"700-pm Application Form" - Oregon

700-pm Application Form is a legal document that was released by the Oregon Department of Environmental Quality - a government authority operating within Oregon.

Form Details:

  • Released on April 5, 2020;
  • The latest edition currently provided by the Oregon Department of Environmental Quality;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Oregon Department of Environmental Quality.

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For DEQ Use Only
For DEQ Use Only
State of Oregon
Department of Environmental Quality
700 NE Multnomah Street, Suite 600
Date
Date Permit Issued
Portland, Oregon 97232
Amount Received
New Application
File Number
700PM General Permit
Check No.
(See pages 7 - 9 for instructions)
A. New Applicant Category
I am applying for a new registration to suction dredge under the 700PM permit.
A $500 application fee is required for a motorized suction dredge.
I am applying for a new registration to suction dredge under the 700PM permit.
A $25 application fee is required for a gravity or siphon suction dredge.
I am applying for a new registration to suction dredge under the 700PM permit.
A $525 application fee is required for a motorized suction dredge and a gravity or siphon suction dredge.
B. Amendment Information
My assigned permit number is
.
There are changes to my motorized suction dredge specifications.
There are changes to my gravity or siphon suction dredge specifications.
There are changes to my mining site locations.
My registration is for a motorized suction dredge. I am adding a gravity or siphon suction dredge. A $25 fee is
required.
My registration is for a gravity or siphon suction dredge. I am adding a motorized suction dredge. A $500 fee is
required.
C. Applicant Information
Legal full name of applicant:
Last Name (include Sr., Jr., III etc.)
First Name
Middle Name or Initial
Applicant mailing address:
City:
State:
Zip code:
Telephone number:
Alternate telephone number:
Email address:
Invoice mailing address: (if different from applicant mailing address)
City
State
Zip code:
20200504 (TLB)
1
For DEQ Use Only
For DEQ Use Only
State of Oregon
Department of Environmental Quality
700 NE Multnomah Street, Suite 600
Date
Date Permit Issued
Portland, Oregon 97232
Amount Received
New Application
File Number
700PM General Permit
Check No.
(See pages 7 - 9 for instructions)
A. New Applicant Category
I am applying for a new registration to suction dredge under the 700PM permit.
A $500 application fee is required for a motorized suction dredge.
I am applying for a new registration to suction dredge under the 700PM permit.
A $25 application fee is required for a gravity or siphon suction dredge.
I am applying for a new registration to suction dredge under the 700PM permit.
A $525 application fee is required for a motorized suction dredge and a gravity or siphon suction dredge.
B. Amendment Information
My assigned permit number is
.
There are changes to my motorized suction dredge specifications.
There are changes to my gravity or siphon suction dredge specifications.
There are changes to my mining site locations.
My registration is for a motorized suction dredge. I am adding a gravity or siphon suction dredge. A $25 fee is
required.
My registration is for a gravity or siphon suction dredge. I am adding a motorized suction dredge. A $500 fee is
required.
C. Applicant Information
Legal full name of applicant:
Last Name (include Sr., Jr., III etc.)
First Name
Middle Name or Initial
Applicant mailing address:
City:
State:
Zip code:
Telephone number:
Alternate telephone number:
Email address:
Invoice mailing address: (if different from applicant mailing address)
City
State
Zip code:
20200504 (TLB)
1
D. New and Amended Suction Dredge Specifications
Suction Dredge 1:
Please check the appropriate box and provide specification(s)
Motorized suction dredge:
Suction hose inside diameter:
inches
(max. 4 inches inside diameter outside ESH):
Maximum horsepower (hp) rating (max. 30hp):
hp
Gravity or siphon suction dredge:
Suction hose inside diameter (max. 6 inches outside ESH):
inches
Suction hose inside diameter (max 4 inches in ESH):
inches
Suction Dredge 2:
Please check the appropriate box and provide specification(s)
Motorized suction dredge:
Suction hose inside diameter:
inches
(max. 4 inches inside diameter outside ESH):
Maximum horsepower (hp) rating (max. 30hp):
hp
Gravity or siphon suction dredge:
Suction hose inside diameter (max. 6 inches outside ESH):
inches
Suction hose inside diameter (max 4 inches in ESH):
inches
Suction Dredge 3
Please check the appropriate box and provide specification(s)
Motorized suction dredge:
Suction hose inside diameter:
inches
(max. 4 inches inside diameter outside ESH):
Maximum horsepower (hp) rating (max. 30hp):
hp
Gravity or siphon suction dredge:
Suction hose inside diameter (max. 6 inches outside ESH):
inches
Suction hose inside diameter (max 4 inches in ESH):
inches
20200504 (TLB)
2
E. New and Amended Mining Site Locations
Mining Site Location 1
Provide the name of the mineral claim (if any):
ESA:
Yes
No
Mining Claim Name:
Claim # ORMC
Please designate whether the land is privately owned or public land. If public land, please designate type as indicated on the
online mapping tool. Click the cursor on the land of this mining site location to get info in a pop-up field.
Private land
Public land (check one):
BLM,
Federal Forest,
State Forest,
County,
Other:
Please indicate how the mining site location will be accessed.
Boat ramp
Stream crossing/ford
Access is approved by the land management agency
Other (please explain how mining site location will be accessed)
Please provide the upstream and downcurrent Township-Range-Section, Latitude and Longitude:
Upstream Township:
N
S; Range:
W
E; Section:
Upstream Lat:
; Upstream Long:
Downstream Township:
N
S; Range:
W
E; Section:
Downstream Lat:
; Downstream Long:
Please check this box if there is an attachment that includes substantial evidence specific to the mining claim that
establishes that the application of Schedule D, Condition 18 (per Oregon Revised Statute 468B.116(3)) either violates
federal law, or constitutes a regulatory taking.
Name of stream or other state water to be mined at this mining location as indicated on the mapping tool. If the state water to be
mined is unnamed, provide name of nearest state water (downstream tributary creek or river) that is named:
River:
, Creek:
, Other:
Yes
No Is this location in Oregon State Scenic Waterways?
Yes
No Is this location Outstanding Resource Water?
Yes
No Is this site tribal lands or waterways that constitute a boundary of a tribal reservation?
Yes
No For this location, or within 500 feet downstream of this location, is any stream segment listed as water quality
limited for sedimentation, turbidity or toxics (other than chlorine) on the 303(d) list?
Yes
No Is this site inside one of the 12 wilderness areas with limited discharge where mining must not cause any
visible turbidity in this wilderness, listed in Schedule A, Condition 4 of the permit?
Yes
No Is this location in Essential Salmon Habitat? (Only gravity or siphon dredge with a max. 4 inch diameter hose is
allowed.)
No Is this location in a Willamette Basin Mercury TMDL stream?
Yes
20200504 (TLB)
3
Mining Site Location 2
Provide the name of the mineral claim (if any):
ESA:
Yes
No
Mining Claim Name:
Claim # O R M C
Please designate whether the land is privately owned or public land. If public land, please designate type as indicated on
the online mapping tool. Click the cursor on the land of this mining site location to get info in a pop-up field.
Private land
Public land (check one):
BLM,
Federal Forest,
State Forest,
County,
Other:
Please indicate how the mining site location will be accessed.
Boat ramp
Stream crossing/ford
Access is approved by the land management agency
Other (please explain how mining site location will be accessed)
Please provide the upstream and downcurrent Township-Range-Section, Latitude and Longitude:
Upstream Township:
N
S; Range:
W
E; Section:
Upstream Lat:
; Upstream Long:
Downstream Township:
N
S; Range:
W
E; Section:
Downstream Lat:
; Downstream Long:
Please check this box if there is an attachment that includes substantial evidence specific to the mining claim that
establishes that the application of Schedule D, Condition 18 (per Oregon Revised Statute 468B.116(3)) either violates
federal law, or constitutes a regulatory taking.
Name of stream or other state water to be mined at this mining location as indicated on the mapping tool. If the state
water to be mined is unnamed, provide name of nearest state water (downstream tributary creek or river) that is named:
River:
, Creek:
, Other:
Yes
No Is this location in Oregon State Scenic Waterways?
Yes
No Is this location Outstanding Resource Water?
Yes
No Is this site tribal lands or waterways that constitute a boundary of a tribal reservation?
Yes
No For this location, or within 500 feet downstream of this location, is any stream segment listed as water quality
limited for sedimentation, turbidity or toxics (other than chlorine) on the 303(d) list?
Yes
No Is this site inside one of the 12 wilderness areas with limited discharge where mining must not cause
any visible turbidity in this wilderness, listed in Schedule A, Condition 4 of the permit?
Yes
No
Is this location in Essential Salmon Habitat? (Only gravity or siphon dredge with a max. 4 inch diameter hose is
allowed.)
No Is this location in a Willamette Basin Mercury TMDL stream?
Yes
20200504 (TLB)
4
Mining Site Location 3
Provide the name of the mineral claim (if any):
ESA:
Yes
No
Mining Claim Name:
Claim # O R M C
Please designate whether the land is privately owned or public land. If public land, please designate type as indicated on
the online mapping tool. Click the cursor on the land of this mining site location to get info in a pop-up field.
Private land
Public land (check one):
BLM,
Federal Forest,
State Forest,
County,
Other:
Please indicate how the mining site location will be accessed.
Boat ramp
Stream crossing/ford
Access is approved by the land management agency
Other (please explain how mining site location will be accessed)
Please provide the upstream and downcurrent Township-Range-Section, Latitude and Longitude:
Upstream Township:
N
S; Range:
W
E; Section:
Upstream Lat:
; Upstream Long:
Downstream Township:
N
S; Range:
W
E; Section:
Downstream Lat:
; Downstream Long:
Please check this box if there is an attachment that includes substantial evidence specific to the mining claim that
establishes that the application of Schedule D, Condition 18 (per Oregon Revised Statute 468B.116(3)) either violates
federal law, or constitutes a regulatory taking.
Name of stream or other state water to be mined at this mining location as indicated on the mapping tool. If the state
water to be mined is unnamed, provide name of nearest state water (downstream tributary creek or river) that is named:
River:
, Creek:
, Other:
Yes
No Is this location in Oregon State Scenic Waterways?
Yes
No Is this location Outstanding Resource Water?
Yes
No Is this site tribal lands or waterways that constitute a boundary of a tribal reservation?
Yes
No For this location, or within 500 feet downstream of this location, is any stream segment listed as water quality
limited for sedimentation, turbidity or toxics (other than chlorine) on the 303(d) list?
Yes
No Is this site inside one of the 12 wilderness areas with limited discharge where mining must not cause
any visible turbidity in this wilderness, listed in Schedule A, Condition 4 of the permit?
Yes
No Is this location in Essential Salmon Habitat? (Only gravity or siphon dredge with a max. 4 inch diameter hose
allowed.)
is
No Is this location in a Willamette Basin Mercury TMDL stream?
Yes
20200504 (TLB)
5
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