1. CHAPTER 105 WATER OBSTRUCTIONS AND ENCROACHMENT
    2. GENERAL PERMIT REGISTRATION

3150-PM-BWEW0500
Rev. 8/2016
COMMONWEALTH OF PENNSYLVANIA
Instructions
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WATERWAYS ENGINEERING AND WETLANDS
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CHAPTER 105 WATER OBSTRUCTIONS AND ENCROACHMENT
GENERAL PERMIT REGISTRATION
Please review the language of the General Permit(s) prior to completing the General Permit Registration to determine if
the project is eligible for use of the General Permit and meets the terms and conditions of the permit(s).
REGISTERING A GENERAL PERMIT (GP):
After determining that the project is eligible for use and meets the terms and conditions of the General Permit (GP)
intended to be registered, the following instructions are useful to properly complete the GP Registration (Registration)
process. A properly completed Registration, done in blue or black ink, allows for a more efficient and timely review.
Marking “N/A” indicates that a requirement is non-applicable to the project.
If the project is located in a county where the Conservation District (District) has been delegated responsibility under the
Chapter 105 program, the Registration form and other associated documents (Registration package) must be sent to the
District (except GP-10, GP-11, GP-15 or a GP for oil and gas related activities). If the District is not delegated or the
applicant intends to register a GP-10, GP-11, GP-15 or a GP for oil and gas related activities, the Registration package
must be sent to the appropriate Department of Environmental Protection (DEP) Regional Office. Contact Information for
District and DEP Regional Offices can be found on GP Registration
Exhibit B (3150-PM-BWEW0500B)
and
Exhibit C
(3150-PM-BWEW0500C)
; and on DEP’s eLibrary at
http://www.elibrary.dep.state.pa.us
.
Please provide
ONE (1) ORIGINAL
and
ONE (1) COPY
of the Registration package. An additional copy is required to be
available at the project site during construction along with the GP terms and conditions. Prepare the Registration package
for submission beginning with the Registration form, followed by the required attachments in the order they are requested.
Not all attachments will be required in all situations for all projects. This standardized format will assist the permit
reviewer to process the Registration package more efficiently.
The Registration package should be assembled and
provided in the following order (additional details are in Section E):
1. General Permit Registration form
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See 16 for additional requirements for GP-11
2. General Permit Registration Fee & Chapter 105 Fee
Calculation Worksheet
3. Notification sent to the Municipality & County
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Proof of receipt is optional
4. PASPGP-5 Reporting Criteria Checklist
5. Location Map
6. Color Photographs
7. Stream Name and Chapter 93 Classification
8. Project Description & Aquatic Resource Impact Table
9. Site Specific and/or Standard Drawings
10. Site Plan
11. Erosion & Sediment Control Plan (E&S Plan)
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Where required per Chapter 105 permit
12. Written Directions to Project Site
13. Pennsylvania Natural Diversity Inventory (PNDI) receipt
14. Request for a Bog Turtle Habitat Screening Form
15. Activities which impact wetlands:
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wetland delineation
?
wetland replacement plan
?
check (where required for compensatory mitigation)
16. Registration of a GP-11:
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E&S Plan
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Bridge and/or Culvert Replacement Projects or
Projects
That
Change
the Waterway Opening
Worksheet
Upon review by the District or DEP Regional Office, if the project is determined to not meet the terms and conditions of
the GP or the Registration package is incomplete, the applicant will be contacted appropriately.
CHAPTER 105 GPs:
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PLEASE MARK (“X”) ALL THAT APPLY:
Place an “X” in the box next to the GP(s) the applicant intends to register.
Mark all GPs that apply to the project.
o
If registering
GP-2
, place an “X” in the box next to the appropriate dock or facility type. Additional details are
available in the GP-2 permit.
o
GP-11
registrations will require additional items under Section E, Item 16.

3150-PM-BWEW0500
Rev. 8/2016
Instructions
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Activity Related to Oil and Gas Exploration, Production or Transmission:
Place an “X” in the box next to “Activity
Related to Oil and Gas Exploration, Production or Transmission” if the activity is oil and gas related.
Contact Information for DEP’s Regional Oil and Gas offices can be found on GP Registration
Exhibit B
(3150-PM-BWEW0500B)
; and on DEP’s eLibrary at
http://www.elibrary.dep.state.pa.us
.
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Activity Subject to Federal Energy Regulatory Commission (FERC) approval:
Place an “X” in the box next to
“Activity Subject to FERC approval” if the activity is regulated by FERC and provide the FERC docket number.
Place an “X” in the box next to “FERC Natural Gas Act Facility” if the activity is also regulated under the Federal
Natural Gas Act.
SECTION A. APPLICANT INFORMATION:
Please fill in the requested information about the applicant (the owner) as accurately as possible. If the property of the
project site is privately owned, please list all owners. If owned by a partnership, please list all members. If owned by a
corporation, a political subdivision, or a Commonwealth department, board, commission, receiver, trustee or authority,
please list the name of the entity.
See SECTION H. CERTIFICATION (page 9) for clarification of applicant signature.
Please be sure to include DEP Client Identification Number (if known) and Employer Identification Number (EIN), as well
as select or write in the proper Client Type and Code (listed below). This information is important to DEP’s data tracking
system. Please leave blank if the information is unknown or there is a question regarding the proper answer or
information. Please note however, that leaving out information may result in delays or denial of the authorization to use
the GP.
Government
AUTH
Authority
CNTY
County
FED
Federal Agency
MUNI
Municipality
SCHDI School District
STATE State Agency
OTHG
Other (Government)
NONPG Non-Pennsylvania Government
Non-Government
ASSOR
Association/Organization
NPACO
Non-Pennsylvania Corporation
PACOR
Pennsylvania Corporation
PARTG
Partnership-General
PARTL
Partnership-Limited
OTHER
Other (Non-government)
SOLEP
Sole Proprietorship
LLP
Limited Liability Partnership
LLC
Limited Liability Company
ESTST
Estate/Trust
Individual
INDIV
Individual
Business entities desiring to do business within the Commonwealth of Pennsylvania must register with the
Pennsylvania Department of State.
This requirement includes foreign filing associations such as; corporations for profit,
corporations not-for-profit, limited partnerships, limited liability companies, professional associations and business or
statutory trusts, which were not created or formed under the laws of Pennsylvania.
This requirement does not apply to
Individuals
.
To register with the Commonwealth, please visit Pennsylvania Department of State, Bureau of Corporations and
Charitable Organization registration website at
http://www.dos.pa.gov/BusinessCharities/Pages/default.aspx
SECTION B. CONSULTANT INFORMATION:
If there is a consultant involved in the project, please fill in the requested information about the consultant as accurately as
possible. Please be sure to include Employer Identification Number (EIN). If there is no consultant, please place an “X” in
the box next to “N/A”.
SECTION C. PROJECT INFORMATION:
Please fill in the requested information to identify the project.
Please be sure to include DEP Site Identification Number (if known), as well as select or write in the proper Site-to-Client
Relationship and Code (listed below). Please leave blank if the information is unknown or there is a question regarding
the proper answer or information. Please note however, that leaving out information may result in delays or denial of the
authorization to use the GP.
AGENT Agent for Owner or Operator
CONTR Contractor for Owner or Operator
LESSE Lessee
LESOP Lessee/Operator
OPR
Operator
OWN
Owner
OTHER Other
GEN
Generator
OWNOP Owner/Operator
PROWN Property Owner

3150-PM-BWEW0500
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Instructions
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The applicant will provide the latitude and longitude coordinates for each proposed impact as required in Section G. The
coordinates should be in decimal degrees. It is important to identify the method used to determine the latitude and
longitude. Check the appropriate box matching the collection method used. Also check the appropriate box matching the
Horizontal Reference Datum (or projection datum) employed in the latitude and longitude collection process. Identify the
date of collection (mm/dd/yyyy) if latitude and longitude coordinates were collected via GPS, WAAS and LORAN.
Description of collection methods:
EMAP
:
Method based on eMAP Pa program.
(
www.emappa.dep.state.pa.us
).
HGIS
:
Method based on the Pennsylvania Natural Heritage Program database (formerly known as PNDI). The database is
located at
www.naturalheritage.state.pa.us
.
Note: This method may be preferable since all GP registrations
require a PNDI search be conducted.
GISDR
:
Method based on the use of GIS and Digital Raster Graphic 1:24,000 scale USGS 7.5 minute quadrangle maps.
ITPMP
:
Method based on map interpolation of USGS 7.5 minute quadrangle maps.
GPS
:
Global Positioning method with unspecified parameters.
WAAS
:
Method base on GPS WAAS differentially correct.
LORAN
:
Method based on Loran C.
Types of Horizontal Reference Datum (or projection datum):
NAD27
:
North American Datum of 1927
NAD83
:
North American Datum of 1983
WGS84
:
World Geodetic System of 1984 (GEO84)
SECTION D. RESOURCE IDENTIFICATION:
Please place an “X” in the appropriate box to indicate if the applicant has identified that any of these resources may be
present at the project site; indicate that no resources were identified or indicate and list those resources which were
identified.
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National Register of Historic Places
?
National Registry of Natural Landmarks
?
Local historical site
?
Exceptional Value (EV) Waters
?
High Quality (HQ) Waters
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Threatened and Endangered Species
?
Wild or Stocked Trout Streams
?
Wild and Scenic Rivers
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Wetlands
Please review the conditions of the specific GP(s) as they pertain to these items prior to completing the Registration form
to determine eligibility. The registration resource identification list in this form is not all-inclusive and other resources may
also require certain restrictions or prohibit registering the GP. Identification of these resources on the project site may
result in specific areas, sites or conditions where the GP does not apply and is not valid.
The following items are useful in identifying these resources:
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Historic Places:
The Pennsylvania Historic and Museum Commission, Bureau for Historic Preservation manages
the National Register of Historic Places for Pennsylvania. Access to these paper records is free and open to the public
by appointment at the office in Harrisburg (see
Exhibit A - 3150-PM-BWEW0500A
).
Access to some of these data is available on the Cultural Resources Geographic Information System (CRGIS) at
http://www.phmc.pa.gov/Preservation/Cultural-Resources-GIS/Pages/default.aspx
.
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National Natural Landmarks:
Additional information on Natural National Landmarks and the National Registry of
Natural Landmarks is available at
http://www.nature.nps.gov/nnl/
.
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Exceptional Value and High Quality Waters (including Exceptional Value Wetlands):
Additional information on
Exceptional
Value
(EV)
and
High
Quality
(HQ)
waters
can
be
found
on
DEP’s
website
at
http://www.dep.pa.gov/Business/Water/PointNonPointMgmt/WaterQuality/Pages/ExistingUse.aspx
and 25 Pa. Code
Chapter 93 at
http://www.pacode.com/secure/data/025/chapter93/chap93toc.html
.
25 Pa. Code Chapter 93 also provides an important linkage to Exceptional Value Wetlands which are determined in
25 Pa. Code Chapter 105.17 found here
http://www.pacode.com/secure/data/025/chapter105/s105.17.html
.
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Threatened and Endangered Species:
(see also Section E, Items 13 & 14 for requirements and documentation)
:
Additional information on the Pennsylvania Natural Heritage Program (PNHP) regarding the presence of Federal
threatened and endangered (T&E) species and State T&E species and species of special concern on the project site

3150-PM-BWEW0500
Rev. 8/2016
Instructions
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and the PA Conservation Explorer, previously known as the Pennsylvania Natural Diversity Inventory (PNDI)
Environmental Review Tool (PNDI ER Tool) can be accessed at
http://www.naturalheritage.state.pa.us/
First time users will have to register at the website before conducting the review. Upon completion of the review, a
PNDI Receipt, valid for a period of two years from the date the search was conducted, is automatically available for
printing.
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Wild and Stocked Trout Waters:
Additional information on Wild and Stocked Trout Waters can be found at
http://fishandboat.com/waters_trout.htm
.
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Wild or Scenic Rivers:
Additional information on National or State Wild or Scenic rivers can be found at
http://www.rivers.gov/pennsylvania.php
and
http://www.dcnr.state.pa.us/brc/conservation/rivers/scenicrivers/index.htm
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Wetlands:
(see also Section E, Item 15 for requirements and documentation): Additional information on the 1987
Corps of Engineers Wetlands Delineation Manual and the appropriate Regional Supplements to the Corps of
Engineers
Wetland
Delineation
Manual
for
use
in
Pennsylvania
can
be
found
at
http://www.usace.army.mil/missions/civilworks/regulatoryprogramandpermits/reg_supp.aspx
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Additional Information:
Additional Information on resource identification (including agency contact information) can
be found on GP Registration
Exhibit A (3150-PM-BWEW0500A)
and
Exhibit B (3150-PM-BWEW0500B)
; on DEP’s
website at
http://www.dep.pa.gov
; and on DEP’s eLibrary at
http://www.elibrary.dep.state.pa.us
.
SECTION E. REGISTRATION CHECKLIST AND REQUIREMENTS:
Please place an “X” next to each item (1-16) to ensure it is completed and/or provided. Unless otherwise specified, all
items are required to ensure
a complete Registration package
. Please carefully read the terms and conditions of the
GP(s) the applicant intends to register, as additional actions may be required outside of the registration and
acknowledgement process prior to construction. Please retain the GP(s) terms and conditions to be available at the
project site during construction.
Please provide
ONE (1) ORIGINAL
and
ONE (1) COPY
of the Registration package; retain an additional copy to be available at
the project site during construction. Prepare the Registration package for submission beginning with the Registration form
and follow by the required attachments in the order they are requested.
1. General Permit Registration form properly completed and signed
The original GP Registration form shall be accurately completed, signed and provided.
2. General Permit Registration Fee and Chapter 105 Fee Calculation Worksheet
The fee required for a project authorized under these GPs shall be consistent with 25 PA Code §105.13 (relating to
regulated activities – information and fees). To determine the registration fee, please complete the
Chapter 105
Fee(s) Calculation Worksheet (3150-PM-BWEW0553)
. Please provide the completed worksheet and a check for the
applicable fee(s) made payable to the “Commonwealth of Pennsylvania Clean Water Fund” OR “
County
Conservation District, Clean Water Fund”, whichever is the reviewing entity.
3. Notification sent to the Municipality & County:
Please provide a copy of the Registration form to the Municipality & County in which the work will be performed.
Please mark the checklist appropriately to indicate that the applicant has done so. Proof of receipt is not required to
be provided to DEP, however if it is volunteered, it shoud be provided in this position within the Registration package.
4.
PASPGP-5 Reporting Criteria Checklist (3150-PM-BWEW0051)
properly completed:
PASPGP-5 Reporting Criteria Checklist must be completed and provided as part of all PADEP Chapter 105
applications / registrations to determine the appropriate federal Pennsylvania State Programmatic General Permit-5
(PASPGP 5) review procedure. Specific instructions are found on the form and should be carefully followed.
See PASPGP-5 Part II for definition of “Single and Ccomplete Pproject” prior to answering questions. PASPGP-5 can
found here:
http://www.nab.usace.army.mil/Missions/Regulatory/PermitTypesandProcess.aspx
5. Location Map with project site marked:
The location map shall be 1:24000 scale 8 ½” x 11” photocopy of the appropriate portion of the U.S.G.S. Quadrangle
Map with the project site marked. The Location Map may be a GIS generated map containing the required items with
the project site marked.

3150-PM-BWEW0500
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Instructions
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6. Color Photographs with dates and descriptions:
Please provide color photographs of the project site area including dates and descriptions. The photos, dates and
descriptions should be provided on an 8 ½” x 11” piece of paper.
Color photographs are only required for GP-3 and GP-11. Please see those permit conditions for additional details.
7. Stream Name and Chapter 93 Classification (example: UNT to HOUSE RUN, HQ-WWF/EV):
Please indicate the stream name and Chapter 93 classification in a format similar to the example. Please reference
both the Designated Use Classification found in 25 Pa. Code Chapter 93 and the Existing Use Classification found on
DEP’s website (provided in Section D). If the stream segment is on the Existing Use list, then that classification
should be provided.
The stream name will assist DEP or District reviewers in determing if the project or activity also requires a Submerged
Lands License Agreement (SLLA). GPs shall not be effective to authorize any project on, under or over submerged
lands of this Commonwealth until the owner has obtained a license from DEP authorizing the occupation of such
submerged lands issued under Section 15 of the Dam Safety and Encroachments Act, (32 P.S. § 693.15),
Section 514 of The Administrative Code of 1929 (71 P.S. § 194), or other applicable laws. Upon receipt of the
Registration package, the Department will review the project to determine if its location is on, under or over
submerged lands of the Commonwealth.
If applicable, DEP will prepare an SLLA and forward it to the applicant for execution prior to acknowledgement of
registration to use the GP. An annual charge is required for facilities constructed, owned or operated except for
categories of activities and structures at 25 Pa. Code § 105.35 (c)(1)-(7).
8. Project Description including potential impacts to waters and/or wetlands and T&E species or species of special
concern, the PNDI Receipt, and PNDI Avoidance Measures (if applicable):
Briefly describe the project, including proposed impacts to waters and/or wetlands. The Project Description may be
provided on a separate sheet and included in the appropriate location as part of the Registration package.
If the PNDI Receipt for the project contains Avoidance Measures, please include the Avoidance Measures in the
description.
Please prepare and provide a detailed chart of each proposed impact to waters and/or wetlands as it pertains to the
project’s activities per the instructions provided in Section G. Include a unique identifier (
i.e. Stream 1, Wetland 3,
etc
) which will be used in all related items. The
Aquatic Resource Impact Table (3150-PM-BWEW0557)
worksheet or
equivalent which provides all of the details requested must be attached as part of the Registration package.
9. Site Specific Drawing(s) depicting the project’s site specific activities (or Standard Drawing):
Please provide a unique site specific drawing for the project and the GP being registered. Standard Drawings
(included in the GPs) may be properly completed and provided when appropriate to the project and the GP being
registered, but are not required.
If registering multiple GPs at one time, or the project has several locations, please including all applicable Site
Specific and/or Standard Drawings for each GP and location. Please label each drawing with the unique identifer
created for the Impact Table (Section E.8. above and Section G below).
10. Site Plan depicting the site of the project’s General Permit activities:
Please prepare and provide a detailed Site Plan as it pertains to the project’s activities per the instructions provided in
Section F. If registering multiple GPs at one time, or the project has several locations, please mark all Standard
Drawing locations on the Site Plan. Site Plan may consist of required items placed on or provided by a USGS
Quadrangle map, aerial map, etc. If required information cannot be included on the Site Plan, it may be attached as
part of the Registration package. For example, a FEMA map may be provided instead of including the 100 year flood
elevation.
11. Erosion & Sediment Control Plan (E&S Plan) specific to the activity conducted under this permit
Work must be done in compliance with Chapter 102 of the Department's Rules and Regulations (relating to Erosion
Control). Prior to construction, the applicant must provide an E&S Plan to be reviewed and deemed appropriate by the
appropriate DEP Regional Office or delegated District in which the activities are proposed. The E&S Plan shall be
implemented prior to, during and after construction. The E&S Plan is not a requirement for Registration of a GP
(except GP-11 or GPs for oil and gas related activities), and does not need to be included in the Registration package.

3150-PM-BWEW0500
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Instructions
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If the applicant intends to register a GP-11 or a GP for oil and gas related activities an E&S Plan must be provided to
be reviewed and deemed appropriate by the appropriate DEP Regional Office and shall be implemented prior to,
during and after construction. The project site shall at all times be available for inspection by authorized employees of
DEP or the delegated District. The E&S Plan shall be available at the project site during construction.
Guidance for preparing an E & S Plan, as well as BMP specifications that meet DEP requirements, can be found in
the Department’s
Erosion and Sediment Pollution Control Program Manual (363-2134-008)
.
12. Detailed Written Directions to Project Site:
Please provide detailed written driving directions or GPS coordinates to the project site. The directions should go to
the location(s) of the GP activity(s), not just the project site entrance or access point.
The directions and/or
coordinates may be provided on a separate sheet and included in the appropriate location as part of the Registration
package.
13. Pennsylvania Natural Diversity Inventory (PNDI):
Coordination with the Pennsylvania Natural Heritage Program (PNHP) regarding the presence of Federal threatened
and endangered (T&E) species and State T&E species and species of special concern on the project site is a
regulatory requirement for this permit application/registration. Early coordination (prior to submission) with the
appropriate jurisdictional agencies using the PA Conservation Explorer, previously known as the Pennsylvania Natural
Diversity Inventory (PNDI) Environmental Review Tool (PNDI ER Tool), is the most effective means of timely permit
decisions. To provide proof of coordination with PNHP and PNDI, applicants must submit a PNDI Receipt as part of
the permit application/registration.
Please check the appropriate box indicating the information provided:
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PNDI reviews can still be obtained free-of-charge for users without access to a computer using the standard
process of requesting a project review directly from each jurisdictional agency—PA Department of Conservation
and Natural Resources (DCNR), PA Game Commission (PGC), PA Fish and Boat Commission (PFBC) and the
U.S. Fish and Wildlife Service (US FWS) instead of generating a PNDI Receipt instantly through the
PA Conservation Explorer. The standard PNDI review process user is responsible for securing PNDI Receipts
from each jurisdictional agency—DCNR, PGC, PFBC and the U.S. FWS.
o
PNDI Receipts from each jurisdictional agency will be included with the application/registration package.
The PNDI review is not complete or satisfied unless PNDI Receipts are included from all four jurisdictional
agencies listed above. Applicants are encouraged to use the PA Conservation Explorer because using
this tool is the most effective means of a timely permit decision.
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If the review determines there are potential impacts to a T&E species, the PNDI Receipt will provide an
explanation of the potential impact(s) and instructions on how to resolve the potential impact(s). READ AND
FOLLOW THESE INSTRUCTIONS CAREFULLY.
Following the procedure outlined by the Department of
Environmental Protection (DEP)in the Policy for Pennsylvania Natural Diversity Inventory (PNDI) Coordination
During Permit Review and Evaluation, No. 021-0200-001 (PNDI Policy) will allow applicants to meet regulatory
requirements.
There are two options available to applicants for handling PNDI coordination in conjunction with DEP’s Permit Review
Process: sequential review and concurrent review.
Sequential Review:
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The applicant runs
the PNDI search and completes all coordination with the appropriate jurisdictional
agencies, prior to submittingthe permit application/registration.
The applicant will include with the
application/registration a PNDI Receipt, and clearance letter(s) from the jurisdictional agency(ies) if the PNDI
Receipt shows a Potential Impact.
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If selecting sequential review, different items are required to be inlcuded as part of the permit
application/registration based on the search results:
o
If the PNDI Receipt shows “No Known Impacts”, please provide a copy of the signed PNDI Receipt as
part of the Registration package.
o
If the PNDI Receipt contains “Avoidance Measures”, the PNDI review is not complete or satisfied unless
the applicant has signed where required on the PNDI Receipt, indicating he/she can and will fulfill the
Avoidance Measure(s) for that project. DEP recommends including Avoidance Measures in the Project

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Instructions
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Description.
Please provide a copy of the PNDI Receipt signed as explained above and in the
certification section as part of the Registration package.
o
If the applicant cannot or chooses not to meet the Avoidance Measure(s), he/she must follow the
same process for PNDI Receipts showing “Potential Impact”, outlined below.
o
If the PNDI Receipt shows "Potential Impacts”, DEP and the jurisdictional agencies require that the
applicant provide additional information outlined in the PNDI Receipt, to the agencies noted on the
Receipt for further review. Please provide a copy of the signedPNDI Receipt showing “Potential Impacts”
AND the additioanl information outlined on the PNDI Receipt along with proof
of delivery to the
appropriate jurisdictional agency(ies) where further coordination is required. If this coordination is not
complete prior to submitting the permit application/registration package; the application/registration will be
subject to the concurrent review process as outlined below
Concurrent Review:
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The applicant runs the PNDI search and will engage in consultation with the applicable jurisdictional
agency(ies). DEP will allow technical review of the permit to occur concurrently with the T&E species and
State species of special concern consultation with the jurisdictional agency(ies)
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If selecting a concurrent review, the applicant will include with the permit application/registration a signed
PNDI Receipt processed through the PA Conservation Explorer OR PNDI receipts from each jurisdictional
agency if the standard process of requesting a project review was used.
o
It is important to note, however, that the concurrent review option carries certain risks and consequences
to the applicant, including:
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The permit may not be issued/acknowledged until each potential impact is resolved.
See DEP’s
Permit Review Process and Permit Decision Guarantee Policy, Document No. 021-2100-001
(PRP/PDG Policy).
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The proposed activity subject to the permit application/registration may need to be redesigned as a
result of the PNDI consultation
(
PNDI Policy
pages 7-8).
Note: Any substantive project or design
changes to the application will require a new application and fee to be submitted.
14. Bog Turtle Habitat Screening:
Bog Turtle Habitat screening is required for GPs 5, 6, 7, 8, 9, 11, and 15 which may impact wetlands in the following
Counties: Adams, Berks, Bucks, Carbon (Aquashicola Creek Watershed only), Chester, Cumberland, Dauphin
(Swatara Creek Watershed only), Delaware, Franklin (Antietam Creek Watershed), Lancaster, Lebanon, Lehigh,
Monroe, Montgomery, Northampton, Schuylkill (Swatara Creek Watershed only) and York.
Please check the
appropriate box indicating the information is provided:
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Complete the
Request for a Bog Turtle Habitat Screening Form (3150-PM-BWEW0550)
and provide it as part of
the Registration package.
If the completed Request for a Bog Turtle Habitat Screening Form is the only
information provided in the Registration package, additional review time will be required.
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Alternatively, if the applicant plans to contact an agency representative to schedule an on-site assessment of the
wetlands for bog turtle habitat prior to providing the Registration package, different registration items are required
based on the search results:
o
Copy of “No Effect” determination from the Army Corp of Engineers
o
Documented clearance from the US Fish and Wildlife Service
15. Activities which impact wetlands (temporary and/or permanent):
For activities which will impact wetlands (temporary and/or permanent), the following are required to be provided as
part of the Registration package:
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A wetland delineation with complete data sheets in accordance with the 1987 Corps of Engineers Wetland
Delineation Manual AND the appropriate Regional Supplements to the Corps of Engineers Wetland Delineation
Manual for use in Pennsylvania.
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If permanent direct or indirect wetland impacts are greater than 0.05 acres and require compensatory mitigation or
an applicant offers compensatory mitigation to address potential antidegration conerns, include a wetland

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replacement, restoration or enhancement plan in accordance with the Department’s Replacement criteria which
provides wetland replacement acreage or funtion at a minimum one to one acre ratio.
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If compensatory mitigation (for permanent direct or indirect wetland impacts) onsite is not feasible: A check
payable to the National Fish and Wildlife Foundation, N.A. 1237, may be provided in accordance with the fee
schedule below as compensatory mitigation for impacts in wetlands, in accordance with the Pennsylvania Wetland
Replacement Project.
Fee Schedule:
Deminimus impact ≤ .05 acre
$
0.00
> .20 acre to .30 acre -
$2,500.00
> .05 acre to .10 acre -
$ 500.00
> .30 acre to .40 acre - $5,000.00
> .10 acre to .20 acre -
$1,000.00
> .40 acre to .50 acre -
$7,500.00
16. Registration of a
GP-11
:
Registration of a GP-11 can only be performed by DEP and requires additional information based on the details of the
project, please check the appropriate box indicating the information is provided as part of the Registration package:
?
N/A because not registering GP-11
?
An E&S Plan shall be provided as part of the Registration package to be reviewed and deemed appropriate by the
appropriate DEP Regional Office and shall be implemented prior to, during and after construction. The project site
shall at all times be available for inspection by authorized employees of DEP or the delegated District. The E&S
Plan shall be available at the site at all times.
?
If the project includes a bridge or culvert replacement or the proposed work will change the waterway opening,
please complete and provide the
Bridge and/or Culvert Replacement Projects or Projects That Change the
Waterway Opening (3150-PM-BWEW0552B)
worksheet. If the project consists of similar work (replacement or
change in waterway opening) on more than one structure, provide the data requested for each structure included
in this Registration package.
SECTION F. SITE PLAN
Please prepare and provide a detailed Site Plan as it pertains to the project’s activities as requested in Section E, Item 10.
Please place an “X” in the appropriate box to indicate what is shown on the Site Plan; indicate that all items are included
or indicate and list those items which were not included. Unless otherwise specified, all items are required to be included
in the site plan.
?
Stream Name (provide name of impacted stream)
?
Stream Limits and Flow Direction
?
Stream Impacts on site (including dimensions)
?
Wetlands on site (including acreage)
?
Wetland Impacts on site (including acreage)
?
Other Waters (i.e. streams, pond, lakes)
?
Site Specific and/or Standard Drawings location(s)
?
Photograph location(s)
?
100 year Flood Elevation OR FEMA map with location marked
?
Limits of Earth Disturbance Associated with this Activity
?
Location of Property Lines Relative to the Project
?
Existing Utilities, Right Of Ways (ROWs), Easements
?
Existing Buildings, Roadways, Other Structures
?
Proposed Buildings, Roadway ROWs, Other Structures
SECTION G. AQUATIC RESOURCE IMPACTS ASSOCIATED WITH PROJECT WORK SITE
Please prepare and provide a detailed worksheet of the waters and/or wetlands impacts associated with the project work
site as requested in Section E, Item 8; include the unique identifier, project/site name, date and applicant name/client,
project information (including latitude and longitude) and waters and/or wetlands impact data in table format. Provide one
row of data for each regulated (DEP Chapter 105 and Corps Section 404) structure or activity and type of impact for the
proposed project based on the instructions for each requirement below; all dimensions should be reported to the nearest
one (1) foot, rounding up.
Please place an “X” in the appropriate box to indicate what is included in the Aquatic Resources Impact Table indicate
that all items are included or indicate and list those items which were not included. Depending on the details of project,
not all impact types will be included in the table.

3150-PM-BWEW0500
Rev. 8/2016
Instructions
- 9 -
Project Information:
?
Structure / Activity Unique Identifier for each regulated structure and/or activity being proposed
?
Aquatic Resource being impacting; stream or wetland
?
Aquatic Resource Type; based on wetland or stream
o
Stream type: perennial, intermittent, ephemeral stream or floodway
o
Wetland type: PEM, PSS, PFO or POW wetland
?
Latitude (dd nad 83)
?
Longitude (dd nad 83)
?
Work proposed / impact type: aerial, boring, excavation or fill
?
Waters Name: name of the stream or wetland (if available)
?
PA Code Chapter 93 Designation:
Army Corps of Engineers / Section 404 jurisdictional area:
?
Corps Impact Type: temporary, permanent or n/a;
Permanent Impacts – For the purpose of the PASPGP-5, permanent impacts are defined as waters of the United States,
including jurisdictional wetlands indefinitely filled, flooded, excavated, or drained as a result of the regulated activity.
Permanent impacts may or may not be considered a loss of waters of the United States, as defined above, since some
permanent impacts, such as those associated with bank stabilization and stream/wetland enhancement projects, may not
have a permanent adverse effect.
Temporary Impacts – For the purpose of the PASPGP-5, temporary impacts are defined as waters of the United States,
including jurisdictional wetlands not filled, flooded, excavated, or drained for an indefinite period of time, and restored to pre-
construction contours and elevation.
?
"n/a" if no proposed work in, over, or under waters and/or wetlands
?
Stream Impact: width, length and area of stream impact;
o
Width: top of bank to top of bank, of transverse and/or full channel fill stream impacts;
o
Length: down the center line of stream, of transverse and/or full channel fill stream impacts;
o
Area: direct and indirect/secondary stream impact; dewatering or fill placed in stream channel;
?
"n/a" if impact is to a wetland OR if "n/a" to Corps Impact Type
?
Wetland Impact: area of impacts to wetlands; indicate "n/a" if impact is to a stream OR if "n/a" to Corps Impact
Type
DEP / Chapter 105 jurisdictional area:
?
PADEP Impact Type: temporary or permanent.
Permanent Impacts are those areas affected by a water obstruction or encroachment that consist of both direct and
indirect impacts that result from the placement or construction of a water obstruction or encroachment and include areas
necessary for the operation and maintenance of the water obstruction or encroachment located in, along or across, or
projecting into a watercourse, floodway or body of water.
Temporary Impacts are those areas affected during the construction of a water obstruction or encroachment that consists
of both direct and indirect impacts located in, along or across, or projecting into a watercourse, floodway or body of water
that are restored upon completion of construction. This does not include areas that will be maintained as a result of the
operation and maintenance of the water obstruction or encroachment located in, along or across, or projecting into a
watercourse, floodway or body of water (these are considered permanent impacts).
?
Floodway Impact: direct and indirect/secondary 100-year floodway impact, including watercourse;
?
Wetland Impact: Provide the square feet area of impacts to wetlands; indicate "n/a" if impact is to a stream
Provide completed aquatic resource impact table with Chapter 105 Water Obstruction and Encroachment
application/registration. The
Aquatic Resources Impact Table (3150-PM-BWEW0557)
worksheet or equivalent may be
used to complete this requirement.
SECTION H. CERTIFICATION
Please sign, indicate title and date in the appropriate locations. The Registration package will not be accepted unless the
original form and copy are signed and dated by the applicant/owner.
See SECTION A. APPLICANT INFORMATION
.
Clarification on applicant/owner signature:
Individual– The Registration form must be signed by all owners listed within the deed of the property or lease/rental agreement with
their original signatures.
For Individual(s), no indication of title is necessary
.

3150-PM-BWEW0500
Rev. 8/2016
Instructions
- 10 -
Corporations – The Registration form must be signed by the President or Vice President, Attested by the Secretary (Assistant
Secretary) or Treasurer (Assistant Treasurer).
If others are signing on behalf of the corporation,
a document evidencing delegation of contracting authority must be provided.
Acceptance of the delegated documentation is at the sole discretion of DEP. Absent satisfactory documentation of signatory
authority, only the above officers will be accepted as appropriate signatories.
Government agencies – The Registration form must be signed by the Chief Officer or the President/Vice President of the
government agency, if incorporated. Chief Clerk, Secretary or Treasurer Signature is required to witness or attest.
Partnerships – The Registration form must be signed by either one general partner to bind the partnership or all partners must sign.
For Limited Partnerships (LP), where each individual is a general partner, any general partner may sign. If a corporation is a
general partner, the signage must 1) indicate the name of the corporation, 2) that it is a general partner, and 3) the signature of the
President or Vice President
and
the signature of the Secretary or Treasurer.
If others are signing on behalf of the Limited Partnership,
a document evidencing delegation of contracting authority must be
provided. Acceptance of the delegated documentation is at the sole discretion of DEP. Absent satisfactory documentation of
signatory authority, only the above officers will be accepted as appropriate signatories.
Limited Liability Companies – The Registration form must be signed by a member for a Limited Liability Company (LLC), where it is
member managed; where it is manager managed, a manager must sign. Please indicate whether the person is signing as a
“Member” or as a “Manager” of the LLC, according to the Company’s Limited Liability Company Operating Agreement.
If anyone other than a “Member” or “Manager” are signing on behalf of the LLC,
documentation of authority to sign on behalf of
the LLC must be provided.
This GP shall not be authorized until the E&S Plan has been reviewed by the appropriate DEP Regional Office or District,
Federal Authorization has been obtained and, where required, an SLLA has been obtained from DEP.
SECTION I. ACKNOWLEDGEMENT
Upon review of this Registration package, the applicant will receive an acknowledgment letter and
one (1) copy
of the
signed GP Registration form acknowledging use of the GP(s) and federal authorization under Pennsylvania State
Programmatic General Permit (PASPGP). Included with PASPGP authorization will be the PASPGP Permit Compliance,
Self-Certification Form which must be completed, signed and returned to the appropriate Army Corp of Engineers District
office, once the project is completed. If PASPGP is not attached, work on the project may NOT begin work until federal
authorization is obtained.
The acknowledgement letter, Registration package (including acknowledged Registration form), the GP(s) terms and
conditions, required Federal authorization(s), and the E&S Plan must be maintained and available at the project site
during construction. Please remember the authorization is subject to all terms and conditions listed in the GP(s).

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