TOWN OF MENASHA RECLAMATION PERMIT

Town of Menasha

Diana Kanter, Associate Planner

2000 Municipal Dr.

Neenah, WI 54956

 

 

RECLAMATION PERMIT

APPLICATION FOR EXISTING NONMETALLIC MINING SITES

 

Form ________                Date_______

 

PLEASE COMPLETE ALL INFORMATION ON THIS APPLICATION.  PRINT OR TYPE.  Use of this form is required for any nonmetallic mining reclamation permit application filed pursuant to s. NR 135.18(1), Wis. Adm. Code.  To qualify for a reclamation permit, this form must be RECEIVED by August 1, 2001.  The Town will not consider your application unless you complete and submit all information required by this application form.

 

 

1.  Applicant/Operator

______________________________________________________

Address

______________________________________________________

City, State, Zip Code                                            ______________________________________________________

Telephone No. (Include area code)

 

 

2.  Property Owners/Lessors (if different from Applicant/Operator)

______________________________________________________

Address

______________________________________________________

City, State, Zip Code

______________________________________________________

Telephone No. (Include area code)

 

(Additional owner/lessor information can be submitted on separate sheet)

 

3.        Property Description:  Provide the complete  legal description of the property on which the mine is located (example: N ½ , NE ¼,

       Section  3,  T29N, R6E)

                                                                                __________________________________________________________________________

                                                                                Town of Menasha, Winnebago County

                                                                                Tax Parcel Number __________________________________________________________

                                                                                Total Site Acreage ___________________________________________________________

                                   

4.        General Location Map - draw the location of the site on the section map below. Include roads and any other pertinent information and label ¼ ¼ section points.  It is also acceptable to attach a plat map, topographic map or other map providing it contains sufficient detail.                                                    

                                                                                                                         N

 

 

 

 

 

 

 

                                                        

                                                         W                                                                                                                         E

 

 

 

 

 

 

 

                                                                                                                             S

 

5.        Project Information: Please provide a brief description of the general location (including surrounding land use) and the nature of the nonmetallic mine (i.e., type of deposit, proposed frequency of mining activity).

 

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 


 

6.  Permit Certification for Existing Nonmetallic Mine Sites:

 

I hereby certify, as a duly authorized representative or agent, that the operator listed above will comply with the statewide nonmetallic mining reclamation standards established in ss. NR 135.05 through NR 135.15, Wis. Adm. Code.  The contractor will also provide a completed reclamation plan and financial assurance by the date agreed upon with the regulatory authority, but no later than September 1, 2004.

 

Signature of Applicant or Duly Authorized Agent                                                               Date Signed

 

________________________________________________________                               ______________________________________

 

7.  Fees:

 

                       # Unreclaimed acres (per s. NR 135.03(25), Wis. Adm. Code)

                         that are part of a  nonmetallic mining site (per s. NR 135.03(16) ,

                         Wis. Adm. Code) where mining will take place after August 1, 2001                                          _________________

 

                       # Estimate of unreclaimed acres that will be activated between

                         August 31, 2001and December 31, 2001                                                                              +      _________________

                      

                       # Total estimated unreclaimed acres                                                                                       =      _________________

 

                       Fee per acre as established by Regulatory Authority                                                             x      $________________

 

                       Total Fee for 2001                                                                                                                 =      $________________

 

 

I hereby certify that the information contained herein is true and accurate.  I also certify that I am entitled to apply for a permit, or that I am the duly authorized representative or agent of an applicant who is entitled to apply for a permit.

 

 

Signature of Applicant or Duly Authorized Agent                                                                                      Date Signed

 

 

 

 

LEAVE BLANK - FOR RECEIVING AGENCY USE ONLY

 

 

Permit No.

 

 

Date Reclamation Plan is Due

 

 

 

Received by

 

 

Date Received                       Date Application Was Complete

 

 

 

 

FEE SCHEDULE

____________________________________________________________

Mine Size in Unreclaimed Acres            Annual                  

Rounded to the Nearest Whole Acre            Fee                       

                                                                   Total                    

               _______________________________________________________________

1 to 5 acres

[does not include mines < 1 acre]                      $180

 

6 to 10 acres                                                                  $260

                                                                                                                                                     

11 to 15 acres                                                                  $490

 

16 to 25 acres                                                                $720

 

26 to 50 acres                                                                $890

 

51 acres or larger                                                    $1050