Form 5600-FM-BMP0058 "Application for Transfer of Permit" - Pennsylvania

What Is Form 5600-FM-BMP0058?

This is a legal form that was released by the Pennsylvania Department of Environmental Protection - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2017;
  • The latest edition provided by the Pennsylvania Department of Environmental Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 5600-FM-BMP0058 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Environmental Protection.

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Download Form 5600-FM-BMP0058 "Application for Transfer of Permit" - Pennsylvania

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5600-FM-BMP0058
Rev. 6/2017
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF MINING PROGRAMS
APPLICATION FOR TRANSFER OF PERMIT
Instructions: Submit the original of this application and two copies to the appropriate District Mining Office.
A
simple transfer will require updating and submission of at least some parts of the existing approved permit
information. If the successor operator is proposing revisions with the transfer, additional information will be required
as applicable. Please consult the DMO for clarification on what will be required for a complete application for a
transfer with revisions. The public notice must contain notification of the transfer and any proposed major revisions to
the permit (or state “no revisions” are being made). The transferee is encouraged to submit an entire updated
application especially if the original permit has been issued more than 10 years ago. Please do not include copies of
the original application. For additional information, see document 563-2112-218 ‘Permits Transfers for Coal and
Noncoal Operators’.
A. Successor Operator (Transferee)
Name
Mailing Address
Telephone No.
Email address
License No.
B. Current Permittee (Transferor)
Name
Mailing Address
Telephone No.
Email address
License No.
C. Permit Information (for permit being transferred)
Mine Permit No.
NPDES No.
Operation Name
Municipality
County
Were Small Operator Assistance Program (SOAP) funds received for this permit (coal only)?
Yes
No
Has this permit been activated?
Yes
No (If “No” the property map in E.4. is not required.)
D. Does this application incorporate the original permit application and approved revisions from the existing issued
permit?
Yes
No
Explain:
E. Submit the following with this application:
1. New application face sheet (page 1-1 of permit application)
2. Ownership/Compliance Information (Module 3)
3. Property Interests and Right of Entry (Module 5)
4. A property map that shows the extent of completed mining
5. Any additional permit modules requiring revision because of the transfer
6. Proof of Intent to publish (Note: Proof of publication must be received prior to approval of transfer.)
7. Application for Authorization to Conduct Mining Activities. Coal (5600-FM-BMP0312) or Noncoal (5600-
FM-BMP0304).
8. NPDES application (New, Transfer, or Notice of Intent for Coverage under GP-104).
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5600-FM-BMP0058
Rev. 6/2017
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF MINING PROGRAMS
APPLICATION FOR TRANSFER OF PERMIT
Instructions: Submit the original of this application and two copies to the appropriate District Mining Office.
A
simple transfer will require updating and submission of at least some parts of the existing approved permit
information. If the successor operator is proposing revisions with the transfer, additional information will be required
as applicable. Please consult the DMO for clarification on what will be required for a complete application for a
transfer with revisions. The public notice must contain notification of the transfer and any proposed major revisions to
the permit (or state “no revisions” are being made). The transferee is encouraged to submit an entire updated
application especially if the original permit has been issued more than 10 years ago. Please do not include copies of
the original application. For additional information, see document 563-2112-218 ‘Permits Transfers for Coal and
Noncoal Operators’.
A. Successor Operator (Transferee)
Name
Mailing Address
Telephone No.
Email address
License No.
B. Current Permittee (Transferor)
Name
Mailing Address
Telephone No.
Email address
License No.
C. Permit Information (for permit being transferred)
Mine Permit No.
NPDES No.
Operation Name
Municipality
County
Were Small Operator Assistance Program (SOAP) funds received for this permit (coal only)?
Yes
No
Has this permit been activated?
Yes
No (If “No” the property map in E.4. is not required.)
D. Does this application incorporate the original permit application and approved revisions from the existing issued
permit?
Yes
No
Explain:
E. Submit the following with this application:
1. New application face sheet (page 1-1 of permit application)
2. Ownership/Compliance Information (Module 3)
3. Property Interests and Right of Entry (Module 5)
4. A property map that shows the extent of completed mining
5. Any additional permit modules requiring revision because of the transfer
6. Proof of Intent to publish (Note: Proof of publication must be received prior to approval of transfer.)
7. Application for Authorization to Conduct Mining Activities. Coal (5600-FM-BMP0312) or Noncoal (5600-
FM-BMP0304).
8. NPDES application (New, Transfer, or Notice of Intent for Coverage under GP-104).
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5600-FM-BMP0058
Rev. 6/2017
AFFIDAVITS
F.
CURRENT PERMITTEE (TRANSFEROR)
I,
, being duly sworn according to law depose and say that I
(am the current permittee) (am an officer or official of the current permittee), have the authority to make this
Application for Transfer of Permit on behalf of the named current permittee, that current permittee relinquishes all
right, title, and interest in said permit, and that the information included in the foregoing application is true to the best
of my knowledge and belief. (Cross out inapplicable portions in parentheses only.)
(Print Name and Title)
CORPORATE SEAL
(Signature)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
SWORN TO AND SUBSCRIBED BEFORE ME
THIS
DAY OF
,
SS:
(Notary Public)
MY COMMISSION EXPIRES
SUCCESSOR OPERATOR (TRANSFEREE)
I,
, being duly sworn according to law depose and say that I
(am the successor operator) (am an officer or official of the successor operator), have the authority to make this
Application for Transfer of Permit on behalf of successor operator, that
assumes all
Name of Successor Operator
liability for reclamation, water pollution, planting, and all other responsibilities under the law, the rules and
regulations, and the terms and conditions for the permit from the date of original issuance, and that the information
included in the foregoing application is true to the best of my knowledge and belief. (Cross out inapplicable portions
in parentheses only.)
(Print Name and Title)
CORPORATE SEAL
(Signature)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
SWORN TO AND SUBSCRIBED BEFORE ME
THIS
DAY OF
,
SS:
(Notary Public)
MY COMMISSION EXPIRES
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