1. CHAPTER 105 WATER OBSTRUCTIONS AND ENCROACHMENT
    2. GENERAL PERMIT REGISTRATION
    3. CHAPTER 105 WATER OBSTRUCTIONS AND ENCROACHMENT
    4. GENERAL PERMIT REGISTRATION
      1. EXHIBIT A
      2. PENNSYLVANIA OFFICES
      3. EXHIBIT B
      4. U.S. ARMY CORPS OF ENGINEERS DISTRICT OFFICES
      5. DEPARTMENT OF ENVIRONMENTAL PROTECTION REGIONAL OFFICES
      6. EXHIBIT C
      7. CONSERVATION DISTRICTS
    5. CHAPTER 105 FEE(S) CALCULATION WORKSHEET
    6. PART ONE: WATER OBSTRUCTIONS AND ENCROACHMENTS
      1. SECTION A. APPLICATION FEES
      2. SECTION B. OTHER FEES
    7. PART TWO: DAM SAFETY (USE ONE FEE SHEET PER DAM)
      1. SECTION A. APPLICATION FEES
      2. SECTION B. OTHER FEES
      3. GP Fee Explanation (#):
      4. Water Obstruction and Encroachment Examples:
      5. Dam Safety Examples:
      6. INSTRUCTIONS FOR COMPLETING THE PASPGP-5 REPORTING CRITERIA CHECKLIST
      7. PASPGP-5 REPORTING CRITERIA CHECKLIST

3150-PM-BWEW0502
Rev. 8/2013
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WATERWAYS ENGINEERING AND WETLANDS
GENERAL PERMIT
BWEW-GP-2
SMALL DOCKS AND BOAT LAUNCHING RAMPS
TABLE OF CONTENTS
PAGE
INSTRUCTIONS FOR USING THE GENERAL PERMIT
..........................................................................i
PART ONE: APPLIES SPECIFICALLY TO BWEW-GP-2
A.
GENERAL DESCRIPTION AND FEES...................................................................................... 1-1
B.
SITES AND CONDITIONS WHERE THIS GENERAL PERMIT DOES NOT APPLY................ 1-1
C.
DEFINITIONS APPLICABLE TO THIS GENERAL PERMIT ..................................................... 1-2
D.
PROJECT DESIGN AND CONSTRUCTION CRITERIA FOR DOCKS..................................... 1-2
E.
PROJECT DESIGN AND CONSTRUCTION CRITERIA FOR BOAT LAUNCHING RAMPS.... 1-4
F.
SPECIAL PROVISIONS REGARDING PROPERTY RIGHTS................................................... 1-5
G.
AUTHORITY AND CONTINUING AUTHORIZATION ............................................................... 1-5
PART TWO: APPLIES TO BWEW-GP-2 AND OTHER BWEW GENERAL PERMITS
A.
REGISTRATION OF PROPOSED USE OF GENERAL PERMITS ........................................... 2-1
B.
DENIAL OF AUTHORIZATION .................................................................................................. 2-2
C.
STANDARD DEFINITIONS FOR GENERAL PERMITS............................................................ 2-2
D.
PRECONSTRUCTION REQUIREMENTS FOR ALL PROJECTS............................................. 2-3
E.
OTHER PRECONSTRUCTION REQUIREMENTS WHERE APPLICABLE.............................. 2-4
F.
STANDARD PROVISIONS OF THE GENERAL PERMIT ......................................................... 2-4
ATTACHMENTS:
DRAWING NO. 1 - SAMPLE LOCATION MAP
DRAWINGS NO. 2 TO 5 - SAMPLE PROJECTS WITH CRITERIA
EXHIBIT A - OFFICES OF THE PENNSYLVANIA FISH AND BOAT COMMISSION
EXHIBIT B - REGIONAL OFFICES OF THE DEPARTMENT OF ENVIRONMENTAL PROTECTION AND
U.S. ARMY CORPS OF ENGINEERS DISTRICT OFFICES
EXHIBIT C - COUNTY CONSERVATION DISTRICTS
GENERAL PERMIT REGISTRATION FORM (INCLUDES SINGLE AND COMPLETE PROJECT
SCREENING QUESTIONNAIRE)
PENNSYLVANIA NATURAL DIVERSITY INVENTORY FORM

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i
INSTRUCTIONS FOR USING THE GENERAL PERMIT
BWEW-GP-2
Small Docks and Boat Launching Ramps
PRIOR TO REGISTRATION TO USE:
1.
Carefully review the definitions and requirements of the General Permit (Part One and Part Two) to
determine if your project can qualify for authorization under this General Permit. Refer to Part One,
Section B regarding area restrictions and Part One, Sections D and E regarding criteria. If your
project cannot be authorized under the General Permit, you may request approval of an individual
permit by submitting an application to the appropriate Soils and Waterways Section in the Regional
Office as listed on Exhibit B.
2.
Locate your project on a United States Geological Survey (U.S.G.S.) 7½ Minute Quadrangle Map
1
and prepare a project LOCATION MAP, utilizing a photocopy of the U.S.G.S. Quadrangle Map.
3.
Complete the Pennsylvania Natural Diversity Inventory (PNDI) Form and submit it to the person
conducting the online PNDI Project Planning and Environmental Review Tool search. This person
performing the search could be someone from DEP, the County Conservation Districts, or a
consultant. Alternatively, if you plan to conduct the PNDI online search yourself –a search form is
not needed prior to the PNDI online search.
After conducting the PNDI online search, if your PNDI Project Environmental Review Receipt has
"Potential Impacts," DEP and the jurisdictional agencies require that you submit additional
information to the agencies noted on the Receipt for further review. Please send a copy of the
PNDI Receipt, a completed PNDI Form, and a USGS 7.5 minute quadrangle map with project
boundaries delineated on the map to the agencies referenced on your PNDI Receipt.
4.
Your project may also require a permit from the U.S. Army Corps of Engineers under section 404 of
the Federal Clean Water Act, sections 9 and 10 of the Rivers and Harbors Act and/or section 103
of the Marine Protection, Research and Sanctuaries Act. The registration to use this State General
Permit does not relieve you of the obligation to comply with, and the State is not authorized to
address, these Corps of Engineers‟ requirements.
T
statutes, please contact the appropriate U.S. Army Corps of Engineers District Office listed below
to determine whether a Federal permit is required for your project.
Delaware River Basin
Susquehanna River Basin
Philadelphia Dist. Corps of Engineers
Baltimore Dist. Corps of Engineers
Wanamaker Bldg., 100 Penn Square East
P.O. Box 1715
Philadelphia, PA 19107
Baltimore, MD 21203-1715
(215) 656-6725
(410) 962-1846 or (814) 235-0570
Ohio River Basin and Lake Erie Basin
Pittsburgh Dist. Corps of Engineers
Regulatory Branch
1000 Liberty Avenue
Pittsburgh, PA 15222
(412) 395-7152
1
Commonly
called “topographic
maps”, U.S.G.S. Quadrangles may be av
supplies and camping equipment.

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ii
5.
For any earthmoving activity
2
associated with your project, prepare the Erosion and Sediment
Control Plan which must be reviewed and determined satisfactory by the County Conservation
District in the county where your project is located. The required Erosion and Sediment Control
Plan must be prepared and submitted to the Conservation District for review prior to or concurrent
with your registration to use the General Permit.
THE REGISTRATION PROCEDURE:
6.
Fill in all information on the GENERAL PERMIT REGISTRATION form and make multiple copies.
Send one copy each to the municipality and the county in which the project is located.
7.
To register use of the General Permit, prepare a com
-
Two Copies of the GENERAL PERMIT REGISTRATION form
-
Two copies of the LOCATION MAP
-
Two copies of the PNDI Form and an initialed search receipt
Send these items to either:
-
The County Conservation District for projects located in all counties where there is a
delegation agreement (see Exhibit C).
- OR -
-
The Permitting and Technical Services Section having responsibility for the counties where
there is no delegation agreement with the County Conservation District (see Exhibit B).
8.
If you are also applying for an individual Water Obstruction and Encroachment Permit to authorize
related work, you may register to use the General Permit in conjunction with your individual permit
application (See Part Two, Section A, Item 2).
BEFORE AND DURING CONSTRUCTION:
9.
Do not begin work until:
a.
You have received an acknowledgement from the Permitting and Technical Services Section
or County Conservation District that your General Permit Registration form has been
received and registered.
b.
Your Erosion and Sediment Control Plan has been reviewed and determined to be
satisfactory by the County Conservation District.
c.
You have notified the Pennsylvania Fish and Boat Commission and the County Conservation
District 10 days prior to start of construction (See Part Two, Section D).
d.
You have obtained any other Federal, State or local permits which may be required.
e.
You have complied with any other applicable preconstruction requirements as listed in
Part Two, Section E.
f.
You have provided written notifications to the municipalities and county where the projects
are located prior to the start of construction.
10.
During construction of your project, you are responsible for adhering to all terms and conditions of
the General Permit, including your approved Erosion and Sediment Control Plan and all applicable
design and construction criteria in Part One, Sections D and E.
2
For the definition of earthmoving activity, see Part Two, Section C.

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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WATERWAYS ENGINEERING AND WETLANDS
GENERAL PERMIT
BWEW-GP-2
SMALL DOCKS AND BOAT LAUNCHING RAMPS
PART ONE
A.
GENERAL DESCRIPTION AND FEES
- The Department of Environmental Protection hereby
authorizes, by General Permit, subject to the terms and criteria set forth below, the installation,
operation, modification and maintenance of small docks and boat launching ramps in and along the
regulated waters of this Commonwealth.
The fee required for a project authorized under this
General Permit shall be consistent with 25 PA Code §105.13 (relating to regulated
activities –information and fees).
B.
SITES AND CONDITIONS WHERE THIS GENERAL PERMIT DOES NOT APPLY
- This General
Permit does not apply and is not valid in the following situations. Where the General Permit is not
applicable, you may request approval of an individual permit by submitting an application to the
appropriate Permitting and Technical Services Section in the Regional Office (see Exhibit B).
1.
Historical, cultural or archaeological sites as identified in the latest published version of the
Pennsylvania Inventory of Historical Places or the National Register of Historical Places.
This information is available from the Pennsylvania Historical and Museum Commission,
400 North Street, Second Floor, Harrisburg, PA 17120-0093, telephone (717) 783-8946.
2.
Sites identified in the latest published version of the National Registry of Natural Landmarks.
3.
Areas in or within 100 feet of a watercourse designated wild in the National or State Scenic
Rivers system in accordance with the National Wild and Scenic Rivers Act of 1968 or the
Pennsylvania Scenic Rivers Act. For details on scenic river classifications, contact the
DCNR, Division of Greenways and Conservation Partnerships, Pennsylvania Scenic Rivers
Program, P.O. Box 8475, Harrisburg, PA 17105-8475, telephone (717) 787-2316.
4.
Construction activities in stocked trout streams from March 1 through June 15, in wild trout
streams from October 1 through December 31, and in Lake Erie tributaries from March 1
through June 15 and from September 1 through December 31 unless written approval is
obtained
from
the
Pennsylvania
Fish
and
Boat
Com
Services (see Exhibit A). Stocked and wild trout stream locations are compiled by the
Commission‟s Division of Fishery Management (see E
5.
Projects located where there would be an impact on species of special concern listed under
the Endangered Species Act of 1973, the Wild Resources Conservation Act, the Fish and
Boat Code or the Game and Wildlife Code. Records regarding species of special concern
are maintained in a computer database called the “Penns
(PNDI). To verify that there will be no such impacts for a specific project, the Department
requires submission of the attached PNDI Form and an initialed search receipt.
6.
Streams or waterbodies designated as Exceptional Value Waters as defined and listed in
Chapter 93 (relating to water quality standards).
7.
Projects requiring excavation of mudflats in the tidal waters of the Delaware River.

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C.
DEFINITIONS APPLICABLE TO THIS GENERAL PERMIT
- The following words and terms, when
used in this General Permit, have the following meanings:
BOAT LAUNCHING RAMP - A sloping stabilized roadway constructed in and along a stream or
lake for the purpose of launching boats from vehicular trailers, including associated walkways for
boarding boats and on-grade improvements for access, turning and parking.
DREDGE - To remove sand, gravel, mud, or other materials from the beds of regulated waters of
this Commonwealth.
FILL - Sand, gravel, earth or other material placed or deposited to form an embankment or raise
the elevation of the land surface. The term includes material used to replace an area with aquatic
life with dry land or to change the bottom elevation of any regulated water of this Commonwealth.
OTHER PRIVATE AND COMMERCIAL FACILITIES - Docks and boat launching ramps other than
those defined as private recreational docks, public access facilities and public service facilities.
PRIVATE RECREATIONAL DOCK - A dock utilized for private recreational purposes by the
riparian land owner.
PUBLIC ACCESS FACILITY - A dock or boat launching ramp for public recreational purposes
when the facility is open to the general public and maintained on a nonprofit basis or for use without
fee.
PUBLIC SERVICE FACILITY - A dock or boat launching ramp constructed, owned or operated by a
political subdivision of the Commonwealth which provides services necessary for public health and
welfare, or in connection with a service for which no fees or charges other than general taxes are
imposed.
SHORELINE - The edge of water in a lake or other body of water at normal pool elevation; the
edge of water along a waterway at the ordinary low water level.
SMALL DOCK - A single floating, cantilevered or pile structure constructed within a waterway or
other body of water and located on lands or adjacent to riparian lands which are owned or leased
by the dock owner. Small docks authorized under this General Permit are classified in four
categories based on the proposed use and type of ownership. These categories are (1) private
recreational dock, (2) public access facility, (3) public service facility and (4) other private and
commercial facilities.
D.
PROJECT DESIGN AND CONSTRUCTION CRITERIA FOR DOCKS
1.
Small Docks may be constructed to any configuration but shall not exceed 750 square feet
in surface area, except where other limits apply on navigable rivers of the United States and
on Scenic Rivers (see items 1a and 1b which follow).
a.
A Federal permit is required from the U.S. Army Corps of Engineers for small dock
structures located on rivers and other waterways which are designated Navigable
Waters of the United States and regulated under Section 10 of the Rivers and
Harbors Act. The small dock surface area and configuration on these navigable
waters must be in conformance with any applicable Section 10 permit criteria which
may be more restrictive than this General Permit. Size and shape limitations may be
subject to change and may vary between Corps District Offices.
b.
In waterways which are part of the National or Pennsylvania Scenic Rivers System
the total surface area of a small dock shall not exceed 250 square feet.
2.
A small dock on a lake shall not extend more than 50 feet from the edge of normal pool
elevation. In a river or other stream, a small dock shall not extend more than 20 percent of
the width of the stream; however, it shall in no instance extend more than 100 feet from the
ordinary low water mark of a stream.

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3.
Only one small dock shall be constructed on a given riparian parcel under this General
Permit, except where the parcel is common property or where multiple parties have deeded
access rights or easements. See Section F, Items 2 and 3 for specific terms regarding
multiple use of this General Permit on a given riparian parcel.
4.
No part of the small dock structure or associated boat mooring area may extend in front of
adjacent riparian properties or otherwise interfere with access and use of the water by
adjacent riparian land owners.
5.
Each small dock shall be constructed in such a way that it does not hinder commercial or
recreational navigation and does not interfere with normal fish migration.
6.
Construction and other activities authorized by this General Permit shall be performed in a
manner that minimizes use of equipment within the stream channel or body of water.
7.
Construction of a small dock on a waterway shall take place during periods coinciding with
lower stream flows.
8.
Each small dock shall be constructed in such a way as not to obscure any navigation aids or
lights for bridges in the area.
9.
Small docks shall be maintained in a functional condition which includes the periodic
removal of debris.
10.
Maintenance dredging to restore original depths is permitted only in the mooring area for
boats and is limited to 10 feet beyond the edge of the dock.
11.
Dredging for construction purposes is not authorized by this General Permit.
12.
This General Permit does not authorize the storage of fuel or the construction of fuel
servicing facilities on the small dock.
13.
This General Permit does not authorize the construction or modification of a small dock for
use as a habitable structure with living facilities such as beds, bathrooms or kitchens.
14.
The owner shall employ measures to prevent and control spills of fuels or lubricants into the
waterway.
15.
Flotation devices, if used, shall be securely fastened to the structure to prevent separation
from the small dock.
16.
Drums to be utilized as flotation devices that have been previously filled with another
substance shall be thoroughly cleaned before use to preclude the possibility of pollution.
17.
The small dock structure shall be adequately secured to the shoreline to insure the
structure‟sthstand
stability
the effects of wind,to
stream
wi
flows and wave action.
18.
Anchorages shall be placed so they do not accelerate erosion or cause degradation of the
streambanks.
19.
The placement of fill or dredged material into a watercourse, floodway or body of water is not
authorized under this General Permit.
20.
To the greatest extent possible, the project shall be designed and constructed in a manner
which will (a) prevent permanent or long-term changes in water quality, (b) minimize
alterations in natural aquatic habitat and (c) maintain natural streamflow velocities and
mixing patterns.

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21.
Archaeological artifacts discovered during the performance of work authorized under this
General Permit must be adequately protected and their discovery promptly reported to the
Bureau for Historic Preservation, Pennsylvania Historical and Museum Commission,
400 North Street, Second Floor, Harrisburg, PA 17120-0093, telephone (717) 783-8946.
E.
PROJECT DESIGN AND CONSTRUCTION CRITERIA FOR BOAT LAUNCHING RAMPS
1.
Boat launching ramps authorized by this General Permit are limited to a maximum width of
20 feet.
2.
Boat launching ramps shall be located to minimize streambank excavation and wetland
impacts. Boat launching ramps are limited to a maximum length of 100 feet measured from
the top of the ramp to the shoreline.
3.
Only one boat launching ramp shall be constructed on a given riparian parcel under this
General Permit, except where the parcel is common property or where multiple parties have
deeded access rights or easements.
See Section F, Items 2 and 3 for specific terms
regarding multiple use of this General Permit on a given riparian parcel.
4.
Construction and other activities authorized by this General Permit shall be performed in a
manner that minimizes use of equipment within the stream channel or body of water.
5.
Construction of a boat launching ramp along a waterway shall take place during periods
when the stream is at low flow.
6.
To the greatest extent possible, the project shall be designed and constructed in a manner
which will (a) prevent permanent or long-term changes in water quality, (b) minimize
alterations in natural aquatic habitat and (c) maintain natural streamflow velocities and
mixing patterns.
7.
Where required to support boat trailers, the portion of a boat launching ramp located in a
streambed or lakebed may be stabilized by clean rock and/or gravel, timber, pre-cast
concrete planks, or pre-cast concrete slabs (formed onshore and pushed or lifted in place).
This stabilization of the bed surface shall be limited to the minimum length necessary for
boat launching.
8.
Exposed bank areas along the approach ramp shall be stabilized and protected from the
erosive action of waves and stream currents.
9.
For launching ramps which require associated facilities such as parking lots and turn-around
driveways in the floodway along a stream, necessary regrading shall be accomplished
without the addition of fill within the regulated floodway. Parking facilities shall be built on
existing grade or with minimal grade changes not exceeding 12 inches. Surfaces shall be
stabilized with gravel, macadam or concrete. There shall be a volume of soil material
removed from the floodway equal to or greater than the volume of construction materials to
be used, and there shall be no net loss of conveyance area in the floodway cross-section.
Along waterways designated Exceptional Value (EV) or High Quality Waters (HQ) under
Chapter 93 Rules and Regulations (relating to water quality), a 50-foot wide vegetated buffer
strip is required between parking facilities and the streambank. Access roads which cross
wetlands and improved parking areas in wetlands are not authorized by this General Permit.
10.
Boat ramps constructed along Lake Erie shall be located near the western edge of a
property to allow space to dispose future dredge material. Material from maintenance
dredging of a boat ramp along the shoreline of Lake Erie shall be placed on the shoreline to
the east of the removal site.
11.
Archaeological artifacts discovered during the performance of work authorized under this
General Permit must be adequately protected and their discovery promptly reported to the
Bureau for Historic Preservation, Pennsylvania Historical and Museum Commission,
400 North Street, Harrisburg, PA 17120-0093, telephone (717) 783-8946.

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F.
SPECIAL PROVISIONS REGARDING PROPERTY RIGHTS
1.
Submerged Lands License Agreements and Fees - As explained in Part Two, Section E,
Item 1 of this General Permit, a license agreement is required for projects which are located
in certain waters designated navigable or public highways and which are held in trust by the
Commonwealth. In accordance with Chapter 105 Rules and Regulations, a minimum annual
license fee of $250 is assessed except for the following types of facilities and uses:
a.
Private recreational docks constructed under a General Permit.
b.
Public Access Facilities provided without charge or on a nonprofit basis.
c.
Public Service Facilities provided without fees or charges.
There is no annual fee assessed for the facilities listed above. However, other types of
docks or boat launching ramps will require an annual fee when located in Submerged Lands
of the Commonwealth. Therefore, the user of this General Permit is required to indicate the
type of structure on the
General Permit Registration
form.
2.
Multiple Use of the General Permit on Common Property - An association of homeowners or
similar group (association) holding title to common property with riparian rights may register
to construct and maintain docks on behalf of individual members. The association shall
assure that adequate spacing for mooring and access is maintained between docks. Each
dock shall be registered by the association and constructed in accordance with the General
Permit.
3.
Use of the General Permit where Multiple Parties Hold Access Rights on Riparian Land - In
areas where common use of riparian land is reserved by easement or other deed
restrictions, and where there is no homeowners association or similar organization with
appropriate authority, each holder (owner) of such easement or deed restriction may register
and construct one dock and boat launching ramp under the authority of this General Permit.
Owners are mutually responsible to assure that adequate spacing for mooring and access is
maintained between structures. Registering the use of this General Permit does not grant
the right to interfere with other eligible users or with the riparian rights of others. Users of
this General Permit are solely responsible to mutually resolve any problems of interference
or other disagreements on riparian lands where access rights are shared.
G.
AUTHORITY AND CONTINUING AUTHORIZATION
- Authorization of this General Permit is under
section 7 of the Dam Safety and Encroachments Act 32 P.S. §693.7 and the rules and regulations
promulgated thereunder at 25 Pa. Code §§105.441-105.449 (relating to General Permits). This
General Permit shall authorize the continued operation and maintenance of private recreational
docks authorized by General Permit BWEW-GP-2 (Private Recreational Docks) issued on
December 29, 1990.

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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WATERWAYS ENGINEERING AND WETLANDS
GENERAL PERMIT
PART TWO
A.
REGISTRATION OF PROPOSED USE OF GENERAL PERMITS
1.
Standard Procedure
Prior to construction, the owner shall submit the following items to the DEP Permitting and
Technical Services Section in the appropriate Regional Office or the delegated County
Conservation District where the project is located (see Exhibits B and C):
(a)
Two copies of the GENERAL PERMIT REGISTRATION form, one copy with original
signatures.
(b)
Two copies of a location map (see Drawing No. 1).
(c)
Two copies of the PNDI Form and/or initialed search receipt.
(d)
Two copies of any other items required in the Instructions and Part One (if
applicable).
The owner is required to send additional copies of the General Permit Registration form to
the municipality and the County Board of Commissioners where the project is located. Also,
as part of the registration, the owner shall certify that an Erosion and Sediment Control Plan
has been submitted for review to the County Conservation District in which the work will be
performed.
The owner is not authorized to use the General Permit until he has notified
the DEP Permitting and Technical Services Section of the appropriate Regional Office
or the appropriate delegated County Conservation District and received an
acknowledgement of that registration
.
The Department’s acknowledgement
registration to use this General Permit. The owner may not begin work until all
preconstruction requirements of this General Permit have been completed.
Registration for the use of this General Permit must be sent to the County Conservation
District in counties where the District has a delegation agreement with the Department of
Environmental Protection.
To determine whether this alternate registration procedure
currently applies for your location, refer to Exhibit C and/or contact the appropriate DEP
Permitting and Technical Services Section or County Conservation District.
2.
In Conjunction with a Water Obstruction and Encroachment Permit Application:
When an activity or structure authorized by the General Permit is an integral part of a larger
project which requires an individual Water Obstruction and Encroachment permit, intent to
use the General Permit may be registered by attaching copies of the GENERAL PERMIT
REGISTRATION form to the individual permit application, and clearly identifying, in the
permit application narrative and/or on site plans, any structure or activity which will be
constructed in accordance with the terms and conditions of the General Permit. The
Department„s
acknowledgement
Permit registration
ofwill the
be included
General
in the
individual permit, and upon issuance of the permit the owner may begin work on the
structure or activity authorized by the General Permit. Where applicable, this registration
procedure is preferred and recommended by the Department, because written authorization
for a project can be combined into one action and the associated documentation can be
maintained under a single file number.

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3.
In Conjunction with an Enforcement Action:
The General Permit may also be used, at the discretion of the Department, in conjunction
with an enforcement action or settlement of violations, to register regulated activities
conducted without prior permit or authorization.
B.
DENIAL OF AUTHORIZATION -
The Department shall have the discretion, on a case-by-case
basis, to deny, revoke or suspend the authorization to use a General Permit for any project which
the Department determines to have a substantial risk to life, health, property or the environment, or
otherwise could not be adequately regulated by the provisions of this General Permit.
C.
STANDARD DEFINITIONS FOR GENERAL PERMITS -
The terms as used in this General Permit
shall have the following meanings:
BODY OF WATER - Any natural or artificial lake, pond, reservoir, swamp, marsh or wetland.
DEPARTMENT - The Department of Environmental Protection.
EARTHMOVING ACTIVITY - Any construction or other activity which disturbs the surface of the
land including, but not limited to, excavations, embankments, land development, subdivision
development, mineral extraction and the moving, depositing or storing of soil, rock or earth. This
includes any excavation or fill within a stream channel.
EROSION AND SEDIMENT CONTROL PLAN - A plan which is designed to minimize accelerated
erosion and sedimentation consistent with the requirements of 25 Pa. Code Chapter 102.
FLOODWAY - The channel of the watercourse and portions of the adjoining floodplains which are
reasonably required to carry and discharge the 100-year frequency flood.
Unless otherwise
specified, the boundary of the floodway is as indicated on maps and flood insurance studies
provided by the Federal Emergency Management Agency (FEMA). In an area where no FEMA
maps or studies have defined the boundary of the 100-year frequency floodway, it is assumed,
absent evidence to the contrary, that the floodway extends from the stream to 50 feet from the top
of the bank of the stream.
INSTALL - To construct, deposit, place, lay or set in place.
OWNER - A person who owns, controls, operates, maintains, or manages a dam or reservoir,
water obstruction or encroachment.
PERSON - A natural person, partnership, association, corporation, public utility, municipality,
municipal authority, political subdivision of the Commonwealth, receiver or trustee, and any
department, board, commission, or authority of the Commonwealth.
POLITICAL SUBDIVISION - A county, city, borough, incorporated town, township, school district,
authority or other governmental unit or a combination thereof acting jointly.
REGULATED WATERS OF THIS COMMONWEALTH - Watercourses, streams or bodies of water
and their floodways wholly or partly within or forming part of the boundary of this Commonwealth.
SCENIC RIVERS - Areas in or within 100 feet of a watercourse or body of water designated a
component of the Pennsylvania Scenic Rivers System in accordance with the Pennsylvania Scenic
Rivers Act (P.L. 1277, Act No. 283 as amended by Act 110, May 7, 1982), or which are 1-A
candidate rivers listed in the Pennsylvania Scenic Rivers Inventory.
STOCKED TROUT STREAM - A stream classified as approved trout waters by the Pennsylvania
Fish and Boat Commission. For current designations of stocked trout streams, contact the Division
of Fisheries Management (see Exhibit A).

3150-PM-BWEW0502
Rev. 8/2013
2-3
SUBMERGED LANDS OF THIS COMMONWEALTH - Waters and permanently or periodically
inundated lands owned by the Commonwealth, including lands in the beds of navigable lakes and
rivers and beds of streams declared public highways which are owned and held in trust by the
Commonwealth.
WATERCOURSE - A channel or conveyance of surface water having defined bed and banks,
whether natural or artificial, with perennial or intermittent flow.
WETLANDS - Areas that are inundated or saturated by surface water or groundwater at a
frequency and duration sufficient to support, and that under normal circumstances do support, a
prevalence of vegetation typically adapted for life in saturated soil conditions, including swamps,
marshes, bogs and similar areas.
WILD TROUT STREAM - A stream classified as supporting naturally reproducing trout populations
by the Pennsylvania Fish and Boat Commission. For current designations of wild trout streams,
contact the Division of Fisheries Management (see Exhibit A).
D.
PRECONSTRUCTION REQUIREMENTS FOR ALL PROJECTS
1.
OTHER PERMITS - Nothing in this General Permit relieves the owner of the obligation of
complying with all Federal, Interstate Compact, State and local laws, regulations and
standards for the construction, operation or maintenance of the project or activity. The
project owner is advised that written authorization from the U.S. Army Corps of Engineers
may be required for compliance with Section 404 of the Clean Water Act.
2.
BEST MANAGEMENT PRACTICES - Work must be done in compliance with Chapter 102
(relating to Erosion Control).
Prior to construction, an Erosion and Sediment Control
Plan must be reviewed and determined adequate by the County Conservation District
in which the activities are proposed and implemented prior to, during and after
construction. The County Conservation District shall be notified 10 days prior to the
start of construction.
The project site shall at all times be available for inspection by
authorized employees of the County Conservation District. The Erosion and Sediment
Control Plan shall be available at the site.
3.
PENNSYLVANIA FISH AND BOAT COMMISSION NOTIFICATION - The owner shall notify
the
Pennsylvania
Fish
and
Boat
Commission‟s
Regi
Exhibit A) responsible for the County where the activities are proposed 10 days prior to start
of construction. Written notification is suggested. The project site shall at all times be
available for inspection by authorized officers and employees of the Pennsylvania Fish and
Boat Commission.
4.
NOTIFICATION TO OPERATORS OF PUBLIC WATER FACILITIES - Owners will
investigate for drinking water intakes or reservoirs for public water supplies and permitted
public bathing beaches within 5 miles downstream of the site of the project. Written notice
shall be given at least 10 days prior to construction to the Department and to operators of
any such intakes, beaches or reservoirs. This notification shall include expected starting
and completion dates for the construction activities. Owners must notify the Department and
operators immediately and no longer than 1 hour after the occurrence at the site which
results in the release of suspended solids and turbidity to the stream. Public drinking water
sources are listed by the DEP Bureau of Water Standards and Facility Regulation, and this
information is available from each DEP Regional Office.
E.
OTHER PRECONSTRUCTION REQUIREMENTS WHERE APPLICABLE
1.
SUBMERGED LANDS OF THIS COMMONWEALTH - This General Permit shall not be
effective to authorize any project over, across or occupying submerged lands of this

3150-PM-BWEW0502
Rev. 8/2013
2-4
Commonwealth until the owner has obtained a license from the Department 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 General Permit Registration
form from the owner, the Department will review the project to determine if its location is
over, across or occupies submerged lands of the Commonwealth.
If applicable, the
Department will prepare a Submerged Lands License Agreement and forward same to the
owner for execution prior to acknowledgement of registration to use the General Permit. No
annual charge is required for facilities constructed, owned or operated by a Political
Subdivision of the Commonwealth.
2.
UTILIZATION OF GENERAL PERMIT BDWM-GP-8, TEMPORARY ROAD CROSSINGS -
Temporary road crossings of streams and causeways that are necessary for equipment to
move back and forth across a stream during construction of a project are authorized by, and
must be constructed in accordance with BDWM-GP-8. The owners shall indicate utilization
of BDWM-GP-8 on the General Permit Registration form in the box provided. Owners
constructing temporary road crossings in those areas excluded from the application of
BDWM-GP-8 must apply for an individual Water Obstruction and Encroachment Permit for
those road crossings.
3.
USE OF EXPLOSIVES - Prior to the use of explosives in a watercourse or body of water, the
permittee shall secure a written permit from the Pennsylvania Fish and Boat Commission,
under the Fish and Boat Code, Act 1980-175 Title 30 Pennsylvania Consolidated Statutes,
Section 2906. Requests should be directed to the Pennsylvania Fish and Boat Commission,
Division of Environmental Services (see Exhibit A).
F.
STANDARD PROVISIONS OF THE GENERAL PERMIT
1.
EFFECTIVE TIME PERIOD - This General Permit will remain in effect indefinitely unless
specifically modified, suspended or revised by the Department.
2.
SUSPENSION, MODIFICATION OR REVOCATION - The Department may suspend, modify
or revoke this General Permit at any time upon notice in the Pennsylvania Bulletin.
3.
PROJECT INTERFERENCE - This General Permit does not authorize any interference with
any existing or proposed local, State, Federal or Federally licensed project, and permittee
shall not be entitled to compensation for damage or injury to the work authorized herein
which may be caused by or a result of existing or future operations undertaken by the United
States or the Commonwealth of Pennsylvania or its Political Subdivisions in the public
interest.
4.
DEPARTMENT INSPECTION - As a condition of use of this General Permit, and of the
owner‟s
authority
to conduct the activities authorized by this General Permit, the owner
hereby authorizes and consents to allow authorized employees or agents of the Department,
without advance notice or a search warrant, at any reasonable time and upon presentation
of appropriate credentials, and without delay, to have access to and to inspect all areas
where the project is being constructed, operated or maintained. The authorization and
consent shall include consent to conduct tests or sampling, to take photographs, to perform
measurements, surveys and other tests, to inspect the methods of construction, operation or
maintenance, to examine and copy books, papers and records pertinent to any matter under
investigation, and to take any other action necessary to assure that the project is
constructed, operated or maintained in accordance with the terms and criteria of the General
Permit. This General Permit condition is referenced in accordance with Section 16 of the
Dam Safety and Encroachments Act, 32 P.S. §693.16, and in no way limits any other powers
granted under the Dam Safety and Encroachments Act.

3150-PM-BWEW0502
Rev. 8/2013
2-5
5.
ACTIVITIES NOT IN ACCORDANCE WITH THE TERMS OR CONDITIONS - If the
Department determines, upon inspection, that the construction, operation or maintenance of
a project has violated the terms or criteria of this General Permit or of the Chapter 105 Rules
and Regulations, the Department may take such actions, legal or administrative, that it may
deem to be appropriate.
6.
STRUCTURE REMOVAL - The owner shall remove all or any portion of this project upon
written notification to the owner by the Department in the event the project is causing an
adverse impact on public health, safety or the environment, or in any other manner violates
the conditions of this General Permit or Chapter 105 Rules and Regulations.
7.
PROPERTY RIGHTS - This General Permit does not authorize trespassing on private
property nor convey any property rights, either in real estate or material, or in any exclusive
privileges; nor does it authorize any injury to property or invasion of rights or any
infringement of Federal, State or local laws or regulations.
8.
WATER QUALITY CERTIFICATION - The issuance of this General Permit also constitutes
approval of a Water Quality Certification under section 401 of the Federal Clean Water Act
(33 U.S.C.A. §1341).
9.
OTHER APPROVALS - The owner shall secure all other approvals that may be necessary
under other Federal, State or local laws or regulations.
10.
CHANGE OF OWNERSHIP - If there is a change in ownership of a structure installed in
accordance with this General Permit, the new owner is required to register the structure with
the Department in accordance with Part Two, Section A, of this General Permit. The new
owner shall submit one copy of the General Permit Registration form indic
ownership”
and
one
copy
of
a
location
map.
Add
Section A, are not applicable if there are no proposed construction activities.
11.
SIGNATURE - The General Permit Registration form for use with this General Permit shall
be signed by the property owner; the president, vice president or other responsible official of
a Corporation; or the chief official for a Government Agency/Political Subdivision.
An
engineering consultant, contractor or similar agent is not authorized to sign the General
Permit Registration form on behalf of the owner.






3150-PM-BWEW0500
Rev. 8/2016
COMMONWEALTH OF PENNSYLVANIA
Instructions
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WATERWAYS ENGINEERING AND WETLANDS
- 1 -
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
requirement isthat
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
http://www.elibrary.dep.state.pa.us
eLibrary at
.
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
?
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
?
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)
?
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:
?
wetland delineation
?
wetland replacement plan
?
check (where required for compensatory mitigation)
16. Registration of a GP-11:
?
E&S Plan
?
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:
?
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
- 2 -
?
Activity Related to Oil and Gas Exploration, Production or Transmission:
Place an “X”
in the box next
Related to Oil and Gas Exploration, Production or Transmission” the
if
activity is oil and gas related.
Contact Information for DEP’s
Regional offices
Oilcanand
be found
Gas
on GP Registration
Exhibit B
(3150-PM-BWEW0500B)
; and on
DEP’s
http://www.elibrary.dep.state.pa.us
eLibrary at
.
?
Activity Subject to Federal Energy Regulatory Commission (FERC) approval:
Place an
“X”
in
the
bo
“Activity Subject
”if theto
activityFERC
is regulated
approval
by FERC and provide the FERC docket number.
Place
an
“X”
in“FERC
the
box
Natural
next
Facility”
Gas
to
if the activity
Actis 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
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
Rev. 8/2016
Instructions
- 3 -
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”
indicate
the
if the applicant
appropriate
has identified thatbox
any of these
to resources may be
present at the project site; indicate that no resources were identified or indicate and list those resources which were
identified.
?
National Register of Historic Places
?
National Registry of Natural Landmarks
?
Local historical site
?
Exceptional Value (EV) Waters
?
High Quality (HQ) Waters
?
Threatened and Endangered Species
?
Wild or Stocked Trout Streams
?
Wild and Scenic Rivers
?
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:
?
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
.
?
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/
.
?
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
websi
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
.
?
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
- 4 -
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.
?
Wild and Stocked Trout Waters:
Additional information on Wild and Stocked Trout Waters can be found at
http://fishandboat.com/waters_trout.htm
.
?
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
?
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
?
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’
website at
http://www.dep.pa.gov
; and on
DEP’s
http://www.elibrary.dep.state.pa.us
eLibrary at
.
SECTION E. REGISTRATION CHECKLIST AND REQUIREMENTS:
Please place an “X”
-16)next
to ensure itto
is completed
eachand/or
item
provided.
(1Unless 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
Commonwealth
payable
of Pennsylvania
to Clean
the
Wate“
r Fund”OR
County
Conservation District,
cheverClean
is the reviewing
Water
entity.
Fund”, whi
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
Single
definition
and Ccomplete
of “
Pproject”
. PASPGP-5
prior
can
to
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”
11”
photocopy
x
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
Rev. 8/2016
Instructions
- 5 -
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”
11”
piece
x
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
per activities
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 toper the instructions
project’s
provided in
acti
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
Rev. 8/2016
Instructions
- 6 -
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:
?
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.
?
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
Process: sequential review and concurrent review.
Sequential Review:
?
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.
?
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
cts”
, please
Impa
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

3150-PM-BWEW0500
Rev. 8/2016
Instructions
- 7 -
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 below.
showing “Potential
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 “P
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:
?
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)
?
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:
?
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).
?
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:
?
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.
?
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 Eng
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:
?
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.
?
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

3150-PM-BWEW0500
Rev. 8/2016
Instructions
- 8 -
replacement, restoration or enhancement plan in accordance with the Department’s
Replacemen
provides wetland replacement acreage or funtion at a minimum one to one acre ratio.
?
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 toasthe
requested
project’s
in Section E, Item 10.activ
Please place an “X” in the
what isappropriate
shown on the Site Plan; indicate
box that
to
all items
indicate
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”
indicate
the
what isappropriate
included in the Aquatic Resources
box to
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”
as a “Manager”
or
of the LLC, according to the Company’s
.
Limite
If anyone other than are signing
“Member”
on behalf of the
or
LLC,“Manager”
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).

3150-PM-BWEW0500
Rev. 8/2016
COMMONWEALTH OF PENNSYLVANIA
Form
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WATERWAYS ENGINEERING AND WETLANDS
- 1 -
CHAPTER 105 WATER OBSTRUCTIONS AND ENCROACHMENT
GENERAL PERMIT REGISTRATION
PLEASE MARK (“X”)
ALL THAT APPLY:
GP- 1
Fish Habitat Enhancement Structures
GP- 2
Small Docks & Boat Launching Ramps
Please mark (“X”)
the specific type of project:
private recreational dock
public access facility
public service facility
other private or commercial facility
GP- 3
Bank Rehabilitation, Bank Protection and
Gravel Bar Removal
GP- 4
Intake and Outfall Structures
GP- 5
Utility Line Stream Crossing
GP- 6
Agricultural Crossings & Ramps
GP- 7
Minor Road Crossings
GP- 8
Temporary Road Crossings
GP- 9
Agricultural Activities
GP-10
Abandoned Mine Reclamation
GP-11
Maintenance, Testing, Repair, Rehabilitation, or
Replacement of Water Obstructions and
Encroachments (reviewed by DEP Regional Office
only)
GP-15
Private Residential Construction in Wetlands
Activity Related to Oil and Gas Exploration, Production or Transmission
Activity Subject to FERC approval (Docket number
)
FERC Natural Gas Act Facility
SECTION A. APPLICANT INFORMATION
Applicant’
s Name / Client
DEP Client ID#
(if known)
Employer ID#
(EIN)
Client Information
- Please select Client Type / Code from
drop down box under the correct entity shown to the right.
(or may be written in) →
Government
Non-Government
Individual
Mailing Address
City
State
ZIP + 4
Contact Person –
Last Name
First
MI
Suffix
Telephone
(
)
Email Address
SECTION B. CONSULTANT INFORMATION
(Complete if different than above)
N/A
Contact Person –
Last Name
First
MI
Suffix
Consultant’ Title
Consulting Firm
Mailing Address
City
State
ZIP + 4
Telephone
(
)
Fax
(
)
Email
Employer ID# (EIN)
SECTION C. PROJECT INFORMATION
Project /Site Name:
DEP Site ID#
(if known or leave blank)
Client Relationship
- Please select Site-to-Client Relationship / Code
from drop down box to the right. (or may be written in)
Double-click on shaded area below to select
correct Site-to-Client Relationship / Code ↓
County
Municipality
City
Borough
Township
Site Location / Address
City
State
ZIP + 4
Collection Method:
EMAP
HGIS
GISDR*
ITPMP
GPS
WAAS
LORAN
Check the horizontal reference datum (or projection datum) employed in the collection method.
EMAP and HGIS (PNDI) have known datum and do not require checking here.
NAD27
NAD83
WGS84
(GEO84)
Enter the date of collection if coordinates were derived from GPS, WAAS or LORAN.
mm
dd
yyyy

3150-PM-BWEW0500
Rev 8/2016
Form
- 2 -
Applicant’s Name
GENERAL PERMIT REGISTRATION
SECTION D. RESOURCE IDENTIFICATION
Please place an “X” in the appropriate box t any
toof indicate if
these resources may be present at the project site;
indicate that no resources were identified or
indicate and list those resources which were identified.
Each General Permit (GP) has a specific set of restrictions and some resources may require certain
actions or prohibit the project from being eligible to register use of the GP.
Applicant
Entry
DEP Use
Only
No resources
identified as being present at the project site …………………………………….
Resources identified as being present at the project site:
-
-
-
SECTION E. REGISTRATION CHECK LIST AND REQUIREMENTS
Please place an “X” - 16)
next
to ensure
to
it iseach
completeditem
and/or provided.
(1
Unless otherwise specified, all items are
required
to ensure a complete Registration package.
**Provide ONE (1) ORIGINAL and ONE (1) COPY of the Registration package**
Applicant
Entry
DEP Use
Only
1.
General Permit Registration form
properly completed and signed:
- I have read the terms and conditions of the GP(s) indicated above...........................................
2.
Permit Fee:
- General Permit Registration Fee ................................................................................................
- Chapter 105 Fee Calculation Worksheet....................................................................................
3.
Notification sent to the Municipality & County: (copy of
General Permit Registration form
)
4.
PASPGP-5 Reporting Criteria Checklist
properly completed:
5.
Location Map
(USGS quad map) with project site marked:
6.
Color Photographs
with dates and descriptions:
(see instructions)
N/A
7.
Stream Name and Chapter 93 Classification:
(example:
UNT to #40637 HOUSE RUN,
HQ-WWF/EV)
8.
Project Description:
- Project Description including PNDI avoidance measures (if applicable) ....................................
- Aquatic Resource Impacts Table ................................................................................................
9.
Site Specific and/or Standard Drawings
depicting the project’s
GP activities.
10.
Site Plan
depicting the site of the project’s
GP activities.
(see Section F.)
11.
Erosion & Sediment Control Plan (E&S Plan)
(required for GP-11 only - see instructions)
12.
Written Directions to Project Site:
-
-
-
13.
Pennsylvania Natural Diversity Inventory (PNDI):
Please place an “X”
priate
next
box indicating
to the
information
appro
provided:
Signed PNDI Receipt showing:
- “
No Known Impacts”..................................................................................................................
- “Avoidance which
Measures”
have ALSO been incorporated into the project description........
- “Potential
ANDImpacts”
proof of delivery to the appropriate agency(ies) where further
coordination is required............................................................................................................

3150-PM-BWEW0500
Rev. 8/2016
Form
- 3 -
Applicant’s Name
GENERAL PERMIT REGISTRATION
Please place an “X” - 16)
next
to ensure
to
it iseach
completeditem
and/or provided.
(1
(continued)
Applicant
Entry
DEP
Use
Only
14.
Bog Turtle Habitat Screening:
Please place an “X” next to
ating the
information
appropriate
provided:
box indic
- Completed Request for a Bog Turtle Habitat Screening Form....................................................
- “No Effect” determination from
.......................................................
the Army Corp of Engine
- Documented clearance from the US Fish and Wildlife Services.................................................
- N/A due to GP type, wetland impact and/or County of project....................................................
15. Activities which impact wetlands:
Please place an “X” next
box indicating
to the
information
appropriate
provided:
- N/A because no wetland impacts are proposed or no compensatory mitigation is necessary.
- 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.................................
- If direct or indirect wetland impacts are greater than 0.05 acres, a compensatory mitigation
plan
in
accordance
with
Replacement
thecriteria
Department’s
which provides
compensation at a minimum one to one acre ratio.....................................................................
-
If compensatory mitigation onsite is determined not feasible:
A check, number
, in the amount of $
payable to the National Fish and Wildlife
Foundation, N.A. 1237, as compensatory mitigation for
acres of impact in wetlands, in
accordance with the Pennsylvania Wetland Replacement Project.............................................
16. Registration of a GP-11:
Please place an “X” next to the appropriate box indicating t
- N/A because not registering use of GP-11..................................................................................
- E&S Plan .....................................................................................................................................
- Bridge and/or Culvert Replacement Projects or Projects That Change the Waterway Opening
SECTION F. SITE PLAN
Please place an ppropriate
“X” next
box indicating
to the
what is shown
a
on the site plan.
Unless
otherwise specified in the permit, all items are
required
to ensure a complete Registration package.
Applicant
Entry
DEP
Use
Only
All items
included on Site Plan.....................................................................................................
Items not included on Site Plan and reason:
-
-
-
SECTION G. IMPACT TABLE
Please place
an “X”
next to the s appropriate
shown on the Impact Table.
box indicating
The
Aquatic Resource Impact Table (3150-PM-BWEW0557)
worksheet or equivalent is required.
Applicant
Entry
DEP
Use
Only
All information
included on Impact Table ....................................................................................
Information not included on Impact Table and reason:
- Project Information:
- Corps / 404:
- DEP / 105:

3150-PM-BWEW0500
Rev. 8/2016
Form
- 4 -
Applicant’s Name
GENERAL PERMIT REGISTRATION
SECTION H. CERTIFICATION
I certify under penalty of law that the information provided in this permit registration is true and correct to the best of my
knowledge and information and that I possess the authority to undertake the proposed action. I am aware that there are
significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.
(If any of the information and/or plans is found to be in error, falsified, and/or incomplete, this authorization/verification may be
subject to modification, suspension, or revocation in accordance with applicable regulations.)
Signature of Applicant/Owner
Date
Typed / Printed Name
Typed / Printed Title
PA Fish and Boat Commission Approval
(for GP-1 only)
Signature of Reviewer
Date
(
)
Reviewer’s Typed / Printed Name
Phone Number
Reviewer’s Typed / Printed Title
Email Address
This General Permit shall not be effective until the owner has had their E&S Plan reviewed by the appropriate Regional Office
or District, obtained Federal Authorization and, where required, obtained an SLLA from DEP.
AN ACKNOWLEDGED COPY OF THIS GENERAL PERMIT REGISTRATION PACKAGE (INCLUDING THE
ACKNOWLEDGEMENT LETTER AND TERMS AND CONDITIONS), REQUIRED FEDERAL AUTHORIZATION,
AND THE E&S PLAN MUST BE AVAILABLE AT THE PROJECT SITE DURING CONSTRUCTION.
SECTION I. ACKNOWLEDGEMENT –DEP USE ONLY
Signatures authorizing acknowledgment to use and register:
A. Completeness Review:
DEP / District Reviewer Signature
Reviewer’s Typed / Printed Name
Begin Date:
Incomplete Date:
Response Date:
End Date:
Completeness Status
YES
NO
B. Eligibility Review:
DEP / District Reviewer Signature
Reviewer’s Typed / Printed Name
Begin Date:
Incomplete Date:
Response Date:
End Date:
Deficient -
DENIED
C. Decision Review:
DEP / District Manager Signature
Reviewer’s Typed / Printed Name
Begin Date:
End Date:
Disposition Status
WITHDRAWN
RETURNED
APPROVED
DENIED
D. Contact Information:
(
)
Typed / Printed Name
Phone Number
Email Address
E. Permit Tracking:
Received
Acknowledged
SLLA required:
NO
YES PASPGP-5:
NO
YES
REP
NONREP
GP -
GP -
GP -
GP -
GP -
Notes:

3150-PM-BWEW0500A
9/2012
- 1 -
EXHIBIT A
PENNSYLVANIA OFFICES
PENNSYLVANIA FISH AND BOAT COMMISSION
Regional Headquarters Address
County Responsibility
Northwest Region
Regional Manager
Butler, Clarion, Crawford, Erie, Forest, Lawrence,
11528 Highway 98
Mercer, Venango and Warren
Meadville, PA 16335-7320
814-337-0444
Southwest Region
Regional Manager
Allegheny, Armstrong, Beaver, Cambria, Fayette,
236 Lake Road
Greene, Indiana, Somerset, Washington and
Somerset, PA 15501-1644
Westmoreland
814-445-8974
Northcentral Region
Regional Manager
Cameron, Centre, Clearfield, Clinton, Elk, Jefferson,
1150 Spring Creek Road
Lycoming, McKean, Montour, Northumberland,
Bellefonte, PA 16823
Potter, Snyder, Tioga and Union
814-359-5250
Southcentral Region
Regional Manager
Adams, Bedford, Blair, Cumberland, Dauphin,
1704 Pine Road
Franklin, Fulton, Huntingdon, Juniata, Lebanon,
Newville, PA 17241
Mifflin, Northumberland (Mahatango Creek in
717-486-7087
Jordan and Lower Mahanoy Townships only),
Perry and York
Southeast Region
Regional Manager
Berks, Bucks, Chester, Delaware, Lancaster,
P.O. Box 9
Lehigh, Montgomery, Northampton, Philadelphia
Elm, PA 17521
and Schuylkill
717-626-0228
Northeast Region
Regional Manager
Bradford, Carbon, Columbia, Lackawanna, Luzerne,
5566 Main Road
Monroe, Pike, Sullivan, Susquehanna, Wayne and
Sweet Valley, PA 18656
Wyoming
570-477-5717

3150-PM-BWEW0500A
9/2012
- 2 -
PENNSYLVANIA FISH AND BOAT COMMISSION continued
DIVISION OF ENVIRONMENTAL SERVICES
450 Robinson Lane, Bellefonte, PA 16823-9620
814-359-5147
DIVISION OF FISHERIES MANAGEMENT
450 Robinson Lane, Bellefonte PA 16823-9620
814-359-5110
BUREAU OF LAW ENFORCEMENT
Aids to Navigation Coordinator
P.O. Box 67000, Harrisburg, PA 17106
717-705-7861
PENNSYLVANIA HISTORIC AND MUSEUM COMMISSION
BUREAU FOR HISTORIC PRESERVATION
Commonwealth Keystone Building,
400 North Street, 2nd Floor,
Harrisburg, PA 17120-0093
717-783-8946
PENNSYLVANIA DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES
BUREAU OF FORESTRY
ECOLOGICAL SERVICES SECTION
P.O. Box 8552,
Harrisburg, PA 17105-8852
717-787-3444

3150-PM-BWEW0500B
9/2012
- 1 -
EXHIBIT B
U.S. ARMY CORPS OF ENGINEERS DISTRICT OFFICES
AND
DEPARTMENT OF ENVIRONMENTAL PROTECTION REGIONAL OFFICES
U.S. ARMY CORPS OF ENGINEERS DISTRICT OFFICES
Ohio River Basin
Portions of Lake Erie and Genesee
River Basins
Located in PA
Susquehanna River Basin
Delaware River Basin
Pittsburgh District Corps of Engineers
Regulatory Branch
Federal Building, 20
th
Floor
1000 Liberty Avenue
Pittsburgh, PA 15222
Phone:
412-395-7155
Fax: 412-644-4211
Baltimore District Corps of Engineers
Pennsylvania Field
Office
1631 South Atherton Street, Suite 101
State College, PA 16801
Phone:
814-235-0570
Fax: 814-235-0576
Philadelphia District Corps of Engineers
Regulatory Branch
Wanamaker Building
100 Penn Square East
Philadelphia, PA 19107
Phone:
215-656-6725
Phone: 215-656-6729
(to report violations)
Fax: 215-656-6724
DEPARTMENT OF ENVIRONMENTAL PROTECTION REGIONAL OFFICES
General Permit Registrations associated with oil and gas activities -
The General Permit Registration form and other associated documents must be sent to the appropriate DEP Bureau
of Oil and Gas Management, Surfaces Permitting Section, Regional Office listed below.
Bureau of Oil and Gas Management
Surfaces Permitting Section
County Responsibility
Northwest Regional Office
230 Chestnut Street
Butler, Clarion, Crawford, Elk, Erie, Forest, Jefferson,
Meadville, PA 16335
Lawrence, McKean, Mercer, Venango and Warren
(814) 332-6860
Southwest Regional Office
400 Waterfront Drive
Allegheny, Armstrong, Beaver, Cambria, Fayette,
Pittsburgh, PA 15222-4745
Greene, Indiana, Somerset, Washington and
(412) 442-4024
Westmoreland
Eastern Regional Office
208 W. Third Street, Suite 101
Adams, Bedford, Berks, Blair, Bradford, Bucks, Carbon,
Williamsport, PA 17701
Cameron, Centre, Chester, Clearfield, Clinton, Columbia,
(570) 974-2602
Cumberland, Dauphin, Delaware, Franklin, Fulton,
Huntingdon, Juniata, Lackawanna, Lancaster, Lebanon,
Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Montgomery,
Montour, Northampton, Northumberland, Perry,
Philadelphia, Pike, Potter, Schuylkill, Snyder, Sullivan,
Susquehanna, Tioga, Union, Wayne, Wyoming and York

3150-PM-BWEW0500B
9/2012
- 2 -
DEPARTMENT OF ENVIRONMENTAL PROTECTION REGIONAL OFFICES continued
General Permit Registrations not associated with oil and gas activities –
The General Permit Registration form and other associated documents must be sent to the appropriate delegated
County Conservation District (see Exhibit C). This process does not apply to GP-11 or GP-15, which are sent to the
DEP Regional Offices.
If the County Conservation District has not been delegated responsibility under the Chapter 105 program the General
Permit Registration form and other associated documents must be sent to the appropriate DEP Permitting and
Technical Service Section, Regional Office listed below.
Permitting and Technical Services Section
County Responsibility
Northwest Regional Office
230 Chestnut Street
Butler, Clarion, Crawford, Elk, Erie, Forest, Jefferson,
Meadville, PA 16335
Lawrence, McKean, Mercer, Venango and Warren
(814) 332-6984
Southwest Regional Office
400 Waterfront Drive
Allegheny, Armstrong, Beaver, Cambria, Fayette,
Pittsburgh, PA 15222-4745
Greene, Indiana, Somerset, Washington and Westmoreland
(412) 442-4315
Northcentral Regional Office
208 W. Third Street, Suite 101
Bradford, Cameron, Centre, Clearfield, Clinton, Columbia,
Williamsport, PA 17701
Lycoming, Montour, Northumberland, Potter, Snyder,
(570) 327-0529
Sullivan, Tioga and Union
Southcentral Regional Office
909 Elmerton Avenue, Second Floor
Adams, Bedford, Berks, Blair, Cumberland, Dauphin,
Harrisburg, PA 17110
Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon,
(717) 705-4802
Mifflin, Perry and York
Northeast Regional Office
2 Public Square
Carbon, Lackawanna, Lehigh, Luzerne, Monroe,
Wilkes-Barre, PA 18711-0790
Northampton, Pike, Schuylkill, Susquehanna, Wayne
(570) 826-2511
and Wyoming
Southeast Regional Office
2 East Main Street
Bucks, Chester, Delaware, Montgomery and Philadelphia
Norristown, PA 19401
(484) 250-5970

3150-PM-BWEW0500C
Rev. 10/2014
- 1 -
EXHIBIT C
CONSERVATION DISTRICTS
?
Adams County
670 Old Harrisburg Rd., Suite 201
Gettysburg, PA 17325
717-334-0636
?
Allegheny County
?33
Terminal Way, Suite 325B
Pittsburgh, PA 15219
412-241-7645
?
Armstrong County
Armsdale Admin. Building
124 Armsdale Rd., Suite B-2
Kittanning, PA 16201
724-548-3425
?
Beaver County
?156
Cowpath Rd.
Aliquippa, PA 15001
724-378-1701
?
Bedford County
702 W. Pitt St., Suite 4
Bedford, PA 15522
814-623-7900 Ext. 4
?
Berks County
?1238
County Welfare Rd.,Suite 200
Leesport, PA 19533
610-372-4657 Ext. 5
?
Blair County
1407 Blair St,
Hollidaysburg, PA 16648
814-696-0877 Ext. 5
?
Bradford County
?Stoll
Natural Resource Center
RR 5, Box 5030C,
Towanda, PA 18848
570-265-5539 Ext. 6
?
Bucks County
1456 Ferry Rd., Suite 704
Doylestown, PA 18901
215-345-7577
?
Butler County
?122
McCune Dr.
Butler, PA 16001
724-284-5270
?
Cambria County
?401
Candlelight Dr., Suite 221
Ebensburg, PA 15931
814-472-2120
?
Cameron County
?20
E. Fifth St., Room 105
Emporium, PA 15834
814-486-9353
?
Carbon County
5664 Interchange Rd.
Lehighton, PA 18235
610-377-4894 Ext. 4
?
Centre County
?414
Holmes Ave., Suite 4
Bellefonte, PA 16823
814-355-6817
?
Chester County
Willowdale Town Center
688 Unionville Rd., Suite 200
Kennett Square, PA 19348
610-925-4920
?
Clarion County
County Administrative Building
330 Main Street, Room 9
Clarion, PA 16214
814-226-4070 Ext. 113
?
Clearfield County
650 Leonard St.
Clearfield, PA 16830
814-765-2629
?
Clinton County
?45
Cooperation Lane
Mill Hall, PA 17751
570-726-3798
?
Columbia County
?702
Sawmill Rd., Suite 204
Bloomsburg, PA 17815
570-784-1310 Ext. 5
?
Crawford County
?Woodcock
Creek Nature Center
21742 German Rd.
Meadville, PA 16335
814-763-5269
?
Cumberland County
310 Allen Rd., Suite 301
Carlisle, PA 17013
717-240-7812
?
Dauphin County
1451 Peters Mountain Rd.
Dauphin, PA 17018
717-921-8100
?
Delaware County
?Rose
Tree Park Hunt Club
1521 N. Providence Rd.
Media, PA 19063
610-892-9484
?
Elk County
?P.O.
Box 448
300 Center St.
Ridgway, PA 15853
814-776-5373
?
Erie County
?1927
Wager Rd.
Erie, PA 16509
814-825-6403
?
Fayette County
10 Nickman Plaza
Lemont Furnace, PA 15456
724-438-4497
Forest County
526 Elm St., Box 4
Tionesta, PA 16353
814-755-3560
?
Franklin County
185 Franklin Farm Lane
Chambersburg, PA 17202
717-264-5499
?
Fulton County
216 N. Second St., Suite 15
McConnellsburg, PA 17233
717-485-3547
?
Greene County
?19
S Washington St., Suite 150
Waynesburg, PA 15370-1839
724-852-5278
?
Huntingdon County
10605 Raystown Rd., Suite A
Huntingdon, PA 16652
814-627-1627
?
Indiana County
?625
Kolter Dr., Suite 8
Indiana, PA 15701
724-471-4751
?
Jefferson County
?1514
Route 28
Brookville, PA 15825
814-849-7463
?
Juniata County
146 Stoney Creek Dr.
Mifflintown, PA 17059
717-436-8953 Ext. 5
?
Lackawanna County
1300 Old Plank Rd.
Mayfield, PA 18433
570-281-9495
?
Lancaster County
?1383
Arcadia Rd., Room 200
Lancaster, PA 17601-3149
717-299-5361 Ext. 5
?
Lawrence County
430 Court St.
New Castle, PA 16101
724-652-4512
Delegated Programs
?
Chapter 105
?
NPDES and E&S Permits

3150-PM-BWEW0500C
Rev. 10/2014
- 2 -
?
Lebanon County
Lebanon Valley Ag. Center
2120 Cornwall Rd., Suite 5
Lebanon, PA 17042-9788
717-272-3908 Ext. 4
?
Lehigh County
Lehigh Ag. Center, Suite 102
4184 Dorney Park Rd.
Allentown, PA 18104
610-391-9583
?
Luzerne County
325 Smiths Pond Rd.
Shavertown, PA 18708
570-674-7991
?
Lycoming County
542 County Farm Rd., Suite 202
Montoursville, PA 17754
570-433-3003
?
McKean County
?17137
Route 6
Smethport, PA 16749
814-887-4001
?
Mercer County
?753
Greenville Rd.
Mercer, PA 16137-5023
724-662-2242
?
Mifflin County
20 Windmill Hill #4
Burnham, PA 17009
717-248-4695
?
Monroe County
?8050
Running Valley Rd.
Stroudsburg, PA 18360
570-629-3060
?
Montgomery County
143 Level Rd.
Collegeville, PA 19426
610-489-4506
?
Montour County
?112
Woodbine Lane, Suite 2
Danville, PA 17821
570-271-1140
?
Northampton County
Greystone Building.
14 Gracedale Ave.
Nazareth, PA 18064
610-746-1971
?
Northumberland County
?441
Plum Creek Rd.
Sunbury, PA 17801
570-495-4665 Ext. 4
?
Perry County
P.O. Box 36
31 W. Main St.,
New Bloomfield, PA 17068
717-582-8988 Ext. 4
?
Pike County
?556
Route 402
Hawley, PA 18428
570-226-8220
?
Potter County
?107
Market St.
Coudersport, PA 16915
814-274-8411 Ext. 4
?
Schuylkill County
1206 AG Center Dr.
Pottsville, PA 17901
570-622-3742 Ext. 5
?
Snyder County
10541 Route 522
Middleburg, PA 17842
570-837-3000 Ext. 0
?
Somerset County
6024 Glades Pike, Suite 103
Somerset, PA 15501
814-445-4652 Ext. 5
?
Sullivan County
9219 Route 487, Suite B
Dushore, PA 18614
570-928-7057
?
Susquehanna County
?81
Public Ave
Montrose, PA 18801
570-278-4600 Ext. 280
?
Tioga County
?50
Plaza Lane
Wellsboro, PA 16901
570-724-1801 Ext. 3
?
Union County
?155
N. 15
th
St.
Lewisburg, PA 17837
570-524-3860
?
Venango County
1793 Cherrytree Rd.
Franklin, PA 16323
814-676-2832
?
Warren County
?
300 Hospital Dr., Suite D
Warren, PA 16365
814-726-1441
?
Washington County
?100
W. Beau St., Suite 105
Washington, PA 15301
724-228-6774
?
Wayne County
?Wayne
Co. Park St. Complex
648 Park St.
Honesdale, PA 18431
570-253-0930
?
Westmoreland County
?Center
for Conservation Ed.
218 Donohoe Rd.
Greensburg, PA 15601
724-837-5271
?
Wyoming County
1 Hollowcrest Complex
Tunkhannock, PA 18657
570-836-2589 Ext. 3
?
York County
118 Pleasant Acres Rd.
York, PA 17402
717-840-7430

3150-PM-BWEW0553
Rev. 7/2016
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WATERWAYS ENGINEERING AND WETLANDS
- 1 -
CHAPTER 105 FEE(S) CALCULATION WORKSHEET
Additional information can be found at
25 PA Code §105.13
(relating to regulated activities –information and fees),
the General Permit Registration
(
3150-PM-BWEW0500
), the Joint Permit Application
(
3150-PM-BWEW0036
)
and the Dam Permit Application
(
3140-PM-BWEW0001
)
Federal, State, county or municipal agencies or municipal authorities:
EXEMPT from fees
These entities are exempt from these fees. If the applicant falls into one of these categories, please check the box above and
provide only the first page of this worksheet with the project application or registration.
ALL OTHERS:
1. Please place an “X” in
all authorizations
the box
that apply
next
to theto
project and complete the fee information below those
authorization(s). Projects may require multiple authorizations and fees, further clarification and examples are included below
and at the end of this document.
2. Total each authorization, Section, and Part. Part One is for Water Obstructions and Encroachment authorizations, Part Two is
for Dam Safety authorizations.
3. Please provide this completed worksheet (page 1 and page 2 and/or page 3, as is appropriate to the project) and a check for
the applicable fee(s) with the project application or registration. The check should be made payable
Commonwealth
to the “
of Pennsylvania Clean Water Fund
OR
Conservation District Clean Water Fund
”,
whichever
is
entity.
NOTES:
Per
25 PA Code §105.13(c)(2)(iii)
Disturbance review fees are calculated by individually adding all of the permanent and
temporary impacts to waterways, floodways, floodplains and bodies of water including wetlands to the next highest tenth acre
and multiplying the permanent and temporary impacts by the respective fees and then these amounts are added to the other
applicable fees.
Entities proposing structures or activities to occupy a Submerged Lands of the Commonwealth must obtain a Submerged
Lands License Agreement (SLLA) and pay the appropriate annual charge. The applicant will be contacted if this charge
applies to the project.
Floodway
–The channel of the watercourse and portions of the adjoining floodplains which are reasonably required to carry
and discharge the 100-year frequency flood. Unless otherwise specified, the boundary of the floodway is as indicated on
maps and flood insurance studies provided by FEMA. In an area where no FEMA maps or studies have defined the boundary
of the 100-year frequency floodway, it is assumed, absent evidence to the contrary, that the floodway extends from the stream
to 50 feet from the top of the bank of the stream.
Wetland and Stream Clarification:
1
In many instances, wetlands are located
within the floodplain of a stream.
These
resources for the purposes of calculating
disturbance fees are considered co-located
or overlapping and the area of disturbance
would only be used once.
2
In the case of GP-5, GP-7 and GP-8 fees
are charged per structure per resource
crossing and the following also applies to
the disturbance fees:
?
A crossing of the stream and the
floodplain with wetlands present within
the
floodplain
is
considered
one
resource crossing.
?
When the crossing traverses a stream
and the floodplain and a wetland that is
located outside of the floodplain or a
wetland that extends out beyond the
floodplain, it is considered two resource
crossings.
Wetland
s
Streams
Floodplains

3150-PM-BWEW0553
7/2016
- 2 -
PART ONE: WATER OBSTRUCTIONS AND ENCROACHMENTS
SECTION A. APPLICATION FEES
WATER OBSTRUCTION AND ENCROACHMENT PERMIT
(Joint Permit Application)
Some activities or structures within a project may also qualify for an accumulation of General Permit fees, please mark
the box above indicating an Individual Water Obstruction and Encroachment Permit AND the corresponding fee(s) in
the General Permit section below those. Activities or structures not qualifying for a General Permit fee must include a
disturbance fee.
Administrative Filing Fee
1
.............................................................................
$ 1,750
+
Temporary Disturbance ($400/0.1ac) ........... acres x $4,000 =
$
+
Permanent Disturbance ($800/0.1ac) ........... acres x $8,000 =
$
= $
WO&E FEE subtotal (a)
$
GENERAL PERMIT(S)
(select activity/structure(s) below, see page 4 for “#”) explanation
Some activities or structures within a project requiring an Individual Water Obstruction and Encroachment Permit may
qualify for an accumulation of General Permit fees, please mark the corresponding fee(s) below but not the box above
indicating a General Permit.
GP-1 Fish Habitat Enhancement Structures ...............................................
$ 50
= $
GP-2 Small Docks and Boat Launching Ramps...........................
(#) x
$ 175
= $
GP-3 Bank Rehabilitation, Bank Protection and
Gravel Bar Removal........................................................... (#) x
$ 250
= $
GP-4 Intake and Outfall Structures .............................................. (#) x
$ 200
= $
GP-5 Utility Line Stream Crossings
2
............................
(#) x
(#) x
$ 250
= $
GP-6 Agricultural Crossings and Ramps ..................................... (#) x
$ 50
= $
GP-7 Minor Road Crossings
2
...................................................... (#) x
$ 350
= $
GP-8 Temporary Road Crossings
2
.............................................. (#) x
$ 175
= $
GP-9 Agricultural Activities .........................................................................
$ 50
= $
GP-10 Abandoned Mine Reclamation ..........................................................
$ 500
= $
GP-11 Maintenance, Testing, Repair, Rehabilitation, or
Replacement of Water Obstructions and Encroachments
1
.................
$ 750
+
Temporary Disturbance ($400/0.1ac) ........... acres x $4,000 =
$
+
Permanent Disturbance ($800/0.1ac) ........... acres x $8,000 =
$
= $
GP-15 Private Residential Construction in Wetlands
1
...................................
$ 750
+
Temporary Disturbance ($400/0.1ac) ........... acres x $4,000 =
$
+
Permanent Disturbance ($800/0.1ac) ........... acres x $8,000 =
$
= $
GP(s) FEE subtotal (b)
$
PART ONE: SECTION A.
APPLICATION FEE(S) subtotal (a+b=c)
$
SECTION B. OTHER FEES
Environmental Assessment for Waived Activities (§105.13(c)(2)(iv)) .........................
$ 500
$
Amendment to Water Obstruction and Encroachment Permit
Major Amendment
1
.....................................................................................
$ 500
+
Temporary Disturbance ................................. acres x $4,000 =
$
+
$
Permanent Disturbance................................. acres x $8,000 =
$
= $
Minor Amendment ......................................................................................
$ 250
$
Transfer of Water Obstruction and Encroachment Permit
does not require submission of this form;
see
Application for Transfer of Permit / Submerged Lands License Agreement (3150-PM-BWEW-0016)
PART ONE: SECTION B.
OTHER FEE(S) subtotal (d)
$
PART ONE:
FEE(S) TOTAL (c+d=e)
$
DEP USE ONLY
FEE TOTAL:
Permit / Authorization Number (s):
Correct Amount:
Check #:
Check Amount:
Payable to:

3150-PM-BWEW0553
7/2016
- 3 -
PART TWO: DAM SAFETY (USE ONE FEE SHEET PER DAM)
SECTION A. APPLICATION FEES
DAM PERMIT APPLICATION –NEW DAM
Size A
Hazard 1 $26,500
Hazard 2 $26,500
Hazard 3 $25,500
Hazard 4 $23,500
$
Size B
Hazard 1 $19,000
Hazard 2 $19,000
Hazard 3 $18,500
Hazard 4 $17,000
$
Size C
Hazard 1 $10,500
Hazard 2 $10,500
Hazard 3 $10,000
Hazard 4 $ 8,000
$
STAGED CONSTRUCTION
NO. OF STAGES BEYOND INITIAL STAGE
X APPLICATION FEE
X 0.90 (90%)
$
DAM PERMIT APPLICATION –MODIFICATION OF DAM
Size A
Hazard 1 $18,500
Hazard 2 $18,500
Hazard 3 $18,500
Hazard 4 $18,000
$
Size B
Hazard 1 $12,000
Hazard 2 $12,000
Hazard 3 $12,000
Hazard 4 $11,500
$
Size C
Hazard 1 $ 7,500
Hazard 2 $ 7,500
Hazard 3 $ 7,500
Hazard 4 $ 7,500
$
STAGED CONSTRUCTION
NO. OF STAGES BEYOND INITIAL STAGE
X APPLICATION FEE
X 0.85 (85%)
$
DAM PERMIT APPLICATION –OPERATION & MAINTANANCE OF EXISTING DAM
Size A
Hazard 1 $12,500
Hazard 2 $12,500
Hazard 3 $12,000
Hazard 4 $10,000
$
Size B
Hazard 1 $10,000
Hazard 2 $10,000
Hazard 3 $ 9,500
Hazard 4 $ 8,500
$
Size C
Hazard 1 $ 7,000
Hazard 2 $ 7,000
Hazard 3 $ 6,500
Hazard 4 $ 6,000
$
PART TWO: SECTION A.
APPLICATION FEE(S) subtotal (a)
$
SECTION B. OTHER FEES
Letter of Amendment or Authorization
Major (≥$250,000)
Size A
$14,700
Size B
$ 8,700
Size C
$ 4,400
$
Minor (<$250,000)
Size A
$ 1,300
Size B
$ 1,000
Size C
$
650
$
Major Dam Design Revision
Size A
$ 4,700
Size B
$ 3,200
Size C
$ 1,700
$
Environmental Assessment
Environmental Assessment for Dam Removal (§105.12(a)(16))
$
500
$
Non-Jurisdictional Dams
$
900
$
Letter of Amendment or Authorization
Size A
$ 1,400
Size B
$ 1,000
Size C
$
900
$
Transfer of Dam Permit
No Proof of Financial Responsibility $ 550
Proof of Financial Responsibility $300
$
Annual Registration
Hazard 1 $ 1,500
Hazard 2
$ 1,500
Hazard 3 $
800
$
PART TWO: SECTION B.
OTHER FEE(S) subtotal (b)
$
PART TWO:
FEE(S) TOTAL (a+b=c)
$
DEP USE ONLY
FEE TOTAL:
Permit / Authorization Number (s):
Correct Amount:
Check #:
Check amount:
Payable to:

3150-PM-BWEW0553
7/2016
- 4 -
GP Fee Explanation (#):
GP #
Description
Fee
Fee Explanation (#)
GP-1
Fish Habitat Enhancement Structures
$ 50
Fee is assessed per project not per individual structure.
GP-2
Small Docks and Boat Launching Ramps
$175
Fee is assessed per individual dock or boat ramp. The fee is the
number
of docks and ramps
totaled times the fee.
GP-3
Bank Rehabilitation, Bank Protection and
Gravel Bar Removal
$250
Fee is assessed per project and not individual bank or gravel bar removal
locations.
Only one single and complete project along a continuous
stream reach not exceeding 500 feet measured down centerline of
stream. Additional projects or areas must be separately registered and
the fee would apply to each registration.
GP-4
Intake and Outfall Structures
$200
Fee is assessed per individual intake or outfall structure. The fee is the
total
number of structures
times the fee.
GP-5
2
Utility Line Stream Crossings
2
$250
Fee is assessed per individual utility line or conduit crossing (a wetland
and stream crossing may be separate crossings even if adjacent). The
fee is the total
number of utility lines
times the
number of resource
crossings
times the fee.
GP-6
Agricultural Crossings and Ramps
$ 50
Fee is assessed per individual crossing or ramp structure. The fee is the
total
number of crossings and ramps
times the fee.
GP-7
2
Minor Road Crossings
2
$350
Fee is assessed per individual minor road crossing (a wetland and stream
crossing may be separate crossings even if adjacent). The fee is the total
number of road crossings
times the fee.
GP-8
2
Temporary Road Crossings
2
$175
Fee is assessed per individual temporary road crossing (a wetland and
stream crossing may be separate crossings even if adjacent). The fee is
the total
number of temporary road crossings
times the fee.
GP-9
Agricultural Activities
$ 50
Fee is assessed per project not per individual structure or activity.
Multiple projects can be registered under a single registration and as such
the fee is applied to each project and then totaled.
GP-10
Abandoned Mine Reclamation
$500
Fee is assessed per project not per individual activity. Multiple projects
can be registered under a single registration and as such the fee is
applied to each project and then totaled.
GP-11
1
Maintenance, Testing, Repair,
Rehabilitation, or Replacement of Water
Obstructions and Encroachments
1
$750
Fee is assessed for each registration package (can include multiple
activities or structures)
and is added to the permanent and temporary
disturbance review fees
calculated for each registration package
respectively.
GP-15
1
Private Residential Construction in
Wetlands
1
$750
Fee is assessed for each registration package (can include multiple
activities or structures)
and is added to the permanent and temporary
disturbance review fees
calculated for each registration package
respectively.
Water Obstruction and Encroachment Examples:
1. GP-7 Minor Road Crossing:
Minor road crossing of a stream that qualifies for BDWM GP-07.
GENERAL PERMIT(S)
(select activity/structure(s) below)
Some activities or structures within a project requiring an Individual Water Obstruction and Encroachment Permit may
qualify for an accumulation of General Permit fees, please mark the corresponding fee(s) below but not the box above
indicating a General Permit.
GP-7 Minor Road Crossings............................................................. 1 (#) x
$ 350
= $ 350
GP(s) FEE subtotal (b)
$ 350
2. Joint Permit Application for Individual Water Obstruction Encroachment Permit:
The project proposes to construct an
access road requiring the placement of fill in 0.27 acres of wetlands as part of a residential subdivision.
Administrative Filing Fee ..............................................................................
$ 1,750
+
Temporary Disturbance ($400/0.1ac).................................0.0 acres x $4,000 =
$
0
+
Permanent Disturbance ($800/0.1ac).................................0.3 acres x $8,000 =
$ 2,400
= $ 4,150
WO&E FEE subtotal (a)
$ 4,150

3150-PM-BWEW0553
7/2016
- 5 -
3. Joint Permit Application for Individual Water Obstruction Encroachment Permit:
The project proposes to construct an
access road and utility line through a wetland and stream. The road will require placement of fill in 0.28 acres of wetlands,
placement of a 45 foot long x 36 inch CMP in the stream and placement of fill in the floodway for road approaches to the
culvert (east approach 35 feet wide x 4 feet deep x 50 feet long and west approach 35 feet wide x 2 feet deep x 15 feet).
The utility line is 30 inch diameter steel pipe carrying petroleum products. The utility line will be open trenched through the
wetland with a permanent right of way of 50 feet x 350 feet and an additional construction right of way 25 feet x 350 feet.
The utility line will be open trenched traversing through the entire floodway and stream with a permanent right of way totaling
50 feet x 68 feet (east floodway 50 feet x 50 feet, stream 50 feet x 3 feet and west floodway 50 feet x 15 feet) and an
additional construction right of way 25 feet x 68 feet.
Administrative Filing Fee ..............................................................................
$ 1,750
+
Temporary Disturbance ($400/0.1ac).................................0.3 acres x $4,000 =
$ 1,200
+
Permanent Disturbance ($800/0.1ac).................................0.9 acres x $8,000 =
$ 7,200
= $10,150
WO&E FEE subtotal (a)
$10,150
4. Joint Permit Application for Individual Water Obstruction Encroachment Permit:
The project proposes to construct a
building, two minor road crossings that qualify for BDWM GP-07 and place three separate utility lines through a wetland and
a separate stream that qualify for BDWM GP-05. The building will require placement of fill in 0.17 acres of wetlands.
Administrative Filing Fee ..............................................................................
$ 1,750
+
Temporary Disturbance ($400/0.1ac).................................0.0 acres x $4,000 =
$
0
+
Permanent Disturbance ($800/0.1ac).................................0.2 acres x $8,000 =
$ 1,600
= $ 3,350
WO&E FEE subtotal (a)
$ 3,350
GENERAL PERMIT(S)
(select activity/structure(s) below)
Some activities or structures within a project requiring an Individual Water Obstruction and Encroachment Permit may qualify
for an accumulation of General Permit fees, please mark the corresponding fee(s) below but not the box above indicating a
General Permit.
GP-5 Utility Line Stream Crossings..................................................... 6 (#) x
$ 250
= $ 1,500
GP-7 Minor Road Crossings............................................................... 2 (#) x
$ 350
= $ 700
GP(s) FEE subtotal (b)
$ 2,200
PART ONE: SECTION A. APPLICATION FEE(S) subtotal (a+b=c)
$ 5,550
Resource/Impact Type Permanent Temporary
Road
0.28
0
Utility Const. ROW
0
0.2
Utility Perm. ROW
0.4
0
Road
0.05
0
Utility Const. ROW
0
0.04
Utility Perm. ROW
0.08
0
Totals:
0.81
0.24
Rounded Totals:
0.9
0.3
Impact Calculations and Summary
Wetland
Floodway/Stream
25 foot construction ROW
50 foot ROW and utility line
35 foot wide road

3150-PM-BWEW0553
7/2016
- 6 -
Dam Safety Examples:
5. New Dam Permit Application:
This project proposes to construct a 25-foot high dam that has a maximum storage of
500 acre-feet of water. This dam would be classified as
§105.91.
a size
There is one
category
home and one “C”
roadway within the inundation area downstream of the dam. This dam would have a hazard
All stream
clas
and wetland impacts are covered under the Dam Permit Application. An Environmental Assessment is required as part of
the Dam Permit Application, but a separate fee is not required.
DAM SAFETY APPLICATION FEES
(TO BE FILED WITH DAM SAFETY WITH THE DAM PERMIT APPLICATION)
DAM PERMIT APPLICATION –NEW DAM
Size C
Hazard 1 $10,500
Hazard 2 $10,500
Hazard 3 $10,000
Hazard 4 $8,000
$ 10,500
DAM SAFETY FEE total
$ 10,050
6. Letter of Authorization with Environmental Assessment:
This project proposes to modify a 25-foot high dam that has a
maximum storage of 500 acre-feet of water. This dam
would be classified as§105.91.
a
size
The
c
proposed modification involves buttressing the downstream slope of the dam with soil to improve the stability. The total
project cost will be $100,000. A small wetland area will be impacted near the toe of the buttress. An Environmental
Assessment will be required to assess the impacts to the wetland.
DAM SAFETY FEES
Letter of Amendment or Authorization
Minor (<$250,000)
Size A
$ 1,300
Size B
$ 1,000
Size C
$
650
$ 650
Environmental Assessment
Letter of Amendment or Authorization
Size A
$ 1,400
Size B
$ 1,000
Size C
$
900
$ 900
DAM SAFETY FEE total
$ 1,550
H
PROPOSED DAM
EXISTING DAM
HOUSE
INUNDATION
LIMIT
WETLANDS
EXISTING
IMPOUNDMENT AREA
H
EXISTING DAM
PROPOSED DAM
HOUSE
INUNDATION
LIMIT
PROPOSED
IMPOUNDMENT AREA

3150-PM-BWEW0553
7/2016
- 7 -
7. New Dam Permit Application with Staged Construction and Disturbance Review Fees:
The project proposes to
construct a staged construction, high hazard dam, to be utilized for containing a slurry impoundment. There will also be a
refuse pile constructed adjacent to the slurry impoundment impacting 1000 linear feet of stream, causing a permanent
disturbance to the 3-foot wide stream and 50 feet of floodway on either side of the stream [1000 x (50+3+50)]. A refuse
stockpile will also impact 200 linear feet of stream, causing a permanent disturbance to the 3-foot wide stream and 50 feet of
floodway on either side of the stream [200 x (50+3+50)]. The Dam Safety Application Fee will include the application fee for
the applicable size and hazard classification of the dam. The Dam Safety Application Fee will also include a fee equal to
90% of the original application fee for each stage beyond the initial stage, including any closure stages.
WATER OBSTRUCTION AND ENCROACHMENT FEES
(TO BE FILED WITH DEP REGIONAL OFFICE, COUNTY CONSERVATION OFFICE, OR DISTRICT MINING)
Administrative Filing Fee
$1,750
Temporary Disturbance ($400/0.1ac)
0.0 acres x $4,000 =
Permanent Disturbance ($800/0.1ac)
2.9 acres x $8,000 =
$23,200
WO&E FEE total
$24,950
DAM SAFETY APPLICATION FEES
(TO BE FILED WITH DAM SAFETY WITH THE DAM PERMIT APPLICATION)
DAM PERMIT APPLICATION –NEW DAM
Size A
Hazard 1 $26,500
Hazard 2 $26,500
Hazard 3 $25,500
Hazard 4 $23,500
$ 26,500
STAGED CONSTRUCTION
No. OF STAGES BEYOND INITIAL STAGE 3 X APPLICATION FEE $26,500 X 0.90 (90%)
$ 71,550
DAM SAFETY FEE total
$ 98,050
Resource/Impact Type Permanent Temporary
Refuse Pile
0
0
Stockpile
0
0
Refuse Pile
2.36
0
Stockpile
0.47
0
Totals:
2.83
0
Rounded Totals:
2.9
0
Wetland
Floodway/Stream
Impact Calculations and Summary
CLOSURE STAGE
STAGE 3
STAGE 2
STAGE 1
(INITIAL STAGE)
SLURRY
DAM
STOCKPILE
SLURRY
IMPOUNDMENT
REFUSE PILE
TOTAL AREA IMPOUNDED
BY DAM

3150-PM-BWEW0553
7/2016
- 8 -
Resource/Impact Type Permanent Temporary
Refuse Pile
0
0
Stockpile
0
0
Refuse Pile
0
0
Stockpile
0.47
0
Totals:
0.47
0
Rounded Totals:
0.5
0
Impact Calculations and Summary
Wetland
Floodway/Stream
8. New Dam Permit Application with Staged Construction:
The project proposes to construct a staged construction, high
hazard dam, to be utilized for containing a slurry impoundment and refuse pile. A refuse stockpile will also impact 200 linear
feet of stream, causing a permanent disturbance to the 3-foot wide stream and 50 feet of floodway on either side of the
stream [200 x (50+3+50)]. The Dam Safety Application Fee will include the application fee for the applicable size and hazard
classification of the dam. The Dam Safety Application Fee will also include a fee equal to 90% of the original application fee
for each stage beyond the initial stage, including any closure stages.
WATER OBSTRUCTION AND ENCROACHMENT FEES
(TO BE FILED WITH DEP REGIONAL OFFICE, COUNTY CONSERVATION OFFICE, OR DISTRICT MINING)
Administrative Filing Fee
$1,750
Temporary Disturbance ($400/0.1ac)
0.0 acres x $4,000 =
Permanent Disturbance ($800/0.1ac)
0.5 acres x $8,000 =
$4,000
WO&E FEE total
$5,750
DAM SAFETY APPLICATION FEES
(TO BE FILED WITH DAM SAFETY WITH THE DAM PERMIT APPLICATION)
DAM PERMIT APPLICATION –NEW DAM
Size A
Hazard 1 $26,500
Hazard 2 $26,500
Hazard 3 $25,500
Hazard 4 $23,500
$ 26,500
STAGED CONSTRUCTION
No. OF STAGES BEYOND INITIAL STAGE 3 X APPLICATION FEE $26,500 X 0.90 (90%)
$ 71,550
DAM SAFETY FEE total
$ 98,050
CLOSURE STAGE
STAGE 3
STAGE 2
STAGE 1
(INITIAL STAGE)
SLURRY
DAM
STOCKPILE
REFUSE PILE
SLURRY
IMPOUNDMENT
TOTAL AREA IMPOUNDED BY
DAM

3150-PM-BWEW0051
Rev. 7/2016
COMMONWEALTH OF PENNSYLVANIA
Instructions
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WATERWAYS ENGINEERING AND WETLANDS
- 1 -
INSTRUCTIONS FOR COMPLETING THE PASPGP-5 REPORTING CRITERIA CHECKLIST
Follow the instructions below (pages 1-6) to complete the PASPGP-5 Reporting Criteria Checklist (pages 1-4)
questionnaire. The questionnaire must be completed and provided as part of all DEP Chapter 105 applications /
registrations to determine the appropriate federal Pennsylvania State Programmatic General Permit-5 (PASPGP-5)
review procedure.
Incomplete submissions, including lack of certification signature, will be returned. Only the completed form
(pages 1-4 need to be provided as part of the DEP Chapter 105 application / registration; do not submit the
instructions.
NOTE:
Many of the questions relate to work
associated
with
a
“Single
and
PASPGP-5 Part II for definition of “Single and Complete Pro
SECTION A: ELIGIBILITY DETERMINATION
Question 1:
Answer YES
if the proposed work associated with the Single and Complete Project individually or cumulatively impacts more
than 1.0 acre of waters and/or wetlands, or results in the loss of greater than 1,000 linear feet of stream
channel(s). The 1.0 acre area measurement includes all attendant features, both temporary and permanent, that
are part of the Single and Complete Project, and the calculation is the sum total of all impacts to waters (streams,
rivers, and other watercourses) and/or wetlands.
Question 2:
Answer YES
if any of the proposed work is located waterward of the ordinary high water mark (OHWM) and/or the mean high
water line (MHWL) of the following ineligible waterbodies within Pennsylvania:
a.
The Delaware River, downstream of the U.S. Route 202 Bridge at New Hope, Pennsylvania;
b.
The Schuylkill River downstream of the Fairmount Dam in Philadelphia, Pennsylvania;
c.
All of the Ohio River;
d.
All of the Beaver River;
e.
All of the Little Beaver Creek;
f.
All of the Mahoning River;
g.
All of the Monongahela River;
h.
The Youghiogheny River from its mouth at McKeesport, Pennsylvania to river mile 31.2 at West Newton,
Pennsylvania;
i.
The Allegheny River, from its mouth in Pittsburgh, Pennsylvania to river mile 197.4 at Kinzua Dam, north of
Warren, Pennsylvania;
j.
The Kiskiminetas River from its mouth near Freeport, Pennsylvania to river mile 26.8 at Saltsburg,
Pennsylvania;
k.
Tenmile Creek from its mouth at Millsboro, Pennsylvania to river mile 2.7; and
l.
Lake Erie activities which require submittal of a DEP Chapter 105 Joint Permit Application or Environmental
Assessment to the DEP. For Lake Erie, the OHWM is located at elevation 573.4.
Question 3:
Answer YES
if any portion of the proposed work has been denied a DEP Chapter 105 Permit, a State Water Quality
Certification as required under Section 401 of the Clean Water Act, or a Coastal Zone Consistency
Determination.
Question 4:
Answer YES
if the proposed work will result in the diversion of more than 10,000 gallons per day of surface water or
groundwater into or out of the Great Lakes Basin (Lake Erie Watershed).
*****

3150-PM-BWEW0051
Rev. 7/2016
Instructions
- 2 -
SECTION B: REPORTING ACTIVITY DETERMINATION
Question 1:
Answer YES
if the proposed work associated with the Single and Complete Project, including any attendant features,
permanently or temporarily impacts greater than 0.5 acre of waters of the United States, including jurisdictional
wetlands.
Questions 2a –2d:
Answer YES
for
2a
if your proposed Single and Complete Project permanently impacts greater than 250 linear feet of streams,
rivers, or other watercourses (excluding wetlands).
If YES
for 2a, answer YES for
2b
if the work associated with the Single and Complete Project for stream bank
stabilization, rehabilitation, protection and/or enhancement propose impacts of greater than 500 linear feet for
stream channel(s).
If YES
for 2a, answer YES for
2c
if the Single and Complete Project qualifies for a DEP GP-1 for Fish and Enhancement
Structures.
If YES
for 2a, answer YES for
2d
if your project is covered by a programmatic state water quality certification issued by
DEP that is conditioned upon receiving approval by the Environmental Review Committee.
See PASPGP-5 Non-reporting Activity 20b for further information.
Question 3:
Answer YES
if more than 0.10 acre of shrub-scrub or forested wetland will be permanently converted to emergent wetland.
Question 4:
Answer YES
if the utility line impacts for the Single and Complete Project exceed 500 linear feet.
Question 5:
Answer YES
if the utility line runs parallel to a stream bed that is within a wetland/stream/waterbody complex.
If the application/registration does not include a utility line, answer NO.
Question 6:
Answer YES
if your application/registration is associated with a Single and Complete Project whereby a previous Department
of the Army authorization has been issued through an Individual Permit, a Nationwide Permit, or a PASPGP
processed by the Army Corps of Engineers (Corps) as a Category III/Reporting Activity. Also enter data
associated with the prior authorizations into table, including the type of authorization or permit, permit or
authorization number(s), date(s) of issuance, and permitted impacts (including square feet or linear feet). Types
of authorizations or permits may be abbreviated as Corps Nationwide Permit (NWP), Corps Individual
Permit (IP), or Corps PASPGP (SPGP).
Questions 7a and 7b:
Answer YES
to
7a
if your project is proposed in one of the following waterways occupied by Federally listed, proposed, or
candidate mussels or fish, or in waters of the United States within 300 feet of these listed waterways.
WATERWAYS
COUNTY
Allegheny River (from Kinzua Dam to the Ohio River)
Armstrong, Clarion, Forest, Venango, Warren,
Conewango Creek
Warren
French Creek
Crawford, Erie, Mercer, Venango
Conneaut Outlet
Crawford
Conneautee Creek
Crawford
LeBoeuf Creek
Erie
Muddy Creek
Crawford
Shenango River (Pymatuning Reservoir to Big Bend)
Crawford and Mercer
Delaware River
Monroe, Pike, Wayne
Cussewago Creek
Crawford
Little Mahoning Creek
Indiana
Little Shenango River
Mercer
Oil Creek
Venango
West Branch of French Creek
Erie
Woodcock Creek
Crawford

3150-PM-BWEW0051
Rev. 7/2016
Instructions
- 3 -
Questions 7a and 7b (cont):
If YES
for 7a, answer YES to
7b
if
you
have
received
documented
clearance
determination from the Corps pursuant to Section 7 of the Endangered Species Act dated May 4, 2015 or later.
Documented clearance from the USFWS could include PNDI l
USFWS
letter
the
language
must
indicate
“no
effect”
or
species.”
Questions 8a and 8b:
Answer YES
to
8a
if the proposed work will impact Federally regulated wetlands in one of the below listed counties.
Counties: Adams, Berks, Bucks, Carbon (only Aquashicola Creek Watershed), Chester, Cumberland, Delaware,
Dauphin (only Swatara Creek Watershed), Franklin (only Antietam Creek Watershed) Lancaster, Lebanon,
Lehigh, Monroe, Montgomery, Northampton, Schuylkill (only Swatara Creek Watershed), and York.
If YES
for 8a, answer YES for
8b
if you have received documented
clearance
from
the
USFWS,
determination from the Corps pursuant to Section 7 of the Endangered Species Act dated May 4, 2015 or later.
Documented clearance from the USFWS could include a PNDI l
USFWS
letter
the
language
must
indicate
“no
effect”
or
species.”
Questions 9a and 9b:
Answer YES
for
9a
if your completed PNDI search identifies a potential conflict(s) for a Federally listed species.
If YES
for 9a, answer YES for
9b
if you have received additional documented clearanc
determination from the Corps, or agree through signing the PNDI receipt to comply with the avoidance measures
associated with Federally listed species in completing the proposed work.
Question 10:
Answer YES
if the proposed work is associated with maintenance dredging of a reservoir to maintain the designed storage
capacity, including the removal of accumulated sediments, and the work is authorized pursuant to Section 7 of
the Dam Safety and Encroachments Act, 32 P.S. § 693.1, et seq., and the rules and regulations promulgated
there under in the PA Bulletin (codified at 25 PA. Code, Chapter 105, § 105.131 (c)).
For work associated with maintenance of a pond that qualifies for DEP Chapter 105 Waiver 14, enter NO.
Questions 11a –11c:
Answer YES
for
11a
if the DEP Chapter 105 application/registration required you to submit a Cultural Resources Notification
Form to the Pennsylvania Historic and Museum Commission (PHMC), and you have included the response letter
from the State Historic Preservation Office (SHPO), i.e. PHMC.
Cultural Resources Notification Form is not required for DEP Chapter 105 General Permits (GP). If registering
use of a GP, answer YES.
If YES
for 11a, answer YES for
11b
if the SHPO, i.e., PHMC has determined that archaeological or other cultural
resources are believed to exist within the permit area, or has recommended that a Phase 1 archeological survey
be performed.
If PHMC has determined that archaeological or other cultural resources are believed NOT to exist within the
permit area, answer NO.
If YES
for 11b, answer YES for
11c
if you have received documented clearance from PHMC or a No Potential to Effect
determination from the Corps.
Documented clearance from
on Historic Properties”;
ng that “Historic
a letter Properties
stati
(historic a
unlikely to occur within
or a letter stating
the
that noproject
sites that are listed
area”;
or eligible for listing in the
National Register will be effected.
If YES, provide copy of such document(s) in application / registration.
Questions 12a and 12b:
Answer Yes
for
12a
if the proposed work occurs in a component of the National Wild and Scenic River System or in a river
officially designated by
for possible
Congress
inclusion in as
the System
a “Study
(See below for River”
listing of
waters).
1.
Allegheny River, from the Kinzua Dam Mile 197.2, downstream approximately 7 miles to the US Route 6
Bridge, at mile 190.7, in Warren, then from the Buckaloons Recreation Area in Allegheny National Forest at
mile 181.7 downstream 47 miles to Alcorn Island just north of Oil City at river mile 133.7, and then continuing
from the Franklin Wastewater Treatment Plant at mile 122.7, downstream 31 miles to the refinery at
Emlenton mile 90.7;

3150-PM-BWEW0051
Rev. 7/2016
Instructions
- 4 -
Questions 12a and 12b (cont):
2.
Clarion River from mile 91.1 in the Borough of Ridgeway, Elk County, Pennsylvania, at the National Forest
and Gamelands Boundary to mile 39.4 at the normal pool elevation of Piney Dam;
3.
Upper Delaware Scenic and Recreational River, including the ¼ mile buffer from each bank, beginning at
Hancock, New York, and continuing 73.4 river miles to Mill Rift, Pennsylvania;
4.
Middle Delaware Scenic and Recreational River (from bank to bank) as it flows through the Delaware Water
Gap National Recreation Area;
5.
Lower Delaware River beginning 7 river miles north of Belvidere, New Jersey, continuing to Washington
Crossing, Pennsylvania, including Paunnacussing Creek within Solebury Township, all of the Tinicum Creek
including Rapp Creek and Beaver Creek Tributaries, and Tohickon Creek from the mouth to the Lake
Nockamixon Dam, including a ¼ mile buffer from each bank; and
6.
White Clay Creek watershed including all of its tributaries.
If YES
for 12a, answer YES for
12b
if you received a written determination from the Federal agency with direct
management responsibility for such river that the proposed activity will not adversely affect any Wild and Scenic
River including study rivers.
If YES, provide copy of such document(s) in application / registration.
Question 13:
Answer YES
if the proposed project requires the preparation of an Environmental Impact Statement (EIS).
Question 14:
Answer YES
if the proposed regulated activity or area of indirect impact (secondary impact) extends across state boundaries
(i.e., the work in not wholly located within the Commonwealth of Pennsylvania).
Question 15:
Answer YES
if you are proposing activities authorized pursuant to DEP Chapter 105 permits in conjunction with coal and non-
coal mining permits issued by the DEP District Mining Offices (Bureau of Mining and Reclamation), including
activities authorized pursuant to Chapter 105 Waiver 4 [25 Pa. Code §105.12(a)(4)] and GP-101 and GP-102.
Question 16:
Answer YES
if the proposed work is associated with the construction of a Mitigation Bank or In Lieu Fee site, developed to
meet the requirements of the Corps and EPA April 10, 2008 Compensatory Mitigation for Losses of Aquatic
Resources: Final Rule.
Question 17:
Answer YES
if the proposed work will alter, use, build upon, attempt to possess, or potentially harm or impair any existing or
proposed Corps of Engineers Civil Works project, or any Corps of Engineers owned or managed property.
Additional information on the location of Corps Civil Works projects and property may be obtained by checking
with the appropriate Corps District.
Questions 18a –18c:
Answer YES
for
18a
if the proposed project is part of or involves the construction or expansion of a residential, commercial or
institutional subdivision or development.
If YES
for 18a, answer YES for
18b
if greater than 0.25 acre of wetlands exist within the property boundary that are not
being directly impacted as part of this application/registration.
If YES, provide total remaining wetland
acreage.
If YES
for 18a, and 18b, answer YES for
18c
if you proposing to protect the wetland area(s) through a deed restriction
or conservation easement that
Protective
follows
Covenants. the
If YES, attach
Corps’
a copy of
Model
the
proposed deed restriction or conservation easement to this form and submit with your application /
registration form.
Question 19:
Answer YES
if temporary impacts associated with a Single and Complete Project will be in place greater than 1 year.
Also, answer YES if you are requesting an extension of an existing DEP Chapter 105 GP-8 or GP-11
acknowledgement that will result in the temporary impacts now exceeding one year.
Question 20:
Answer YES
if you have any pending applications/registrations with DEP or the Corps that are necessary for your total
proposed project to function and meet its intended purposed.
If YES, provide the following information:
?
Application/registration Number / Type: The application/registration number given by DEP, if known. If
unknown, the application/registration type, enter DEP General Permit, Joint Permit Application, Dam Permit,
Environmental Assessment, etc.

3150-PM-BWEW0051
Rev. 7/2016
Instructions
- 5 -
Question 20 (cont):
?
Project Name: The name the project is commonly referred to
?
Date of Submittal: The date the application/registration was submitted to DEP
?
DEP Reviewing Office:
Name of DEP Regional Office, or County Conservation District reviewing
application/registration.
?
Corps Reviewing Office:
If application/registration is being reviewed by the Corps, enter Baltimore,
Pittsburgh or Philadelphia District.
Question 21:
Answer YES
if you are proposing to do work in the Delaware River (upstream from the U.S. Route 202 Bridge in New Hope,
Pennsylvania.) and/or the Lehigh River (from the mouth to FE Walter Dam, located in Carbon and Luzerne
County, Pennsylvania between March 15 and June 30.
Questions 22a and 22b:
Answer YES
for
22a
if you are proposing work in the below listed waters.
Waterway
Action Area
(From Point Specified to the
Confluence with the Delaware River)
Latitude
Longitude
Marcus Hook Creek
US Route 13 Bridge
39.822054
-75.409873
Stoney Creek
US Route 13 Bridge
39.828408
-75.400953
Chester Creek
Kerlin Street Bridge
39.855846
-75.37641
Ridley Creek
McDade Boulevard
39.869522
-75.356692
Crum Creek
US Route 13 Bridge
39.866799
-75.340677
Darby Creek
Pine Street Bridge
39.914006
-75.259994
Frankford Creek
Frankford Avenue/US 13 Bridge
40.005314
-75.070173
Frankford Creek (Original Mouth)
End of Channel
40.004912
-75.070173
Pennypack Creek
Route 13 Bridge
40.043421
-75.020638
Poquessing Creek
Mill Road bridge
40.043421
-75.982076
Neshaminy Creek
Rapids just below Hulmeville
Road Bridge (SR 513), Bucks
County
40.141393
-74.911899
Unnamed Tributary 1, located in Croydon, PA
River Road crossing
40.085774
-74.8856
Otter/Mill Creek
US 13 (Bristol Pike) Bridge
40.100424
-74.866976
Unnamed Tributary 2, located in Bristol, PA
Wood Street Bridge
40.102044
-74.845682
Martins Creek
Main Street (Tulleytown)
40.141975
-74.812026
Scott's Creek
End of creek
40.12921
-74.793879
Scott's Creek Relocated Channel, located
at Money Island, Bucks County, PA
First culvert crossing
40.125578
-74.776886
Non-Tidal Tributaries
Buck Creek
Delaware Canal
40.243699
-74.838279
Dyers Creek
Delaware Canal
40.267098
-74.858495
Houghs Creek
Delaware Canal
40.28148
-74.865783
Jericho Creek
Delaware Canal
40.313984
-74.902899
Pidcock Creek
Delaware Canal
40.331508
-74.935788
If YES
for 22a, answer YES for
22b
if you can conduct the work in compliance with the following conservation
measures:
1.
No work shall occur from March 15 to November 15, of any given year.
2.
All Dredging shall be performed by a mechanical dredge and/or techniques (clamshell bucket etc.).
3.
All work, including the installation of turbidity curtains and dewatering cofferdams, shall be performed during
low tide or when the tide is waterward of the proposed work in all tidal waterbodies listed, or during periods
of low or no flow in the non-tidal waterbodies listed.

3150-PM-BWEW0051
Rev. 7/2016
Instructions
- 6 -
Questions 22a and 22b (cont):
4.
Blasting is not authorized by the PASPGP-5 within the listed waterbodies.
5.
Pile Driving:
a.
Piles shall not be greater than 12 inches in diameter;
b.
Piles shall be installed using a vibratory hammer or an impact hammer provided noise attenuation
devices (cushion blocks,
ft etc.)
start”are
is used,
performed
and
each
“so da
start” is the building up of power slowly during pil
leave the area; and
c.
Pile driving activities shall be limited to no more than 12 hours per day.
*****
SECTION C: CERTIFICATION
Please sign and date in the appropriate locations. The submission will not be accepted unless the original form and copy are
signed and dated by the applicant (the owner). (See
Chapter 105 Water Obstructions and Encroachment General Permit
Registration (3150-PM-BWEW0500)
Section A –Applicant Information for clarification on applicant signatures)
*****
IMPERVIOUS SURFACE DATA FOR CORPS
Questions 1a –1c:
Answer YES
for
1a
if your project is located in the area covered by the Corps of Engineers Philadelphia District (Delaware
River Watershed), or Chester, Lancaster, or York County. If YES, answer 1b and 1c.
If YES
for 1a, answer YES for
1b
if your project proposes a permanent impervious surface(s) within the footprint of a
waterbody, including wetlands, and enter the amount of impervious fill within the waterbody on the blank line
following the question. Impervious surfaces are defined as a hard surface area which either prevents or retards
the entry of water into the soil. Common impervious surfaces include roof tops, walkways, patios, driveways,
parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen material, and oiled
surfaces. Examples of project fill components constructed as a result of permanent discharges of dredged or fill
material into waters of the United States that are considered to be an impervious surface may include, but are
not limited to: house pads, walkways, patios, driveways, parking lots, storage areas, concrete, asphalt paving,
pre-cast concrete planks or slabs, road crossings, and concrete abutments. For bank stabilization activities, an
impervious surface is only applicable to the concrete lining of waterways and grouted riprap/rock within
jurisdictional waters of the United States that exist above the mean high water (MHW) line in tidal waters or
above the ordinary high water mark (OHWM) in non-tidal waters.
The following list contains examples of project components that are
n
ot considered impervious surface cover:
temporary fills/structures; fill for lawns/parks; mechanized land clearing (tilling, etc.); pavers (specifically
designed to allow water infiltration, i.e. with vegetation holes); boat ramps with loose rock, stone, gravels, and
metal grate panels; and bank stabilization with ungrouted riprap, rock, utilizing bio-engineering techniques (e.g.
willow planting, root wads, large woody debris, etc.); rock filled gabions; and any project feature that is
specifically designed to infiltrate water.
If YES
for 1a, answer YES for
1c
if you will be removing any impervious surfaces as part of your project.
If YES, then
enter the amount of impervious surface being permanently removed as part of project.

- 1 -
3150-PM-BWEW0051
Rev. 8/2016
Checklist
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WATERWAYS ENGINEERING AND WETLANDS
DEP USE ONLY
Non-Reporting
Reporting
PASPGP-5 REPORTING CRITERIA CHECKLIST
The following questionnaire must be completed (instructions on pages 1-6) and submitted as part of all DEP
Chapter 105 applications / registrations to determine the appropriate Federal Pennsylvania State Programmatic
General Permit-5 (PASPGP-5) review procedure.
Incomplete submissions, including lack of certification
signature, will be returned.
Applicant / Project Name:
County(s):
SECTION A: ELIGIBILITY DETERMINATION
YES
NO
1.
Does the proposed work associated with the Single and Complete Project temporarily and/or
permanently impact greater than 1.0 acre of waters and/or wetlands, and/or result in the loss of greater
than 1,000 linear feet of stream channel(s)?
YES
NO
2.
Is any of the proposed work located waterward of the ordinary high water mark (OHWM) of any of the
ineligible waterbodies identified in the instructions?
YES
NO
3.
Has any portion of the proposed work been denied a DEP Chapter 105 Permit, a State Water Quality
Certification as required under Section 401 of the Clean Water Act, or a Coastal Zone Consistency
Determination?
YES
NO
4.
Does the proposed work result in the diversion of more than 10,000 gallons per day of surface water or
groundwater into or out of the Great Lakes Basin (Lake Erie Watershed)?
*****
SECTION B: REPORTING ACTIVITY DETERMINATION
YES
NO
1.
Does the proposed work associated with a Single and Complete Project, including any attendant
features, permanently and/or temporarily impact greater than 0.5 acre of waters of the United States,
including jurisdictional wetlands?
YES
NO
2a. Does the application/registration include any proposed Single and Complete Projects permanently
impacting greater than 250 linear feet of streams, rivers, or other watercourses (excluding wetlands)?
YES
NO
2b. Is the Single and Complete Project for stream bank stabilization, rehabilitation, protection and/or
enhancement and propose impacts of greater than 500 linear feet of stream channel(s)?
YES
NO
2c. Does the Single and Complete Project qualify for DEP GP-1 for Fish and Enhancement Structures?
YES
NO
2d. Is the project covered by a programmatic State Water Quality Certification issued by DEP - that is
conditioned upon receiving approval by- the Environmental Review Committee?
YES
NO
3.
Does the application/registration include any Single and Complete Projects that propose the permanent
conversion of greater than 0.10 acre of forested and/or shrub-scrub wetlands in association with a
regulated activity?
YES
NO
4.
If the application/registration is for a utility line, do any of the single and complete projects in waters of
the United States, including jurisdictional wetlands, exceed 500 linear feet (excluding overhead lines)?
YES
NO
5.
Is this application/registration to place a buried utility line in waters and/or wetlands in a manner that the
utility line will run parallel to or along a stream bed?

3150-PM-BWEW0051
Rev. 8/2016
Checklist
- 2 -
SECTION B: REPORTING ACTIVITY DETERMINATION (CONT)
YES
NO
6.
Is the application/registration associated with a Single and Complete Project whereby a previous
Department of the Army authorization has been issued through an Individual Permit, a Nationwide Permit,
or a PASPGP processed by the Corps as a Category III/Reporting Activity?
If YES, please complete the
following table.
Authorization
Type
Authorization
Number
Date
(mm/dd/yyyy)
Federal Permitted Impacts
Wetlands
Waters
YES
NO
7a. Is the proposed project located in waterways occupied by Federally listed, proposed, or candidate
mussels or fish, or in waters of the United States within 300 feet of these listed waterways?
See
instructions for list of waterways.
YES
NO
7b. If 7a is yes, have you received documented clearance from the USFWS, or a Section 7 of the Endangered
Species Act (ESA)
“no
effect”
determination
from
the
Corps
could include PNDI language stating
if in a USFWS letter
“NO
the language
KNOWN
mustIMPACT”;
indicate “no effect” or “the project or activity wil
YES
NO
8a. Does the project propose impacts to Federally regulated wetlands in a county that requires bog turtle
screening procedures?
See instructions for list of counties.
YES
NO
8b. If 8a is YES, have you received documented clearance
determination from the Corps? Documented clearance from the USFWS could include PNDI language
stating
“NO
KNOWN
IMPACT”;
or,age
if must
in
a indicate
USFWS
letter
“no
project or activity will not affect Federally listed
YES
NO
9a. Does the completed Pennsylvania Natural Diversity Inventory (PNDI) search receipt identify a potential
conflict(s) for a Federally listed species?
YES
NO
9b. If YES for 9a, have you received additional documented Section 7 ESA clearance, or do you agree,
through signing of the PNDI receipt, to comply with all avoidance measures identified on the PNDI receipt
associated with Federally listed species for the proposed work?
YES
NO
10. Is
the
proposed
work
associated
with
maintenance
dre
including the removal of accumulated sediments? This corresponds to activities authorized pursuant to
Section 7 of the Dam Safety and Encroachments Act (DSEA), 32 P.S. § 693.1, et seq., and the rules and
regulations promulgated there under in the PA Bulletin (codified at 25 PA. Code, Chapter 105, §
105.131(c)).
YES
NO
11a. If the DEP Chapter 105 application/registration requires submittal of a Cultural Resources Notification
Form as part of the application/registration, have you included the response letter from the State Historic
Preservation Officer (SHPO), i.e., Pennsylvania Historic and Museum Commission (PHMC) with your
application/registration?
YES
NO
11b. Has the PHMC determined that archaeological or other cultural resources are believed to exist within the
permit area?
YES
NO
11c. If yes for 11b, have you received follow-up documented clearance from PHMC, or a Section 106 “no
effect” determination from the Corps?
YES
NO
12a. Does the proposed work occur in a component of the National Wild and Scenic River System or in a river
officially
designated
by
Congress
as the
a System?
“Study
See
Rive
instructions for listing.
YES
NO
12b. If yes for 12a, have you received a written determination from the Federal agency with direct management
responsibility for such river that the proposed activity will not adversely affect any Wild and Scenic River
including study rivers?
YES
NO
13. Does the proposed project require the preparation of an Environmental Impact Statement?
YES
NO
14. Does the proposed regulated activity or area of indirect impact (secondary impact) extend across state
boundaries (i.e., the work in not wholly located within the Commonwealth of Pennsylvania)?

3150-PM-BWEW0051
Rev. 8/2016
Checklist
- 3 -
SECTION B: REPORTING ACTIVITY DETERMINATION (CONT)
YES
NO
15. Is the proposed work authorized pursuant to DEP Chapter 105 permits in conjunction with coal and non-
coal mining permits issued by the DEP District Mining Offices (Bureau of Mining and Reclamation),
including activities authorized pursuant to Chapter 105 Waiver 4 [25 Pa. Code §105.12(a)(4)] and GP-101
and GP-102]?
YES
NO
16. Is the proposed work associated with the construction of a Mitigation Bank or In Lieu Fee site developed
to meet the requirements of the Corps and EPA April 10, 2008 Compensatory Mitigation for Losses of
Aquatic Resources: Final Rule?
YES
NO
17. Will the proposed work alter, use, build upon, attempt to possess, or that may harm or impair any existing
or proposed Corps Civil Works project, and any Corps-owned or managed property?
YES
NO
18a. Does the Single and Complete Project involve the construction or expansion of a residential, commercial
or institutional subdivision or development?
YES
NO
18b. Does greater than 0.25 acre of wetland(s) exist within the property boundary that are not proposed to be
directly impacted as part of this application/registration?
If YES, provide wetland acreage:
acres.
YES
NO
18c. Are you proposing to protect the wetland area(s) through a deed restriction or conservation easement that
follows the Protective
Corps’
Covenant?
Model
YES
NO
19. Does the proposed work temporarily impact waters and/or wetlands that will remain in place for more than
1 year?
YES
NO
20. Do you have any other pending applications/registrations with the DEP or Corps that are necessary for
this total proposed project to function and meet its intended purpose?
If YES, provide following
information.
Application / Registration
Number / Type
Project Name
Date of
Submittal to
DEP
(mm/dd/yyyy)
DEP / CCD
Reviewing
Office
Corps
Reviewing Office
YES
NO
21. Are you proposing to do work in the Delaware River (upstream from the U.S. Route 202 Bridge in New
Hope, Pennsylvania.) and/or the Lehigh River (from the mouth to Francis E. Walter Dam, located in
Carbon and Luzerne County, Pennsylvania between March 15 and June 30?
YES
NO
22a. Does the proposed work occur in any of the waters listed in the instructions?
YES
NO
22b. Will you comply with all of the identified conservation measures?
*****

3150-PM-BWEW0051
Rev. 8/2016
Checklist
- 4 -
SECTION C: CERTIFICATION
I certify that the information provided on this form is true and correct to the best of my knowledge and information.
If any
of the information and/or plans is found to be in error, falsified, and/or incomplete, your Chapter 105/PASPGP-5
authorization/verification may be subject to modification, suspension, or revocation in accordance with applicable regulations.
Signature of Applicant
Date
Name Typed or Printed
*****
IMPERVIOUS SURFACE DATA FOR CORPS
YES
NO
1a. Is your project located in the Corps of Engineers Philadelphia District (Delaware River Watershed), or in
Chester, Lancaster, or York County?
YES
NO
1b. Does your project propose impervious surfaces within waters and wetlands?
If YES, provide area of
impervious surface within the footprint of waters and wetlands:
square feet
YES
NO
1c. Does any part of your project propose the removal of any impervious surfaces?
If YES, provide area of
impervious surface being removed:
square feet
FOR DEP USE ONLY
DEP / District Manager Signature
Date
Name Typed or Printed
Permit Number

3150-PM-BWEW0557 7/2016
Aquatic Resource Impact Table
Applicant's Name / Client: ________________________________________
INSTRUCTIONS:
DEP / Corps USE ONLY
leave blank
, it will be completed by DEP upon permit acknowledgement/issuance/verification.
leave blank
, it will be completed by DEP/Corps upon permit acknowledgement/issuance/verification.
leave blank
, it will be completed by DEP upon permit acknowledgement/issuance/verification.
provide the appropriate information based on the details on each impact for the project
this same unique identifier should be used in all aspect of the permit registration/application package.
indicate if the structure or activity is impacting a stream or wetland
select/provide the type of aquatic resource (based on wetland or stream) being impacted;
Stream: select/provide the type of stream being impacted: perennial, intermittent, ephemeral stream or stream floodway
Wetland: select/provide the type of wetland being impacted: PEM, PSS, PFO or POW wetland
provide the latitude of the aquatic resource impact in decimal degrees
provide the longitude of the aquatic resource impact in decimal degrees
select/provide the type of work proposed to impact the resource; aerial, boring, excavation or fill
provide the name of the stream or wetland (if available)
provide the Chapter 93 designation for the aquatic resource
provide the appropriate information based on the aquatic resource impact
within the Section 404 jurisdictional area
, list all impacts separately.
select/provide the type of aquatic resource impact; temporary, permanent or n/a;
indicate "n/a" if you are not proposing any work in, over, or under waters and/or wetlands
WIDTH
provide the linear feet, measuring from top of bank to top of bank, of transverse and/or full channel fill stream impacts;
indicate "n/a" if impact is to a wetland OR if "n/a" to Corps Impact Type
LENGTH
provide the linear feet, measuring down the center line of stream, of transverse and/or full channel fill stream impacts;
indicate "n/a" if impact is to a wetland OR if "n/a" to Corps Impact Type
provide the square feet area of direct and indirect/secondary stream impact; dewatering or fill placed in stream channel such as rip rap or fish habitat;
indicate "n/a" if impact is to a wetland OR if "n/a" indicated above to Corps Impact Type
AREA
provide the square feet area of impacts to wetlands;
indicate "n/a" if impact is to a stream OR if "n/a" to Corps Impact Type
provide the appropriate information based on the aquatic resource impact
within Chapter 105 jurisdictional area
, list all impacts separately.
select/provide the type of aquatic resource impact; temporary or permanent.
AREA
provide the square feet area of direct and indirect/secondary 100-year floodway impact, inlcuding watercourse; indicate "n/a" if impact is to a wetland.
AREA
provide the square feet area of impacts to wetlands; indicate "n/a" if impact is to a stream
Date:
Corps Impact
Stream
Impact
Stream
Impact
Stream
Impact
Wetland
Impact
DEP
Impact
Floodway
Impact
Wetland
Impact
TYPE
WIDTH
LENGTH
AREA
AREA
TYPE
AREA
AREA
leave blank
leave blank
leave blank
unique identifier
being
impacted
TYPE
dd nad83
dd nad83
temp / perm
linear feet
linear feet
sqare feet
square feet
temp /
perm
square feet
square feet
Stream 1
Stream
Perennial
41.7710519 -77.1526930 Excavation
UNT
CWF
Temp
6
110
713
N/A
Temp 2201
N/A
Wetland 1
Wetland Paulstine Emergent (PEM) 42.6895100 -76.1539500
Boring
WETLAND
OTHER
N/A
N/A
N/A
N/A
N/A
Perm
N/A
300
Wetland 2
Wetland Paulstine Emergent (PEM) 42.7026800 -76.1546200
Fill
WETLAND
OTHER
Perm
N/A
N/A
N/A
83
Perm
N/A
83
PADEP / 105 area
PADEP Impact Type:
Floodway Impact:
Wetland Impact:
Wetland Impact:
AREA
provide a unique identifier for each regulated structure and/or activity being proposed, typically a name and number;
Structure / Activity Identifier:
Aquatic Resource:
Aquatic Resource Type:
Latitude
(nad 83)
:
Waters Name:
PA Code Chapter 93 Designation:
Corps / 404 area
Stream Impact:
Corps Impact Type:
for Pennsylvania Chapter 105 Water Obstruction and Encroachment application/registration and US Army Corps of Engineers Section 404 application
Please begin to complete the Aquatic Resource Impact Table by including the Applicant's Name / Client (upper right of the page) for each page. Also, complete the Project / Site Name (upper left of the page) and the
date of application/registration package submission (upper right, under Applicant's Name / Client). Then complete 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 column below; add additional worksheets if needed. Provide completed Aquatic Resource Impact Table with Chapter 105 Water
Obsruction and Encroachment application/registration;
DO NOT submit instructions (page 1) for this table.
Longitude
(nad 83)
:
Work proposed / impact type:
Project Information
Project / Permit Number
Single and Complete Project Number:
Crossing Number:
DEP Permit Number:
Project / Site Name:
Example Project
July 1, 2016
DEP / Corps use only
Project Information
Corps / 404
PADEP / 105
Single and
Complete
Project
PADEP
Permit
Number
Structure /
Activity
Aquatic
Resource
Aquatic Resource
Crossing
Number
Latitude
Longitude
Work
Proposed /
Impact Type
Waters Name
PA Code
Chapter 93
Designation

3150-PM-BWEW0557 7/2016
Aquatic Resource Impact Table
Applicant's Name / Client: ________________________________________
Date:
Corps Impact
Stream
Impact
Stream
Impact
Stream
Impact
Wetland
Impact
DEP
Impact
Floodway
Impact
Wetland
Impact
TYPE
WIDTH
LENGTH
AREA
AREA
TYPE
AREA
AREA
leave blank
leave blank
leave blank
unique identifier
being
impacted
TYPE
dd nad83
dd nad83
temp / perm
linear feet
linear feet
square feet
square feet
temp /
perm
square feet
square feet
Project Information
Corps / 404
PADEP / 105
Single and
Complete
Project
Project / Site Name:
PADEP
Permit
Number
Longitude
Aquatic
Resource
Structure /
Activity
DEP / Corps use only
Crossing
Number
PA Code
Chapter 93
Designation
Waters Name
Work
Proposed /
Impact Type
Aquatic Resource
Latitude

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