DMR Forms

Below is a list of forms used by the Division of Mining and Reclamation.  Only those forms which are not available on the ePermitting system are listed here.  If you have any questions regarding a specific form please contact the DMR.

Please note that if you are using a Microsoft browser, such as Internet Explorer or Edge, you may be prompted for credentials if you click a form that is presented as a Word document.  In that case, right-click the form and choose "Save As..." to download the form.

​Applications

  • Cease Operator Assignment
    • Form: MR-19N
    • Revised:  November, 2003
    • Description:  The purpose of this notice is to inform the DEP that the operator is no longer conducting surface mining and/or surface mining reclamation operators on a specific permitted site.  This form does not serve as a rebuttal or any presumption of ownership or control imposed by the applicable rules and regulations.  In the event there are outstanding violations, or in the event violations occur later, the operator and its owners may be prohibited from receiving surface mining permits or approvals, unless the violations are abated or the operator satisfactorily rebuts any applicable presumption of ownership or control.




  • State Historic Preservation Questionnaire
    • Form:  MR-SHPO
    • Revised:  September, 2006
    • Description:  Applicant shall complete this form and include, along with appropriate maps, with all copies of the application.  One separate copy of this completed form, along with appropriate maps, shall also be submitted to the regional DEP Office for SHPO notification.  The Department of Environmental Protection and the State Historic Preservation Office has agreed that DEP will directly communicate with SHPO on these requests.  Requests received by SHPO from the applicant WILL NOT be reviewed by SHPO.

Blasting

Visit the Blasting page for additional information and policies.


  • Blast Ad
    • Form:  EB-38
    • Revised:  April, 2017
    • Description:  Public notice of blasting operations.


  • Blast Log
    • Form: EB-37
    • Revised: November, 2019









Bonding






  • Option to Invest / W-9
    • Form:  Invest
    • Revised:  December, 2012
    • Description: Cash performance bonds posted with the West Virginia Department of Environmental Protection pursuant to Chapter 22 of the Code of West Virginia are eligible for investment in the West Virginia Consolidated Fund, with interest payable to the operator posting the bond.  Under the provisions of W.Va. Code §12-6-8 and §12-6C-6, State agencies may request the West Virginia State Treasurer to invest funds administered by them.  The State Treasurer sends the moneys to the West Virginia Board of Treasury Investments for inclusion in investments through the Consolidated Fund. Principal amounts and interest earned may be distributed at any time throughout the year when applicable requirements for the release of bond have been met or upon the substitution of acceptable alternate bonding.  Interest on bonds, greater than $50, included in the Consolidated Fund will be withdrawn from the investor’s account and paid to the investor in the first quarter of the calendar year.  Interest on bonds less than $50 will be paid upon request.  Upon forfeiture, the principal amount of the bond becomes the property of the Department of Environmental Protection, and the operator will receive interest earned up to the date of forfeiture.



Checklists






Miscellaneous







NPDES


Reports


Underground Injection Control

  • Reissuance Non-Slurry Application
    • Revised: March, 2019
    • Summary: CLASS 5, TYPE 5X13/TYPE 5G30 UNDERGROUND INJECTION CONTROL (UIC) REISSUANCE APPLICATION For Coal Mines Non-Slurry Injection
    • Description: The purpose of this UIC reissuance application is to gather detailed and technical information the WVDEP and the Division of Mining and Reclamation requires to make sound permitting decisions, within the regulatory framework of West Virginia Code of State Regulations and all other applicable state and federal mining regulations.
  • New Non-Slurry Application
    • Revised: August, 2018
    • Summary: CLASS 5, Type 5X13/Type 5G30 UNDERGROUND INJECTION CONTROL (UIC) NEW PERMIT APPLICATION For Coal Mines Non-Slurry Injections
    • Description: The purpose of this UIC reissuance application is to gather detailed and technical information the WVDEP and the Division of Mining and Reclamation requires to make sound permitting decisions, within the regulatory framework of West Virginia Code of State Regulations and all other applicable state and federal mining regulations.
  • 5G30 Mine Water Transfer Application
    • Revised: September, 2018
    • Summary: CLASS 5, TYPE 5G30 UNDERGROUND INJECTION CONTROL (UIC) MINE WATER TRANSFER PERMIT APPLICATION For Coal Mines and Quarries
    • Description: The purpose of this UIC permit application is to gather sufficient information to review the “Mine Water Transfer” proposal.  This activity involves transferring mine water, by either pumping or gravity flow, from a mine void to the surface, transporting it across the surface via piping, and injecting it back into a mine void via a certified Class 5, Type 5G30 injection well, without treatment or processing of the mine water. 
  • UIC Annual Report
    • Revised: November, 2018
    • Description:  Reporting form for total volume injected, min/max mine pool levels, injection points, modifications to existing UIC control permits, and injection volume details.
  • Permit Application for Slurry Injection
    • Revised: July, 2019
    • Summary: CLASS 5, TYPE 5X13 UNDERGROUND INJECTION CONTROL (UIC) PERMIT APPLICATION For Coal Mines Slurry Injection
    • Description: The purpose of this UIC reissuance application is to gather detailed and technical information the WVDEP and the Division of Mining and Reclamation requires to make sound permitting decisions, within the regulatory framework of West Virginia Code of State Regulations and all other applicable state and federal mining regulations.
  • Modification Application
    • Revised: February, 2020
    • Summary: CLASS 5, TYPE 5X13/TYPE 5G30 UNDERGROUND INJECTION CONTROL (UIC) MODIFICATION APPLICATION For Coal Mines Slurry and Non-Slurry Injection
    • Description: The purpose of this UIC reissuance application is to gather detailed and technical information the WVDEP and the Division of Mining and Reclamation requires to make sound permitting decisions, within the regulatory framework of West Virginia Code of State Regulations and all other applicable state and federal mining regulations.
  • Transfer Application
    • Revised: February, 2020
    • Summary: CLASS 5, TYPE 5X13/5G30 UNDERGROUND INJECTION CONTROL (UIC) PERMIT TRANSFER APPLICATION For Coal Mines and Quarries