| 1. |
Name of Permittee:
Mailing Address:
Street
City State Zip
Telephone Number: Fax Number: |
| 2. |
Permit Number:
Permit Issue Date:
Total Permit Area (acres):
Name of Surface Owner: |
| 3. |
Location of the mining operation:
Section , T.N.,
R.W.,
in County |
| 4. |
Time period covered by this report: From
through . (The reporting period begins on the month
and day of permit issuance in the year reported. The end date of the reporting period is
twelve months after the anniversary date.) |
| 5. |
The volume of topsoil which has been stockpiled during the time
period in No. 4 above is yards. The total volume
of topsoil which has been stockpiled since mining began (including volume
stockpiled during the time period covered by this report) is yards. |
| 6. |
The volume of overburden which has been stockpiled, for use in
reclamation, during the time period in No. 4 above is yards. The total volume of overburden which has been
stockpiled, for use in reclamation, since mining began (including volume stockpiled during
the time period covered by this report) is
yards. |
| 7. |
The quantity of mineral or material which was mined during the time
period in No. 4 above is tons. The total
quantity of mineral or material that has been mined, since mining began
(including quantity mined during the time period covered by this report) is tons. |
| 8. |
The number of acres newly disturbed during the time period in No. 4 above is . The total number of acres (including acres disturbed
during the time period covered by this report) disturbed since mining began is . |
| 9. |
The number of acres of disturbed land that were backfilled or graded and contoured
during the time period in No. 4 above is . |
| 10. |
The number of acres of disturbed land that had topsoil applied during the time period
in No. 4 above is . |
| 11. |
On those lands topsoiled (No. 11 above), the average thickness of the topsoil that has
been applied is inches. |
| 12. |
The number of acres that were seeded during the time period in No. 4 above is . |
| 13. |
On those lands seeded (No. 13 above), please state
a. the date(s) of seeding was ;
b. the plant species that were seeded were ;
c. the rate the seed was applied was (pounds/acre) ;
d. the seed was applied by the following method(s) ;
e. the type of fertilizer applied was ;
f. the rate the fertilizer was applied was (pounds/acre) ;
g. the fertilizer was applied by the following method ;
h. the type of mulch applied was ;
f. the rate the mulch was applied was (pounds/acre) ;
g. the mulch was applied by the following method
|
| 14. |
The total number of acres reclaimed (graded, topsoiled and seeded) since mining began
(including the acres reclaimed during the time period covered by this report) is . |
| 15. |
Describe any facilities (e.g., roads, ponds, buildings, ditches, disposal sites, etc.)
constructed during the report period.
|
| 16. |
Describe water usage and/or water discharge, including quantities. The DEQ-Water
Quality Division NPDES Permit Number, if applicable, is .
|
| 17. |
Describe the mining and reclamation activities planned for the next reporting period.
|
| 18. |
The number of acres that are planned to be newly affected by mining activities in the
next reporting period are . |
| 19. |
The number of acres that are planned be graded and contoured in the next reporting
period are . |
| 20. |
The number of acres that are planned to be topsoiled and seeded in the next reporting
period are . |
| 21. |
Please attach a map or maps clearly showing the following information:
a. Permit area boundary
b. Title block that includes the
1. Name and Address of Permittee (see No. 1 above)
2. Annual Report Time Period (see No. 4 above)
3. Permit Number (see No. 2 above)
4. Location of mine by section, township, and range
(see No. 3 above)
c. North Arrow, scale, contour interval, date
d. Legend showing and identifying all map symbols
e. Location and area of the newly disturbed lands (see No. 8 above)
f. Location and area of all disturbed lands since mining began (see No. 8 above)
g. Location and area of lands which were graded and contoured (see No. 10 above) during
the report period
h. Location and area of lands that were topsoiled (see No. 11 above) during the report
period
i. Location and area of lands that were seeded (see No. 13 above) during the report period
j. Location and area of all reclaimed lands (see No. 15 above) with the year in which each
area was reclaimed (seeded) indicated for each area.
k. Location of newly constructed facilities (see No. 16 above)
Please submit maps in duplicate for state or private land and in triplicate for federal
land. An enlargement of a portion of a USGS 7.5 minute topographic map with a scale of 1
inch equals 200 to 400 feet is preferred. If another type of map is used, section corners
and section lines must be included on the map. |
| 22. |
Please attach an itemized cost
estimate for reclamation of the permit as required by W.S. §35-11-417(c)(ii). The cost
estimate should be itemized to reflect the costs of reclaiming all affected lands,
including buildings and roads, and those
lands to be newly affected during the next report period. All affected lands require
bonding until bond release is approved by the LQD. |
| 23. |
Please use additional sheets as necessary. Return the completed report to:
Land Quality Division
(122 W. 25th St., Herschler Bldg., 3W, Cheyenne, WY 82002)
|