"Annual Permit Status Report Form" - Georgia (United States)

Annual Permit Status Report Form is a legal document that was released by the Georgia Department of Natural Resources - a government authority operating within Georgia (United States).

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ANNUAL PERMIT STATUS REPORT
Mine Name:
Permit #:
Company Name:
Company Contact:
Contact Phone Number:
Mailing Address:
Email Address:
1.
The current number of permitted acres on December 31, 20
.
acres
2.
The current number of permitted acres disturbed on December 31, 20
.
acres
3.
The total number of permitted acres which have never been disturbed.
acres
4.
Total number of acres reclaimed and released from the permit to date.
acres
5.
Total number of acres reclaimed and released from the permit during 20
.
acres
Circle One
6.
NPDES Permit:
YES -- NO -- N/A
Number:
7.
Air Quality Permit:
YES -- NO -- N/A
Number:
8.
Storm Water Permit:
YES -- NO -- N/A
Number:
Circle One
9.
Was any mining activity conducted during the past year?
YES or NO
10.
Were all mining activities on permitted acreage during the past year?
YES or NO
If not, explain on separate page.
11.
Was mineral/material removed from pit, quarry, or dredging site?
YES or NO
12.
Was mineral/material removed from stockpiles?
YES or NO
13.
Were Best Management Practices (BMPs) utilized to control erosion and
YES or NO
sedimentation on site? If not, explain on separate page.
14.
Was impacted water discharged from the site through approved discharge points?
YES or NO
If not, explain on separate page.
15.
Do you anticipate an amendment in the next year?
YES or NO
16.
Identification sign at entrance?
YES or NO
17.
Is mining/reclamation in accordance with approved Surface Mining
YES or NO
Land Use Plan?
18.
Is Map or Aerial Photo on file representative of current site conditions?
YES or NO
If not, is current map attached?
YES or NO
1
ANNUAL PERMIT STATUS REPORT
Mine Name:
Permit #:
Company Name:
Company Contact:
Contact Phone Number:
Mailing Address:
Email Address:
1.
The current number of permitted acres on December 31, 20
.
acres
2.
The current number of permitted acres disturbed on December 31, 20
.
acres
3.
The total number of permitted acres which have never been disturbed.
acres
4.
Total number of acres reclaimed and released from the permit to date.
acres
5.
Total number of acres reclaimed and released from the permit during 20
.
acres
Circle One
6.
NPDES Permit:
YES -- NO -- N/A
Number:
7.
Air Quality Permit:
YES -- NO -- N/A
Number:
8.
Storm Water Permit:
YES -- NO -- N/A
Number:
Circle One
9.
Was any mining activity conducted during the past year?
YES or NO
10.
Were all mining activities on permitted acreage during the past year?
YES or NO
If not, explain on separate page.
11.
Was mineral/material removed from pit, quarry, or dredging site?
YES or NO
12.
Was mineral/material removed from stockpiles?
YES or NO
13.
Were Best Management Practices (BMPs) utilized to control erosion and
YES or NO
sedimentation on site? If not, explain on separate page.
14.
Was impacted water discharged from the site through approved discharge points?
YES or NO
If not, explain on separate page.
15.
Do you anticipate an amendment in the next year?
YES or NO
16.
Identification sign at entrance?
YES or NO
17.
Is mining/reclamation in accordance with approved Surface Mining
YES or NO
Land Use Plan?
18.
Is Map or Aerial Photo on file representative of current site conditions?
YES or NO
If not, is current map attached?
YES or NO
1
CHRONOLOGICAL PERMIT AND AMENDMENT HISTORY
First entry should be original permit issued, and you should only need to complete columns 2 and 3.
Subsequent entries should be a chronological list of all amendments and new permits that resulted in
acreage changes. See example on Page 3.
Date
Original
Permit or
Total New Acres
Acres
Acres
Issued or
Acres
Amendment
Permitted**
Added
Released
Approved
Permitted
Permit
----
----
----
**Last entry in this column should be the total number of acres currently permitted.
I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT:
Permittee or Designated Representative & Title:
Signature:
Date:
2
ANNUAL PERMIT STATUS REPORT GUIDANCE
Definitions
Surface Mining: any activity constituting all or part of a process for the removal of minerals, ores,
and other solid matter for sale or for processing or for consumption in the regular operation of a
business. Tunnels, shafts and dimension stone quarries shall not be considered to be surface
mining.
Disturbed Land: lands that contain open pits, overburden dumps, haul or access roads, sediment
basins, etc. that have not begun to be shaped into a land form for final reclamation.
Released: Reclaimed lands and/or undisturbed lands approved by the EPD through the amendment
& release request process
Undisturbed Land: Permitted land that has not been disturbed and will be used for future mining.
Map or Aerial Photo
Include the following on your map:
1.
Legend with north arrow and scale.
2.
Company name, site name, and surface mining permit number.
3.
Outline of permitted area.
4.
Sediment control features.
5.
Outline of Area released during past year.
Example of Chronological History of Permits and Amendments:
Date
Original
Permit or
Total New Acres
Acres
Acres
Issued or
Acres
Amendment
Permitted**
Added
Released
Approved
Permitted
Permit
1/1/1985
50
----
----
----
25
Amendment 1
6/30/92
50
75
8/5/2000
75
50
125
Permit
4/5/2009
125
60
25
160
Amendment 2
3
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