Form 5600-PM-BMP0004 "General Permit for Short-Term Construction Projects Bmp-Gp-103 Registration/Application" - Pennsylvania

What Is Form 5600-PM-BMP0004?

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 September 1, 2014;
  • The latest edition provided by the Pennsylvania Department of Environmental Protection;
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Download Form 5600-PM-BMP0004 "General Permit for Short-Term Construction Projects Bmp-Gp-103 Registration/Application" - Pennsylvania

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5600-PM-BMP0004
9/2014
COMMONWEALTH OF PENNSYLVANIA
DEP USE ONLY
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Date Received:
BUREAU OF MINING PROGRAMS
Registration Number:
GENERAL PERMIT FOR
SHORT-TERM CONSTRUCTION PROJECTS
BMP-GP-103
REGISTRATION/APPLICATION
Before completing this form, read the step-by-step instructions provided with this Application Package.
SECTION A. APPLICANT INFORMATION
Applicant Name:
Mailing Address:
Telephone Number :
License Number:
Subcontractor:
Will a subcontractor mine the site?
Yes
No
List the name and mining license number if applicable:
Pending
SECTION B. DESCRIPTION OFCONSTRUCTION PROJECT
Name of Construction Project:
Location of Construction Project:
Submit copy of bid form or contact:
County:
Municipality:
SECTION C. SITE INFORMATION
Receiving Stream:
Total Acres To Be Affected Under
USGS Quad:
This Project excluding haul roads:
(5 Acre Maximum)
‟/
Tributary to:
Acres to be Bonded:
Latitude:
°/
‟/
Longitude:
°/
Depth of Mining:
County:
Topsoil/subsoil:
ft.
Overburden:
ft.
Mineral Mined:
ft.
Municipality:
TOTAL DEPTH:
ft.
Name and Address of Landowner(s):
Coal:
Will coal be
Acid
Discharges:
Water
Supplies:
encountered?
Are there existing
How close is the
acid mine drainage
nearest
water
Yes
No.
discharges?
supply?
Yes
No.
(Attach additional sheet if necessary)
Erosion Control Measures:
Groundwater:
Complete the Erosion Control Plan on Exhibit I or provide an
Will this operation encounter the regional groundwater table?
alternate erosion control plan.
Yes
No
Unknown
Revegetation Plan:
Type of Reclamation:
Grasses/Legumes
Trees/Shrubs
Other
Approximate Original Contour
35° Terrace
Complete the Revegetation Schedule on Exhibit I.
Other (specify)
Onsite Processing Activities:
Fugitive Dust Control
Will process activities be performed on this site?
Yes
No
Periodic watering as needed
If yes, you must describe what processing will occur and submit the
Maintain low speeds on haulroads
specifications for the processing equipment.
Other (specify)
- 1 -
5600-PM-BMP0004
9/2014
COMMONWEALTH OF PENNSYLVANIA
DEP USE ONLY
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Date Received:
BUREAU OF MINING PROGRAMS
Registration Number:
GENERAL PERMIT FOR
SHORT-TERM CONSTRUCTION PROJECTS
BMP-GP-103
REGISTRATION/APPLICATION
Before completing this form, read the step-by-step instructions provided with this Application Package.
SECTION A. APPLICANT INFORMATION
Applicant Name:
Mailing Address:
Telephone Number :
License Number:
Subcontractor:
Will a subcontractor mine the site?
Yes
No
List the name and mining license number if applicable:
Pending
SECTION B. DESCRIPTION OFCONSTRUCTION PROJECT
Name of Construction Project:
Location of Construction Project:
Submit copy of bid form or contact:
County:
Municipality:
SECTION C. SITE INFORMATION
Receiving Stream:
Total Acres To Be Affected Under
USGS Quad:
This Project excluding haul roads:
(5 Acre Maximum)
‟/
Tributary to:
Acres to be Bonded:
Latitude:
°/
‟/
Longitude:
°/
Depth of Mining:
County:
Topsoil/subsoil:
ft.
Overburden:
ft.
Mineral Mined:
ft.
Municipality:
TOTAL DEPTH:
ft.
Name and Address of Landowner(s):
Coal:
Will coal be
Acid
Discharges:
Water
Supplies:
encountered?
Are there existing
How close is the
acid mine drainage
nearest
water
Yes
No.
discharges?
supply?
Yes
No.
(Attach additional sheet if necessary)
Erosion Control Measures:
Groundwater:
Complete the Erosion Control Plan on Exhibit I or provide an
Will this operation encounter the regional groundwater table?
alternate erosion control plan.
Yes
No
Unknown
Revegetation Plan:
Type of Reclamation:
Grasses/Legumes
Trees/Shrubs
Other
Approximate Original Contour
35° Terrace
Complete the Revegetation Schedule on Exhibit I.
Other (specify)
Onsite Processing Activities:
Fugitive Dust Control
Will process activities be performed on this site?
Yes
No
Periodic watering as needed
If yes, you must describe what processing will occur and submit the
Maintain low speeds on haulroads
specifications for the processing equipment.
Other (specify)
- 1 -
5600-PM-BMP0004
9/2014
SECTION C. (continued)
Attach either three (3) clear copies of an aerial photo (e.g., Farm Services
Provide two (2) original 7 ½-minute USGS maps
Bureau) (1” = 660‟ or other appropriate scale) or three (3) 7½ minute USGS
showing the location of the proposed surface mine
quadrangle map blow-ups (scale 1” = 400‟) showing the limits of the proposed
site including haulroads.
surface mine site, the area of mineral extraction, the location of erosion control
Provide
Consent
of
Landowner
Forms
facilities, and haul roads.
“Supplemental C” for each affected property.
A reclamation bond for the proposed permit area must be provided prior to DEP approval of a permit.
Is the proposed permit area within any of the following:
YES
NO
Within 100 feet (30.48 meters) of the outside line of right-of-way of a public highway.
Within 300 feet (91.44 meters) of an occupied dwelling, house or commercial or industrial building, unless
released by the owner thereof. (Attach the notarized waiver by the current owner)
Within 300 feet (91.44 meters) of a public building, school or community or institutional building.
Within 300 feet (91.44 meters) of a public park.
Within 100 feet (30.48 meters) of a cemetery.
Within 100 feet (30.48 meters) of the bank of a perennial or intermittent stream.
Within 125 feet (38.1 meters) of an oil or gas well.
If the answer to any of the above is „yes‟, the applicant must demonstrate compliance with §77.504 (distance limitations) of DEP
regulations. Please contact the DEP District Mining Office for information.
No excavation of material can occur within 25 feet (7.26 meters) of the property line unless approved by the Department.
SECTION D. CERTIFICATION
I hereby certify that the information provided in this application is true and correct; that I have the right to remove the mineral; and that
the surface mining activities will be conducted in accordance with this application, the authorizing permit, the Noncoal Surf ace Mining
Conservation and Reclamation Act (NSMCRA) and the Clean Streams Law (CSL) and applicable regulations.
Affix Corporate Seal when applicable
Applicant Name
(type or print)
Applicant Signature (or Responsible Official)
Date
AFFIDAVIT:
COUNTY OF
SWORN AND SUBSCRIBED TO BEFORE ME THIS
COMMONWEALTH OF PENNSYLVANIA:
DAY OF
(month)
(year)
SS:
NOTARY PUBLIC
MY COMMISSION EXPIRES
- 2 -
5600-PM-BMP0004
9/2014
EXHIBIT 1
A.
EROSION CONTROL PLAN
Do not complete this erosion control plan if an alternate erosion control plan (prepared by a person
trained and experienced in erosion control methods and techniques) is submitted with this application.
Is topsoil found on this site?
Yes
No
Depth
in.
Alternate Approximate Site Plan
Size of Pit Sump or Trap
Note: A minimum of 2,000 cubic feet of storage capacity per
acre of disturbed area is required for a sediment trap.
Depth to Overflow:
ft.
Bottom Width:
ft.
Bottom Length:
ft.
Total Volume:
cf.
Example:
5.0 acre (maximum) disturbed area x 2,000 cf/ac = 10,000
cubic feet required
4‟
50‟
50‟
x
x
=
10,000 cf
(depth)
(width)
(length)
- 3 -
5600-PM-BMP0004
9/2014
Provisions:
1.
All controls and other necessary structures will be constructed and stabilized within 20 days of activating or
reactivating previous operations on the site.
2.
Site access roads will be constructed, stabilized and maintained in a manner to prevent accelerated erosion and
sedimentation.
3.
At a minimum all controls will be inspected weekly and after each runoff event. Necessary repairs and/or
maintenance will be performed within 5 working days of the inspection.
4.
Pit sumps/sediment traps will be cleaned out when sediment has deposited to 1/3 of the depth of the sump or trap.
5.
All controls will be maintained until all the areas draining to them have been adequately stabilized (e.g. 70%
minimum uniform perennial vegetative cover).
6.
All new stream encroachments/crossings will be submitted as separate plans.
7.
Upon completion of mining activities on the entire site or on any portion of the site, the disturbed area shall be
immediately seeded, mulched or otherwise protected from accelerated erosion and sedimentation. Revegetation
shall be in accordance with Section B.
All sumps, traps, roads, berms, diversions, collectors and “non-working” stockpiles will be stabilized immediately
8.
upon placement.
At the operator‟s discretion, brush or other vegetation removed from the site may be used as a filter downslope of
9.
the site and returned to the site during reclamation to provide shelter/habitat for wildlife.
B.
REVEGETATION SCHEDULE FOR AREA AFFECTED BY SURFACE MINING
Recommended mixture/rate
Alternate mixture/rates
(Source - Pennsylvania State University Erosion Control &
Conservation Plantings on Noncropland Publication)
Seeding rate
Seeding rate
Species (Select One)
Species
PLS* (lbs/acre)
PLS* (lbs/acre)
Spring Oats
96
Winter Wheat
120
Winter Rye
112
Plus
Plus
Species (select one mix - 1, 2, or 3)
Species
1
Birdsfoot Trefoil
10
Timothy
6
Redtop
3
2
Orchardgrass
30
Birdsfoot Trefoil
10
3
Switchgrass
20
Birdsfoot Trefoil
10
*PLS - Pure Live Seed
Lime and fertilizer will be applied in accordance with a soil test.
Mulch (hay or straw) will be applied at a minimum rate of 3 tons/acre.
These plans were prepared with my knowledge and input. I hereby agree to implement, maintain and modify these
plans, as necessary, to effectively control erosion and sediment pollution on all areas affected under this permit and to
implement revegetation of the areas affected by surface mining.
Applicant Signature
Date
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