Form 5600-FM-BMP0312 "Application for Authorization to Conduct Surface Coal Mining Activities" - Pennsylvania

What Is Form 5600-FM-BMP0312?

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 December 1, 2013;
  • 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-BMP0312 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-BMP0312 "Application for Authorization to Conduct Surface Coal Mining Activities" - Pennsylvania

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5600-FM-BMP0312 Rev. 12/2013
COMMONWEALTH OF PENNSYLVANIA
DEP USE ONLY
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Date Received:
BUREAU OF MINING PROGRAMS
No.:
Bond No.:
Filing Amount:
APPLICATION FOR
AUTHORIZATION TO CONDUCT SURFACE COAL MINING ACTIVITIES
(
Bituminous Coal or
Anthracite Coal)
(
New or
Revision)
Instructions: Submit the original of this application and three copies. The affidavit must be properly signed and
executed. Include proper bond endorsement documents for the type of bond being used.
Note: No portion of the permit area shall be affected by surface coal mining activities unless the operator has provided a
bond to the Department and the Department has approved the bond and issued a written authorization to affect such
area.
Applicant
Surface Mining Permit No.
Address
Operation Name
Municipality
Telephone
County
Name of Landowner
Municipality
County
Acres to be Affected
Consent of Landowner Form (check if applicable)
The Consent of Landowner Form is attached and it has been recorded with the recorder of deeds.
The Consent of Landowner Form was filed with Authorization No.
and it has
been recorded with the recorder of deeds.
Not filing Consent of Landowner Form because lease was in existence prior to January 1, 1964 for Bituminous Coal
and January 1, 1972 for Anthracite Coal. Operator must provide 1) a true and correct copy of the lease; 2) execute a
Consent of Landowner Form as Leasee; and 3) provide a Chain of Title for the Lease. The lease, Consent of
Landowner Form, and Chain of Title have been recorded with the recorder of deeds.
Map
Attach a copy of Exhibit 9, Operations Map indicating the proposed authorized area and any previously authorized area.
Additional Information/Revisions
1.
Have you paid the reclamation fees as required by federal Surface Mining Control and
Yes
No
Reclamation Act of 1977 (30 USC 1232)?
2.
Are you revising your erosion and sediment control plan? If yes, briefly describe the revisions
Yes
No
and complete the appropriate modules and submit with this application.
3.
Are you modifying your approved blasting plan for this bonding increment?
Yes
No
If yes, submit blasting plan with this request (use Module 16: Blasting Plan).
4.
Briefly describe any other proposed revisions to the surface mining permit. Include application
modules and plans for the revision and professional certification where appropriate. If the
revisions are subject to public notice or a stream or road variance is being requested, the proof
of publication must be submitted to the Department prior to any mining authorization being
granted.
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5600-FM-BMP0312 Rev. 12/2013
COMMONWEALTH OF PENNSYLVANIA
DEP USE ONLY
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Date Received:
BUREAU OF MINING PROGRAMS
No.:
Bond No.:
Filing Amount:
APPLICATION FOR
AUTHORIZATION TO CONDUCT SURFACE COAL MINING ACTIVITIES
(
Bituminous Coal or
Anthracite Coal)
(
New or
Revision)
Instructions: Submit the original of this application and three copies. The affidavit must be properly signed and
executed. Include proper bond endorsement documents for the type of bond being used.
Note: No portion of the permit area shall be affected by surface coal mining activities unless the operator has provided a
bond to the Department and the Department has approved the bond and issued a written authorization to affect such
area.
Applicant
Surface Mining Permit No.
Address
Operation Name
Municipality
Telephone
County
Name of Landowner
Municipality
County
Acres to be Affected
Consent of Landowner Form (check if applicable)
The Consent of Landowner Form is attached and it has been recorded with the recorder of deeds.
The Consent of Landowner Form was filed with Authorization No.
and it has
been recorded with the recorder of deeds.
Not filing Consent of Landowner Form because lease was in existence prior to January 1, 1964 for Bituminous Coal
and January 1, 1972 for Anthracite Coal. Operator must provide 1) a true and correct copy of the lease; 2) execute a
Consent of Landowner Form as Leasee; and 3) provide a Chain of Title for the Lease. The lease, Consent of
Landowner Form, and Chain of Title have been recorded with the recorder of deeds.
Map
Attach a copy of Exhibit 9, Operations Map indicating the proposed authorized area and any previously authorized area.
Additional Information/Revisions
1.
Have you paid the reclamation fees as required by federal Surface Mining Control and
Yes
No
Reclamation Act of 1977 (30 USC 1232)?
2.
Are you revising your erosion and sediment control plan? If yes, briefly describe the revisions
Yes
No
and complete the appropriate modules and submit with this application.
3.
Are you modifying your approved blasting plan for this bonding increment?
Yes
No
If yes, submit blasting plan with this request (use Module 16: Blasting Plan).
4.
Briefly describe any other proposed revisions to the surface mining permit. Include application
modules and plans for the revision and professional certification where appropriate. If the
revisions are subject to public notice or a stream or road variance is being requested, the proof
of publication must be submitted to the Department prior to any mining authorization being
granted.
- 1 -
5600-FM-BMP0312
Rev. 12/2013
Bond/Reclamation Fee
Type of Bond:
Surety
Collateral
Credit
Other (Specify)
Bond Amount $
(Attach Bond Calculation Summary Form 5600-FM-BMP0433)
Reclamation Fee. Total acres
@ $100 per acre
(attach a check payable to the Commonwealth of Pa. for the proper amount)
To be completed by the Department
Total Bond Required:
$
Credit Available:
$
Additional Bond Required:
$
Affidavit
Commonwealth of Pennsylvania, County of
I,
being duly sworn, according to law, depose and say that I (am the applicant) (am an officer of the applicant) (have the
authority to make this application) and that the plans, reports and documents submitted as part of the application are true
and correct to the best of my knowledge and belief, I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment (cross out inapplicable portions in parenthesis).
Sworn and Subscribed to Before Me This
Day of
(month)
(year)
Signature of Applicant or Responsible Official
Notary Public
Name (typed)
Title and Seal
Address
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