Exploration rehabilitation and relinquishment report

Transcription

1 Form EDG13 Exploration rehabilitation and relinquishment report Mining Act 1992 and Petroleum (Onshore) Act 1991 April 2016 v2.1 More information For help with lodging this application, or for more information, contact: Division of Resources and Energy Environmental Sustainability Unit Phone minres.environment@industry.nsw.gov.au State of New South Wales through the NSW Department of Industry, Skills and Regional Development. ABN: This publication is copyright. You may download, display, print and reproduce this material providing that the wording is reproduced exactly, the source is acknowledged, and the copyright, update address and disclaimer notice are retained. The information contained in this publication is based on knowledge and understanding at the time of writing. However, because of advances in knowledge, users are reminded of the need to ensure that information upon which they rely is up to date and to check currency of the information with the appropriate officer of the NSW Department of Industry, Skills and Regional Development or the user s independent advisor. Privacy statement This information is collected by the Department of Industry, Skills & Regional Development (NSW Department of Industry) for the purposes of assessing an application for an authorisation or associated with an authority as required by the Mining Act 1992, Mining Regulation 2010, Petroleum (Onshore) Act 1991 and Petroleum (Onshore) Regulation This information may also be used by the department to confirm applicant details in the event that subsequent applications are made, and may also be used to establish and maintain databases to assist the department with its work generally. Except for purposes required by law, the information will not be accessed by any third parties in a way that would identify the person without the consent of that person. You may apply to the department to access and correct any information the department holds if that information is inaccurate, incomplete, not relevant or out of date.

2 When to use this form Complete this form if you are submitting a Rehabilitation and Relinquishment Report for an exploration authorisation issued under the Mining Act 1992, or exploration title issued under the Petroleum (Onshore) Act In this form, an authorisation or title is referred to collectively as an authority. An Exploration Rehabilitation and Relinquishment Report is generally required: To seek formal confirmation from the department that rehabilitation following exploration has been successful (i.e. complies with the authority conditions; has met the rehabilitation objectives and completion criteria; and the landholder is satisfied with the standard of rehabilitation). This can include partial/progressive rehabilitation or the completion of all rehabilitation activities (regardless of whether or not a change to the associated security deposit is also sought). To seek a review of the security deposit following completion of exploration. This can include where rehabilitation has been partially or fully completed and a partial or full return of the security deposit is sought (Note: A security deposit is required to be provided and maintained to secure funding for the fulfilment of obligations under the authority, including obligations under the authority that may arise in the future. For further information refer to the department s ESG1: Rehabilitation Cost Estimate Guidelines). This form has been prepared and approved in accordance with the Mining Act 1992, Mining Regulation 2010, Petroleum (Onshore) Act 1991 and Petroleum (Onshore) Regulation The information requested in this form may not be specifically referenced in the Mining Act 1992, Mining Regulation 2010, Petroleum (Onshore) Act 1991 and Petroleum (Onshore) Regulation 2007, however its inclusion in the approved form validates the authority of the NSW Department of Industry, Division of Resources and Energy (the department) to request it. If there is insufficient room in the fields please provide the information as an attachment. Important notes The department will use the information provided in this form and your Rehabilitation and Relinquishment Report to determine whether rehabilitation has been completed to the department s satisfaction, and that it complies with your authority conditions. The department will then determine whether the associated security deposit, or part thereof, can be returned (where relevant). This process may occur following the completion of progressive rehabilitation or at the completion of rehabilitation. In general, rehabilitation should be consistent with accepted best practice, the authority conditions and the terms of any exploration activity approval. While not mandatory, rehabilitation should also be undertaken to the landholder s satisfaction. Before you complete this form Read the Exploration Code of Practice: Rehabilitation before completing this form. This Code sets out mandatory requirements and provides authority holders with guidance regarding the expected performance to ensure that exploration is undertaken in a manner that manages and minimises risk and achieves sustainable rehabilitation outcomes. If your authority does not include a condition requiring compliance with the Rehabilitation Code, the Code should nonetheless be followed as a best practice guideline. PUB16/186 V15/5289#10 Version 2.1, April

3 How to submit this form By Send the form and any attachments to By mail: Mail your form and any attachments to Division of Resources and Energy, Environmental Sustainability Unit, PO Box 344, Hunter Region Mail Centre NSW In person: Submit your application in person at the Division of Resources and Energy s Environmental Sustainability Unit, 516 High Street, Maitland, New South Wales. Office hours are 9.30am to 4.30pm. How this application will be processed Once your application has been registered and checked, it will be assessed by the department. The Minister for Resources and Energy (or their delegate) will consider the department s recommendation and all relevant information, when making a determination. PUB16/186 V15/5289#10 Version 2.1, April

4 1 Authority details Authority number (e.g. EL, AL, PEL) Authority expiry date Act 2 Authority holder/s details Provide the full name of authority holder/s and if applicable, the ACN or ARBN (for foreign companies). Name ACN / ARBN Registered street address Postal address Same as above Enter here if different Name ACN / ARBN Registered street address Postal address Same as above Enter here if different Name ACN / ARBN Registered street address Postal address Same as above Enter here if different Additional authority holders Provide the full name, ACN or ARBN (for foreign companies), registered street address and postal address details of additional authority holders. PUB16/186 V15/5289#10 Version 2.1, April

5 3 Contact for this application Any correspondence relating to this application will be sent to this person. Contact name Position held Company Postal address Phone (inc. area code) Mobile Your preferred contact method (for companies provide a generic company address which is regularly monitored rather than an individual employee s address.) Mail 4 Landholder approval of rehabilitation Indicate below if a Landholder Rehabilitation Statement* has been sent, received and/or attached *See template at the end of this form. Property details Landholder / Contact Phone Status of any Landholder Approval / Landholder Rehabilitation Statement Sent Verbal Attached PUB16/186 V15/5289#10 Version 2.1, April

6 5 Rehabilitation reporting requirements Attach a Rehabilitation and Relinquishment Report which contains the following information: 5.1 Plan/s Attach a plan/s which shows: Authority and landholder boundaries Land use The location of each surface disturbing activity, or activities if closely grouped, including drillholes The relationship of exploration activities to natural features and improvements 5.2 Description of surface disturbance activities For each surface disturbing activity, or activities if closely grouped, attach descriptions of: The surface disturbing activity itself Pre-activity slope, landform and vegetation Nature and extent of vegetation and ground disturbance caused by the activity, including photographs Capping and sealing details of drillholes For sealed or filled boreholes, the contractor s name and address. Attach documents from the contractor describing sealing works undertaken and amounts of sealant used (refer to EDG01: Borehole Sealing Requirements on Land and EDG02: Borehole Sealing Requirements on the Beds of Water Bodies for specific requirements for coal operations). Rehabilitation works undertaken including, if applicable, spoil disposal, reshaping, topsoil placement, vegetation, weed control, post rehabilitation erosion control For any disturbance not fully rehabilitated, the nature of remaining disturbance, the reason rehabilitation is not required or has not been undertaken, and partial rehabilitation or stabilisation works undertaken Rehabilitation outcomes, including photographs of rehabilitation success and photographs of remaining disturbances 5.3 Landholder/occupier support documents A signed letter from each landholder whose land has been disturbed to indicate the landholder s satisfaction with rehabilitation. While not mandatory, landholder sign off letters may expedite the department s assessment process. A Landholder Rehabiltation Statement template is provided at the end of this form. 5.4 Statutory Declaration The attached statutory declaration. PUB16/186 V15/5289#10 Version 2.1, April

7 6 Declaration This form should be signed by the authority holder/s or an authorised representative. I/We certify that the information provided in this application is true and correct. I/We understand that under Part 5A of the Crimes Act 1900, knowingly giving false or misleading information is a serious offence; and under Section 378C of the Mining Act 1992, any person who provides information that the person knows to be false or misleading is guilty of an offence, for which they may be subject to prosecution. Declaration by authority holder/s Authority Holder Name Position/title Date Authority Holder Name Position/title Date Authority Holder Name Position/title Date OR Declaration by agent authorised to act for this authority holder Provide evidence of appointment by the authority holder/s (must be attached). Name Position/title Date PUB16/186 V15/5289#10 Version 2.1, April

8 Office use only Application received: Time: Date: Received under delegation from the Secretary Name Document control Authorised by: Executive Director, Compliance and Enforcement RM8 Reference: PUB16/186 V15/5289#10 Amendment schedule Date Version # Amendment May Corrected typographical error at Q3 and additional option at point 9 of Statutory Declaration April Template and contents updated PUB16/186 V15/5289#10 Version 2.1, April

9 Statutory declaration New South Wales Oaths Act 1900 Eighth Schedule I,... of... in the State of New South Wales, solemnly and sincerely declare as follows: 1. I am the duly appointed Exploration Project Manager for Exploration Licence.. [number]. 2. I am authorised to make this Declaration on behalf of the Exploration Licence Holder,.(name of licence holder), A.C.N All operations carried out under the Exploration Licence comply with the conditions of the Title. 4. Those operations also comply with the conditions of all other relevant Government Agency approvals and Licences granted in respect of them. 5. Details of all drillholes, excavations and other surface disturbances made by the Exploration Licence Holder within the area of the Title are described in the attached report. 6. I confirm that all of the works referred to in the previous paragraph lie wholly within the area of the Exploration Licence. I also confirm that the details contained in the attached report are true, complete and accurate. 7. The exploration activities listed in the attached report have been rehabilitated as described and in accordance with: (a) the conditions of the Exploration Licence; (b) any directions from an Inspector of Mines or Environmental Officer; (c) the conditions of any other applicable Government Agency approval or licence. 8. Any works not rehabilitated are listed and described in the attached report. I confirm that the reasons for not doing so are true and correct. 9. On the basis of the evidence contained in this Declaration, I request cancellation of the Exploration Licence and/or [delete as necessary] refund of the security deposit held by the Department and/or [delete as necessary] confirmation that rehabilitation has been completed to the satisfaction of the Department. And I make this solemn Declaration, conscientiously believing the same to be true and by virtue of the provisions of the Oaths Act Declared at... in the State of New South Wales on.... day of... in the year... (sgd)... in the presence of an authorised witness, who states: I,... a... [name of authorised witness] [qualification of authorised witness] certify the following matters concerning the making of this statutory declaration by the person who made it: [* please cross out any text that does not apply] * I saw the face of the person OR *I did not see the face of the person because the person was wearing a face covering, but I am satisfied that the person had a special justification for not removing the covering, and * I have known the person for at least 12 months OR *I have not known the person for at least 12 months, but I have confirmed the person s identity using an identification document and the document I relied on was [describe identification document relied on] [signature of authorised witness] [date] PUB16/187 Version 2.1, April 2016

10 Landholder Rehabilitation Statement When signed, this statement confirms that land disturbed by activities during the course of the exploration authority/title has been rehabilitated to the satisfaction of the affected landholder/occupier. Provided that the authority/title holder has rehabilitated exploration disturbance on your property to your satisfaction, sign and return this statement to the authority/title holder. The authority/title holder will attach it to the Exploration Rehabilitation and Relinquishment Report required by the department. The information will be used by the department, to determine the authority/title holder s compliance with the obligations of the exploration authority/title. If rehabilitation is not to your satisfaction, do not sign this statement and discuss outstanding issues with the authority/title holder. If you cannot reach an agreement or you have any queries contact the department. 1 For exploration authority/title holder to complete Authority number (e.g. EL01, AL02, PEL 03) Name of authority holder ACN / ARBN Registered street address Postal address Same as above Affected property Affected property name Affected property address 2 For landholder to complete I am satisfied with the state in which the exploration authority/title holder has left my property and the standard of rehabilitation which has been achieved. Landholder name Property name Property address Phone (inc. area code) Date PUB16/185 Version 2.0, April 2016