Form 5600-PM-BMP0032 "Application for Individual Npdes Permit Associated With Mining Activities" - Pennsylvania

What Is Form 5600-PM-BMP0032?

This is a legal form that was released by the Pennsylvania Department of Environmental Protection - a government authority operating within Pennsylvania. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on August 1, 2014;
  • The latest edition provided by the Pennsylvania Department of Environmental Protection;
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Download Form 5600-PM-BMP0032 "Application for Individual Npdes Permit Associated With Mining Activities" - Pennsylvania

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5600-PM-BMP0032
Rev. 8/2014
COMMONWEALTH OF PENNSYLVANIA
OFFICIAL USE ONLY
Form
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ID #
BUREAU OF MINING PROGRAMS
Date Received
APPLICATION FOR INDIVIDUAL NPDES PERMIT
ASSOCIATED WITH MINING ACTIVITIES
Please answer all questions completely. Refer to the instructions that come with this form.
SECTION A. GENERAL APPLICANT INFORMATION
1.
Application Type
New ($1000)
Renewal ($500)
Modification ($500)
Transfer ($500)
2.
Applicant:
3. Associated Mining Permit No.:
NPDES Permit No:.
4.
Operation Name:
5. License No:.
6. Applicant Email:
7.
Permit/Project Type: (check applicable)
Mining permit (surface or underground)
Exploration
Coal
Noncoal
GP-105 (Bluestone)
Other
8.
Public notice. (See instructions to determine if public notice is required.) Public notice has been submitted for publication. A
draft notice is attached.
Yes
No
9.
Production qualifications (Small business exemption)
COAL: Will coal production be at least 100,000 tons per year?
Yes
No
NONCOAL: Will production be at least $100,000 (1980 dollars) per year?
Yes
No
10. Total Affected Area (Acres):
Include all associated haul roads. Note: This acreage may be greater than the acres for the associated mining permit.
11. Estimated Timeframe:
Start (or permit issuance)
End (or permit expiration)
12. Permit Location or Physical Address:
County
Municipality
City
Boro
Twp
13. Map View of Area
Attach a map with outline of the affected area associated with the mining activity and label all outfalls.
Map is included as part of mining permit documents marked as Exhibit No.
14. Receiving Stream/Watershed Name:
Is this stream subject to a TMDL?
Yes
No
15. Chapter 93 Receiving Water Designated Use:
NOTE:
If designated use is 'HQ'
or 'EV', complete anti-degradation
16. Existing Stream Use (if different from designated use):
supplement form 5600-PM-BMP0007.
17. During mining, drainage will result in:
Point source discharge(s) (complete Section C: Outfall Information)
Surface Stream
Municipal or Private Storm Sewer -- Provide name of Storm Sewer Operator :
Non-discharge
Groundwater – infiltration
Containment without discharge (reuse)
Other (Including off-site discharges) – Describe and attach documentation to support a legal right to discharge.
- 1 -
5600-PM-BMP0032
Rev. 8/2014
COMMONWEALTH OF PENNSYLVANIA
OFFICIAL USE ONLY
Form
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ID #
BUREAU OF MINING PROGRAMS
Date Received
APPLICATION FOR INDIVIDUAL NPDES PERMIT
ASSOCIATED WITH MINING ACTIVITIES
Please answer all questions completely. Refer to the instructions that come with this form.
SECTION A. GENERAL APPLICANT INFORMATION
1.
Application Type
New ($1000)
Renewal ($500)
Modification ($500)
Transfer ($500)
2.
Applicant:
3. Associated Mining Permit No.:
NPDES Permit No:.
4.
Operation Name:
5. License No:.
6. Applicant Email:
7.
Permit/Project Type: (check applicable)
Mining permit (surface or underground)
Exploration
Coal
Noncoal
GP-105 (Bluestone)
Other
8.
Public notice. (See instructions to determine if public notice is required.) Public notice has been submitted for publication. A
draft notice is attached.
Yes
No
9.
Production qualifications (Small business exemption)
COAL: Will coal production be at least 100,000 tons per year?
Yes
No
NONCOAL: Will production be at least $100,000 (1980 dollars) per year?
Yes
No
10. Total Affected Area (Acres):
Include all associated haul roads. Note: This acreage may be greater than the acres for the associated mining permit.
11. Estimated Timeframe:
Start (or permit issuance)
End (or permit expiration)
12. Permit Location or Physical Address:
County
Municipality
City
Boro
Twp
13. Map View of Area
Attach a map with outline of the affected area associated with the mining activity and label all outfalls.
Map is included as part of mining permit documents marked as Exhibit No.
14. Receiving Stream/Watershed Name:
Is this stream subject to a TMDL?
Yes
No
15. Chapter 93 Receiving Water Designated Use:
NOTE:
If designated use is 'HQ'
or 'EV', complete anti-degradation
16. Existing Stream Use (if different from designated use):
supplement form 5600-PM-BMP0007.
17. During mining, drainage will result in:
Point source discharge(s) (complete Section C: Outfall Information)
Surface Stream
Municipal or Private Storm Sewer -- Provide name of Storm Sewer Operator :
Non-discharge
Groundwater – infiltration
Containment without discharge (reuse)
Other (Including off-site discharges) – Describe and attach documentation to support a legal right to discharge.
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5600-PM-BMP0032
Rev. 8/2014
Form
SECTION B. EROSION AND SEDIMENTATION (E & S) PLAN
18. E & S Plan
An E & S plan must be included as part of the associated mining permit information or attached to this application. The plan must
provide a brief narrative describing the use of proposed BMPs and their performance to manage E & S for the project. If E & S
BMPs to be implemented do not follow the guidelines referenced in the PA Erosion and Sediment Pollution Control Program
Manual (TGD # 363-2134-008) or the Engineering Manual for Mining Operations (TGD # 563-0300-101), provide documentation to
demonstrate performance equivalent to, or better than, the BMPs in the Manuals.
Check one:
E & S plan meeting the above criteria is contained within the information associated with the permit/project type listed in
item #2 of this application.
E & S information including a complete description of the implementation of BMPs is included with this NPDES application.
19. Best Management Practices (BMPs) Summary.
Check here if all BMPs are described as part of appropriate Modules of the mining permit (coal or noncoal) described in Item
No. 2.
Complete the following if specific E & S Modules have not been submitted with an associated mining permit.
Check all that will be used at this mining site.
BMP
BMP
Sediment basins/traps with discharge outlet
Bio-infiltration areas
Constructed wetlands
Vegetated swales / Stabilized channels
Retention/containment basins
Constructed filters/ filter bags
Detention basin/pit sump
Stabilized site entrances
Non-discharging sedimentation traps
Wheel washes
Sediment fore bay
Limiting disturbed area with concurrent reclamation
Infiltration measures
Oil/grit separators
Protect Sensitive & Special Value Features
Street sweeping
Protect/Conserve/ Enhance Riparian areas
Runoff capture/Reuse
Restoration: Buffers/ Landscape/ Floodplain
Temporary sediment controls (silt fence/silt-sok)
Top of slope berms
Top of slope diversions
Rock inlets for basins
Other
Erosion control blankets/textiles
Other
20. Reclamation and BMPs
Check here if any of the above checked BMPs will be left after final bond release.
If checked, supply details, signed documentation of permission by the landowner and justification in the reclamation plan with the
mining permit application. If this information is contained in the mining permit documents, please explain:
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5600-PM-BMP0032
Rev. 8/2014
Form
SECTION C. OUTFALL INFORMATION
This Section is to be completed when discrete outfalls are proposed. Attach additional pages for more than 4 points.
21. Identify each point in the tables below. Each discharge point must be shown and labeled as such on a map submitted with this application or as part of the
mining permit/authorization. The labeling of discharge points must correspond with the labels used on the exhibit maps submitted in support of the mining
permit/authorization. Non-discharging sedimentation traps and groundwater infiltration points are not outfalls and should not be included as outfalls, but
should be listed at the end of this section.
Describe the location and source of each point.
Discharge Point
Latitude
Longitude
Receiving Stream
Source of Discharge (e.g., sedimentation pond, groundwater sump, etc.)
(e.g. SP 01, SP 02 etc.)
     '
    “
     '      “
     '
    “
     '      “
     '
    “
     '      “
     '
    “
     '      “
For the same points as above, describe the flow and treatment for each point.
Flow
Discharge Point
Average rate (mgd)
Design rate (mgd)
Frequency (months/yr)
Treatment
(e.g. SP 01, SP 02 etc.)
Design rate is the discharge flow at the Q 7-10 stream flow for post-mining discharges, the maximum hydraulic capacity for other treatment facilities or the routed storm flow for
sedimentation ponds.
Latitude/Longitude Collection Method:
EMAP
GPS
Printed Map
Other
Check the horizontal reference datum (or projection datum) employed in the collection method.
NAD27 (topo maps)
NAD83 (Emap)
WGS84 (GEO84) (most GPS units)
For non-discharging sedimentation traps and groundwater infiltration points, provide the description and location:
Discharge Point:
Latitude:
Longitude:
Source of Discharge (e.g., sedimentation pond, groundwater sump, etc.):
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5600-PM-BMP0032
Rev. 8/2014
Form
22. Evaluation of Thermal Impacts. Describe how thermal impacts were evaluated and, if necessary, how they will be mitigated, in accordance with 25 Pa. Code Chapter 93.
23. Solid or liquid wastes not discharged. Will there be sludge or sediment produced from the treatment described above?
Yes
No
Will there be liquid produced from the treatment described above (not discharged via the outfall)?
Yes
No
Describe the material and its ultimate disposal:
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5600-PM-BMP0032
Rev. 8/2014
Form
SECTION D. EFFLUENT CHARACTERIZATION
Complete the following subsections for each discharge outfall listed in Item #21.
Discharge Point No(s).:
24. Common parameters/pollutants. Complete the table for each constituent. Indicate 'E' if estimate, 'D' if based on actual data. If
needed, attach a separate sheet labeled “Item #24 Common parameters/pollutants”.Please include the units of measurement. If
you are providing data from one discharge for two or more substantially identical effluents, indicate which outfalls the data
represents.
Constituent
Daily Max
Daily Average
Source of Information
pH
Total Suspended Solids (TSS)
Chemical Oxygen Demand (COD)
1
Biochemical Oxygen Demand (BOD)
1
1
Ammonia (NH3)
Total Organic Carbon (TOC)
1
Flow
Temperature (high)
Temperature (low)
1
Waiver option [40 CFR 122.21(k)(5)(i)]: A waiver is requested for the following constituents that are not anticipated to be present
in the discharge:
COD
BOD
NH3
TOC
Provide a justification for this waiver request.
25. Dioxins. As the applicant, do you have reason to believe that at any time dioxins were made, used, stored or buried on or
directly upgradient from the site designated for mining and/or support area? [TCDD, 2,4,5-TP, Erbon, TCH or HCP under
40 CFR 122.21(g)(7)(viii)]
Yes
No
If yes, provide information and data characterizing the potential discharge on a separate sheet labeled “Item #25 Dioxins”
26. Organic Toxic Pollutants (EPA Table II) Provide waiver justification or data regarding organic toxic pollutants for the mine site.
Waiver: This section is not applicable because this operation fulfills one of the following criteria:
For coal, this operation produces less than 100,000 tons per year.
For noncoal, this operation has gross sales of less than $100,000 per year (1980 dollars).
If a waiver is not applicable, refer to Appendix B: Table II - Organic Toxic Pollutants. List any constituents from that table that
are expected to be present in the discharge.
For all constituents listed above, provide a table of the estimated daily maximum concentration, the estimated daily average
concentration and the source of this information on a separate attachment labeled “Item #26 Organic Toxic Pollutants”.
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