Form DMM-U-1 "Application for Uranium Exploration Permit" - Virginia

What Is Form DMM-U-1?

This is a legal form that was released by the Virginia Department of Mines, Minerals and Energy - a government authority operating within Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2016;
  • The latest edition provided by the Virginia Department of Mines, Minerals and Energy;
  • 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 DMM-U-1 by clicking the link below or browse more documents and templates provided by the Virginia Department of Mines, Minerals and Energy.

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Download Form DMM-U-1 "Application for Uranium Exploration Permit" - Virginia

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DIVISION OF MINERAL MINING
900 NATURAL RESOURCES DRIVE, STE. 400
CHARLOTTESVILLE, VIRGINIA 22903
(434) 951-6310
APPLICATION FOR A URANIUM EXPLORATION PERMIT
FOR OFFICE USE ONLY
APPLICATION NO.
PERMIT NO.
RECEIPT NO.
DATE ISSUED
APPLICANT INFORMATION
1. Name of Applicant
2. Office Telephone Number
3. Mailing Address
4. Exploration activity is located
of
(miles)
(direction)
(town)
on Public Road No.
in
County/City.
5. Type of Organization:
(
)Sole Proprietorship - Complete questions A,B,C,D
(
)Corporation
- Complete questions A,B,C,D,F,G,H,I,J
(
)Partnership
- Complete questions A,B,C,D,E,F
(
)Other
- Complete questions A,B,C,D,E,F
Specify (If Other):
(A) Virginia State Corporation Commission registration number
(B) Person with overall responsibility for operating decisions at the exploration site:
Name/Title
Address
Phone
E-mail
(C) Person to be contacted in the event of an accident or emergency:
Name
Address
Telephone
(D) Federal Tax ID Number of Applicant
(E) List all individuals having any ownership interest in the business entity.
Name/Title
Address
Telephone
DMM-U-1
REV. 04/16
Page 1 of 5
DIVISION OF MINERAL MINING
900 NATURAL RESOURCES DRIVE, STE. 400
CHARLOTTESVILLE, VIRGINIA 22903
(434) 951-6310
APPLICATION FOR A URANIUM EXPLORATION PERMIT
FOR OFFICE USE ONLY
APPLICATION NO.
PERMIT NO.
RECEIPT NO.
DATE ISSUED
APPLICANT INFORMATION
1. Name of Applicant
2. Office Telephone Number
3. Mailing Address
4. Exploration activity is located
of
(miles)
(direction)
(town)
on Public Road No.
in
County/City.
5. Type of Organization:
(
)Sole Proprietorship - Complete questions A,B,C,D
(
)Corporation
- Complete questions A,B,C,D,F,G,H,I,J
(
)Partnership
- Complete questions A,B,C,D,E,F
(
)Other
- Complete questions A,B,C,D,E,F
Specify (If Other):
(A) Virginia State Corporation Commission registration number
(B) Person with overall responsibility for operating decisions at the exploration site:
Name/Title
Address
Phone
E-mail
(C) Person to be contacted in the event of an accident or emergency:
Name
Address
Telephone
(D) Federal Tax ID Number of Applicant
(E) List all individuals having any ownership interest in the business entity.
Name/Title
Address
Telephone
DMM-U-1
REV. 04/16
Page 1 of 5
Uranium Exploration Permit Application
No. _____________________________
(F) Principal organization officials, corporate officers, directors and members:
Name/Title
Address
Telephone
(G) Corporation name, address and telephone number if different than applicant:
(H) State of Incorporation
(I) Virginia Registered Agent:
Name
Address
Telephone
(J) If a subsidiary, provide:
Parent Organization Name
Address
Telephone
State of Incorporation
6. Name, address and telephone number of person(s) authorized to sign permit documents:
Name
Address
Telephone
7. List any exploration or mining permits of any type held by the applicant in Virginia and the applicable
permit identification numbers.
Issuing Authority
Permit No./Identification No.
EXPLORATION OPERATION INFORMATION
8. USGS Quadrangle -
Northing -
Easting -
9. Type of Exploration Activity:
(
) Rotary Drill
(
) Surface Excavation
(
) Underground Excavation
(
) Other (specify)
DMM-U-1
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Uranium Exploration Permit Application
No. _____________________________
10. Approximate date exploration operations will commence.
(Applicant shall notify the Division prior to commencing exploration activities.)
11. Distance in feet to nearest inhabited building.
12. List any person with an ownership or leasehold interest in the surface land or minerals to be entered
or explored and the date each person was notified of the applicant’s intent to apply for an exploration
permit.
Name
Address
Date Notified
Surface
Surface
Mineral
Mineral
13. Specify source of applicant's legal right to enter and conduct mining operations on land covered by
the permit:
(Provide deed book number, page number, parties to the deed or lease, date of execution or provide a
copy of the deed or lease.)
14. Please provide the following information for any contractors who will be working on the exploration
site (attach additional sheets as necessary).
Contractor’s Business Name
DMM #
Virginia State Corporation Commission registration number _
Business address
Business telephone
Address of record
Service to be provided
Persons with responsibility for operating decisions:
Name
Address
Persons with responsibility for the health and safety of employees:
Name
Address
15. List rivers, streams, tributaries or water impoundments on or adjacent to permitted property.
pH adjacent to the
Name of waterway
exploration area
Tributary to
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Uranium Exploration Permit Application
No. _____________________________
16. Specify how all exploration fluids will be contained and disposed, and how storm runoff water will be
handled to minimize impact on any water courses. (Detail drainage plan attached).
17. Specify any chemicals or hazardous materials (including petroleum products) which will be used on
the exploration site and methods to be employed to prevent contamination of land and water
resources on or adjoining permitted property.
OPERATION/RECLAMATION PLANS
18. Specify the materials that will be generated by exploration operations and the plans for handling and
disposal during operations and reclamation.
TYPE OF MATERIAL
DISPOSAL METHOD
Overburden
Spoil/Waste Minerals
Used Oil and Lubricants
Trash and Debris
Hazardous Material
Buildings/Structures
19. Describe in detail the method of exploration, procedures for containment and disposal of all drilling
fluids, handling drainage, regrading, and vegetation during active exploration and upon completion
(attach narrative).
1
20. Attach an application map
(at a scale of 1:400 or larger), prepared by a licensed professional engineer
or licensed land surveyor that shows the location of the following, where applicable:
A. Areas of land to be disturbed by the proposed exploration and reclamation.
B. Existing roads, occupied dwellings, pipelines, and bodies of surface water.
C. Topographic and drainage features.
D. Proposed trenches, roads, other access routes to be constructed, and structures to be
constructed.
1
The map shall show the courses and distances of such exploration activity from two permanent points or landmarks
on the tract; the approximate location areas in which test holes or core or stratigraphic holes may be drilled; name of
the owner; and boundaries and acreage of the tract on which exploration activity is to take place.
DMM-U-1
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Uranium Exploration Permit Application
No. _____________________________
E. Proposed land excavations, exploration holes or other drill holes or underground openings.
(The locations of the proposed or actual exploration drill holes and the permanent points
shall be shown in accordance with the Virginia State Plane Coordinate System.)
F. Excavated earth or waste material disposal areas.
G. Critical habitats of any endangered or threatened species listed pursuant to the Endangered
Species Act of 1973.
H. Known Archeological, Cultural or Historic Resources.
21. Attach a narrative describing how each exploration hole shall be drilled, redrilled, plugged and/or
abandoned.
22. Attach a radiation management plan that outlines procedures for monitoring and minimizing radiation
exposure to workers, the public and the environment.
CERTIFICATION/SIGNATURE
I,
, state that all the presentations contained in
(Print Name)
the foregoing application are true to the best of my knowledge; and that I am the ( ) executive officer),
( ) general partner), ( ) sole proprietor), or ( ) legal representative of the applicant, duly authorized to
make this application on its/his/her behalf.
On behalf of the applicant, I hereby authorize the Virginia Division of Mineral Mining to conduct
such safety/reclamation inspections as it may deem necessary or as may be required by law on this
exploration operation.
Signature
Title
subscribed and sworn/affirmed to, this
day of
,
(Month)
(Year)
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