Warren / Warren County Conservation District
609 Rouse Home Avenue, Suite 203
Youngsville, PA 16371
814-563-3117
McKean / McKean County Conservation District
995 South Avenue
P.O. Box E
Custer City, PA 16725
814-368-9960 / Washington / Washington Co. Conservation District
100 W. Beau Street, Suite 602
Washington, PA 15301
724-228-6774
Mercer / Mercer County Conservation District
R.D. 2, Box 2055
747 Greenville Road
Mercer, PA 16137-5023
724-662-2242 / Westmoreland / PA Dept. of Environmental Protection
Greensburg District Office
Armbrust Professional Center
R.D. 2, Box 603-C
Greensburg, PA 15601-0982
724-925-5500
Potter / Potter County Conservation District
107 Market Street
Coudersport, PA 16915
814-274-8411 Ext. 4
Somerset / Somerset County Conservation District
N. Ridge Bldg., Suite 103
1590 N. Center Avenue
Somerset, PA 15501
814-445-4652
Application Date:
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APPENDIX C
DEP REGIONAL OFFICES
SOUTHEAST REGIONAL OFFICE
PA Department of Environmental Protection
2 E. Main Street
Norristown, PA 19401-4915 Phone: (484) 250-5900