20230109_Application_16-44

CAROLINA GEOLOGICAL SERVICES, INC.
January 6, 2023
Mr. Adam Parr, PE
NCDEQ, Land Quality Section
1612 Mail Service Center
Raleigh, NC 27699
Subject: Modification Permit# 16-44, Otway Sand Mine
Dear Mr. Parr;
On behalf of Otway Sand Mine, Inc, I am submitting this application for modification of
the above-referenced Mining Permit. As we have discussed, this is the same
modification that was submitted in 2019 (and subsequently approved), but the new
reclamation bond was never posted. This application uses the same site plan and
information as was previously submitted.
This request does not add acreage to the permitted area but expands the"mining area"
into a previous buffer area. This will add 4.15 acres to the "mining area". There are no
wetlands or streams within this area.
This modification request also includes allowing concrete to be brought onsite for
crushing and recycling for re-sale. This will occur in the present "stockpile" area, so no
new acreage is affected.
Mining will continue as in the existing permit and will be contiguous to the existing mining
area. All runoff remains within the mining area and ponds and is periodically pumped as
necessary.
Please let me know if you have any questions or need additional information.
Sincerely,
James C. Izzell, Jr., PG RECEIVED
JAA 0 9 zon
LAND QUALITY
MINING PROGRAM
PO Box 429 GARNER, NC 27529

i
NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
NOTE:it is recommended that you contact the appropriate Regional Office or the Raleigh Central Office for a PRE.
APPLICATION MEETING to discuss your intentions and address any questions.
1. Name of Mine Otway Sand Mine (# 16-44)
County Carteret River Basin White Oak
Latitude(decimal degrees to four
places) 34.7741
Longitude(decimal degrees to four
places) -76.5527
2. Name of Applicant Otway Sand Mine, Inc.
Applicant Contact Berkley Gillikan Consultant Contact James Izzell
Applicant Email [e-mail] Consultant Email [e-mail]
Telephone Telephone
Cell Phone [phone] Cell Phone [phone]
3. Permanent Address for Receipt of
Official Mail* 171 Alvie Lane, Beaufort, NC 28516
4. Mine Office Address
5. Mine Manager Berkley Gillikin
Mine Manager Email
Telephone Cell Phone
I certify that all details contained in this permit application are true and correct to the best of our knowledge.We
fully understand that any willful misrepresentation of facts will be cause for permit revocation.
Signature** '6ADate
Print Name ,3�-11
Title
*This will be the name that the mining permit will be issued to and the name that must be indicated on the reclamation bond(security)that
corresponds to this site.
"The Division of Energy,Mineral,and Land Resources must be notified of any changes in the permanent address or telephone number.
***Signature of company officer required.
G.S.74-51 provides that the Department shall grant or deny an application for a permit within 60 days of receipt of a complete
application or,if a public hearing is held,within 30 days following the hearing and the filing of any supplemental information
required by the Department.All questions must be addressed,and all required maps provided before this application can
be considered complete.Attach additional sheets as needed.
Revised July 13,2021 P a g e l

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
NOTE:All the following questions must be thoroughly answered regarding your mining operation for the intended
life of the mine.All responses must be clearly conveyed on a corresponding,detailed mine map.
A.GENERAL CHARACTERISTICS OF THE MINE
1. Answer all the following that apply:
F� This is an application for a NEW permit.
Indicate the total acreage at the site to be covered by the permit
(This is the acreage the new permit fee will be based upon.)
Of this acreage,how much is owned and how much is leased?
Acres owned: Acres leased:
Property owner if leased:
® This is an application for a MODIFICATION to a mining permit.
Mining Permit Number: 16.44 Total permitted acreage: 33.70
Does the modification involve acreage within the previously approved permitted boundary?
©YES �NO
If yes,indicate the acreage to be covered by this modification 4.15
Does the modification involve acreage outside the previously approved permitted boundary?
1-1 YES 7NO
If yes,indicate the additional acreage to be covered by this modification
NOTE:You must complete all of Section F of this application form entitled Notification of Adjoining
Landowners
Of the acreage to be added to the permit,will any portion be affected(i.e.:disturbed,ground cover
removed)by the mining operation?
- - F]YES - 7NO If yes,indicate the acreage to be affected within the acreage to be added to the permit
The modification fee is based upon the proposed new affected acreage within the previously
approved permitted boundary plus the proposed total acreage to be added outside the previously
approved permitted boundary.
This is an application for TRANSFER of a mining permit.
Mining Permit Number: Total permitted acreage:
Revised July 13, 2021 P a g e 12

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
NOTE:All the following questions must be thoroughly answered regarding your mining operation for the intended
life of the mine.All responses must be clearly conveyed on a corresponding,detailed mine map.
A.GENERAL CHARACTERISTICS OF THE MINE
1. Answer all the following that apply:
F-1 This is an application for a NEW permit.
Indicate the total acreage at the site to be covered by the permit
(This is the acreage the new permit fee will be based upon.)
Of this acreage,how much is owned and how much is leased?
Acres owned: Acres leased:
Property owner if leased:
FX-] This is an application for a MODIFICATION to a mining permit.
Mining Permit Number. 16.44 Total permitted acreage: 33.70
Does the modification involve acreage within the previously approved permitted boundary?
AYES �NO
If yes,indicate the acreage to be covered by this modification 4.15
Does the modification involve acreage outside the previously approved permitted boundary?
YES FINO
If yes,indicate the additional acreage to be covered by this modification
NOTE:You must complete all of Section F of this application form entitled Notification of Adjoining
Landowners
Of the acreage to be added to the permit,will any portion be affected(i.e.:disturbed,ground cover
removed by the mining operation? -1 YES NO
If yes,indicate the acreage to be affected within the acreage to be added to the permit
The modification fee is based upon the proposed new affected acreage within the previously
approved permitted boundary plus the proposed total acreage to be added outside the previously
approved permitted boundary.
This is an application for TRANSFER of a mining permit.
Mining Permit Number: Total permitted acreage:
Revised July 13, 2021 P a g e 12

r
NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
MINING FEE SCHEDULE
A nonrefundable permit application processing fee when filing for a new mining permit,permit modification,or transferred permit is
required as follows:
APPLICATION TYPE 0—25 ACRES 26+ACRES
New Permit Applications $3,750.00 $5,000.00
Permit Modifications $750.00 $1,000.00
Permit Transfers $100.00 $100.00
Annualoperating Fee $400.00 $400.00 771
Acres for new permits means the total acreage at the site to be covered by the permit.Acres for modification of permits means the
new affected acres within the previously approved permitted boundary plus the proposed total acreage to be added outside the
previously approved permitted boundary.
2. Name of all materials mined: sand
3. Mining Method:
Hydraulic Dredge ElFront-end Loader&Truck a Shovel&Truck
Dragline&Truck ❑Self.loading Scraper
Other(please explain):
4. Expected maximum depth of mine(feet) 30
Depth is relative to what benchmark?(e.g.,natural ground level,mean seal level,road elevation,etc.)
natural ground level
Expected average depth of mine(feet) 30
5. Has E
rea at this site been mined in the past?
YES NO R
If yes,when and by whom was this activity conducted?applicant. current permit
6. Estimated life of the operation(years): 5
NOTE:The Department may request clarification on how life of mine was calculated.
Revised July 13, 2021 P a g e 3

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
B.MAPS
1. Clearly mark and label the location of your mining operation on six(6)copies of a 7.5-minute quadrangle and a county
highway map.These maps,in addition to six(6)copies of all mine maps and reclamation maps,must be submitted
with each permit application.
7.5-minute quadrangles may be obtained from the N.C.Geological Survey:
Mailing Address Physical Address
1612 Mail Service Center 512 N.Salisbury St.,5th Floor
Raleigh,NC 27699-1612 Raleigh,NC 27604
Http://Portal.ncdenr.o[g/web/Ir/geological home [phone]
County highway maps may be obtained from the N.C.Department of Transportation:
Mailing Address Physical Address
NCDOT GIS Unit NCDOT GIS Unit
1587 Mail Service Center 3401 Carl Sandburg Court
Raleigh,NC 27699-1587 Raleigh,NC 27610
http://www.ncdot.rg/iUgis [phone]
2. A table/chart must be provided on the mine map that clearly lists the approximate acreage of tailings/sediment ponds,
stockpiles,waste piles,processing areas/haul roads,mine excavations and any other major aspect of the mining
operation that is proposed to be affected/disturbed during the life of the mining permit.A table/chart similar to the
following will be acceptable:
AFFECTED ACREAGE TABLE:
For new permits,complete only the total affected acreage column.
For modifications,complete all columns.
CATEGORY CURRENT AFFECTED PROPOSED CHANGE TO TOTAL AFFECTED
ACREAGE AFFECTED ACREAGE ACREAGE
Tailings/Sediment Ponds 0.08 0.00 0.08
Stockpiles 0.02 0.00 0.02
Waste piles 1.38 0.00 1.38
Processing Areas/Haul Roads 0.92 0.00 0.92
Mine Excavations 20.70 4.15 24.85
Other(Please explain) 3.80 3.80
Total Affected Acreage 26.90 4.15 31.05
Total Permitted Acreage 33.70 1 1 33.70
Revised July 13, 2021 P a g e 14

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
3. Mine maps must be accurate and appropriately scaled drawings,aerial photographs,or enlarged topographic maps of
the entire mine site.All aspects of the mine site must be clearly labeled on the maps along with their
corresponding(approximate)acreage.Thus,all mine and reclamation maps must denote those activities that
are intended to be conducted during the life of the mining permit.All maps must be of a scale sufficient to clearly
illustrate the following,at a minimum:
a) Property lines of the tract or tracts of land on which the proposed mining activity is to be located including
easements and rights-of-way.
b) Existing or proposed permit boundaries with geographic controls(e.g.metes and bounds,coordinates)labeled
c) Initial and ultimate limits of clearing and grading
d) Outline and width of all buffer zones(both undisturbed and unexcavated)
e) Outline and acreage of all pits/excavations
f) Outline and acreage of all stockpile areas
g) Outline and acreage of all temporary and/or permanent overburden disposal areas
h) Location and acreage of all processing plants(may be described as to location and distance from mine if
sufficiently far removed)
i) Locations and names of all streams,rivers,and lakes
j) Outline and acreage of all settling and/or processing wastewater ponds
k) Outline and acreage of all planned and existing access roads and on-site haul roads
1) Location of planned and existing on-site buildings
m) Location and dimensions of all proposed sediment and erosion control measures
n) Location of 100-year floodplain limits and wetland boundaries
o) Names of owners of record,both public and private,of all tracts of land that are adjoining the mining permit
boundary;if an adjoining tract is owned or leased by the applicant or is owned by the lessor of the mine tract,
names of owners of record of tracts adjoining these tracts that are within 1,000 feet of the mining permit boundary
must be provided on the mine map.
p) Names of owners of record,both public and private,of all tracts of land that are adjoining the mining permit
boundary which lie directly across and are contiguous to any highway,creek,stream,river,or other watercourse,
railroad track,or utility or other public right-of-way.If an adjoining tract is owned or leased by the applicant or is
owned by the lessor of the mine tract,names of owners of record of tracts adjoining these tracts,that are within
1,000 feet of the mining permit boundary,must be provided on the mine map(s).NOTE:"Highway"means a road
that has four lanes of travel or less and is not designated as an Interstate Highway.
q) Map legend
1) Applicant name 5) Scale
2) Mine name 6) Symbols used and corresponding names
3) North arrow 7) Date prepared and revised
4) County 8) Name and title of person preparing map
Map scales should meet the following guidelines:
PERMITTED ACREAGE MAP SCALE
0—49 acres 1"=50'
50—199 acres 1"=100'
200+acres 1"=200'
NOTE:Smaller scaled maps may be acceptable if they clearly illustrate the above items.
NOTE:In addition to the above,the maps must also include any site-specific information that is provided in
the answers to the following questions(italicized questions/statements)in this application form.This
application will not be considered complete without all relevant items being adequately addressed on the mine
maps.
Revised July 13, 2021 P a g e 15

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
C.PROTECTION OF NATURAL RESOURCES
1. Describe in detail the sequence of events for the development and operation of the mine and reference the sequence
to the mine map(s).Attach additional sheets as needed.
This modification simply changes 4.15 acres of"buffer" into new"mining area"
and allows concrete to be brought onto site to be crushed and recycled. Mining
has been ongoing at this site for several years, and is well established.
Excavation will continue in the manner previously established and under current
operating conditions.
2. Describe specific erosion control measures to be installed prior to land disturbing activities and during mining to
prevent offsite sedimentation(include specific plans for sediment and erosion control for mine excavation(s),waste
piles,access/mine roads,and process areas),and give a detailed sequence of installation and schedule for
maintenance of the measures.Locate and label all sediment and erosion control measures on the mine maps)and
provide typical cross-sectionskonstruction details of each measure.Engineering designs and calculations are required
to justify the adequacy of any proposed measures.
A minimum of three sediment settling ponds are utilized for erosion control, as
indicated on the Mine Map. All runoff is directed into the mining area, and
retained by the ponds. Any disturbed areas will be graded so that runoff flows
into the mining area or ponds.
3. A)Will the operation involve washing the material mined,recycling process water,or other wastewater handling?
FYES FX]NO
If yes,briefly describe all such processes including any chemicals to be used.
B)will the operation involve discharging fresh or wastewater from the mine or plant as a point discharge to the waters
of the State?
FNO FX-1YES
if yes,briefly describe the nature of the discharge and locate all proposed discharge points(along with their method of
stabilization)on the mine map(s).
Fresh water discharged, as shown on mine map
Revised July 13, 2021 Page 16

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
C)Will any part of the proposed mine excavation(s)extend below the water table?
FX]YES NO
If yes,do you intend to dewater the excavation(s)?
FX]YES El NO
Estimated withdrawal rate in gallons per day: 25000.00
If yes,what impact,if any,will mine dewatering have on neighboring wells?Locate all existing wells on the mine
map(s)that lie within 500 feet of the proposed excavation area.Provide data to support any conclusions or statement
made,including any monitoring well data,well construction data,and current water withdrawal rates.Indicate whether
the proposed mine locale is served by a public water system or private wells.
Most water is pumped between existing ponds and retained onsite. However, it
is anticipated that water will be discharged approximately two days per week.
This mine has been in operation for nearly 20 years with no impact on area
groundwater.
D)If you answered yes to any of the above questions,provide evidence that you have applied for or obtained the
appropriate water quality permit(s)(i.e.,non-discharge,NPDES,Stormwater,etc.)from the Stormwater Program.In
addition,the applicant is required to register water use with the Division of Water Resources,Ground Water
Management Branch,if the operation withdraws more than 10,000 gallons per day and needs a capacity use permit
from the Division of Water Resources,Ground Water Management Branch,if the operation lies in a capacity use area
and withdraws more than 100,000 gallons per day.
Mine is currently covered by NPDES General Permit NCG020626
4. A)Will the operation involve crushing or any other air contaminant emissions?
EYES FiNO
If yes,indicate evidence that you have applied for or obtained an air quality permit issued by the Division of Air Quality
or local governing body.
Concrete will be crushed by contractor, who maintains necessary air quality
permits
B)How will dust from stockpiles,haul roads,etc.,be controlled?
Periodic spray with water as needed
Revised July 13, 2021 P a g e 17

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
5. A)A buffer will be required between any mining activity and any mining permit boundary or right-of-way.It may be an
unexcavated buffer(no excavation,but roadways,berms,and erosion&sedimentation control measures may be
installed within it),an undisturbed buffer(no disturbance within the buffer whatsoever),or a combination of the two,
depending upon the site conditions.Note that all buffers must be located within the mining permit boundaries.
How wide a buffer will be maintained between any mining activity and any mining permit boundary or right-of-way at
this site?A minimum buffer of 25 feet is recommended,although a wider buffer may be needed depending on site
conditions.Show all buffer locations and widths on the mine map(s).
As shown on the Mine Map, a 25 foot undisturbed buffer and a 25-30 foot
unexcavated buffer is maintained between the mining activity and mining permit
boundary.
B)A minimum 50 foot wide undisturbed buffer will be required between any land disturbing activities within the mining
permit boundaries and any natural watercourses and wetlands unless smaller undisturbed buffers can be justified.
Depending on site conditions,a buffer wider than 50 feet may be needed.
How wide an undisturbed buffer will be maintained between any land disturbing activities within the mining permit
boundaries and any natural watercourses and wetlands at this site?Show all buffer locations and widths on the mine
map(s).
There are no wetlands or streams onsite.
6. A)Describe methods to prevent landslide or slope instability adjacent to adjoining permit boundaries during mining.
Minimum 2 horizontal to 1 vertical slopes or flatter for clayey material and minimum 3 horizontal to 1 vertical slopes or
flatter for sandy material are generally required unless technical justification can be provided to allow steeper slopes.
Excavated slopes shall be 3:1 or flatter adjacent to permit boundaries, and
buffers shall be maintained as indicated on the Mine Map
B)Provide a cross-section on the mine map(s)for all M slopes(berms,waste piles,overburden disposal areas,etc.),
clearly indicating the intended side slope gradient,installation of any benches and/or slope drains(with supporting
design information)if needed,and the method of final stabilization.
Revised July 13, 2021 P a g e 18

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
C)In excavation(s)of unconsolidated(non-rock)materials,specify the angle of all cut slopes including specifications
for benching and sloping.Cross-sections for all cut slopes must be provided on the mine map(s).
3:1 above water, as shown on mine map
D)In hardrock excavations,specify proposed bench widths and heights in feet.Provide cross-sections of the mine
excavation clearly noting the angles of the cut slopes,widths of all safety benches and mine benches,and the
expected maximum depth of the excavation.
NIA
7. Describe other methods to be taken during mining to prevent physical hazard to any neighboring dwelling,house,
public road,or public,commercial or industrial building from any mine excavation.Locate all such structures on the
mine map if they are within 300 feet of any proposed excavation.
The proposed buffers in conjunction with the slopes will provide adequate
protection to prevent hazards to dwellings, roads, and buildings.
8. Describe what kind of barricade will be used to prevent inadvertent public access along any high wall area and when it
will be implemented.Vegetated earthen berms,appropriate fencing and adequate boulder barriers may be acceptable
high wall barricades.A construction detail/cross-section and location of each type of barricade to be used must be
indicated on the mine map(s).
There are no high-walls in this mine plan. A gate at the mine entrance prevents
inadvertent public access.
9. Are acid roducing minerals or soils present?
HYES FXINO
If yes,how will acid water pollution from the excavation,stockpiles,and waste areas be controlled?
Revised July 13, 2021 P a g e 19

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
10. A)Describe specific plans(including a schedule of implementation)for screening the operation from public view such
as maintaining or planting trees,bushes or other vegetation,building berms or other measures.Show the location of all
visual screening on the mine map(s)and provide cross-sections through all proposed berms or proposed spacing,
sizes and species for tree plantings.
Berms, natural vegetation, and remote location screen the operation from public
view
B)Could the operation have a significantly adverse effect on the purposes of a publicly owned park,forest,or
recreation area?If so,how will such effects(i.e.,noise,visibility,etc.)be mitigated?
No
11. Will r1sives;be used?
YES FX�NO
If yes,specify the types of explosive(s)and describe what precaution(s)will be used to prevent physical hazard to
persons or neighboring property from flying rocks or excessive air blasts or ground vibrations.Depending on the mine's
location to nearby structures,more detailed technical information may be required on the blasting program(such as a
third-party blasting study).Locate the nearest offsite occupied structure(s)to the proposed excavations)on the mine
map and indicate its approximate distance to the proposed excavation.
12. Will fuel tanks,solvents,or other chemical reagents be stored on-site?
YES 1NO
If yes,describe these materials,how they will be stored and method of containment in case of spill.Indicate the
location(s)of all storage facilities on the mine map(s).
Revised July 13, 2021 Page 110

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
D.RECLAMATION PLAN
1. Describe your intended plan for the final reclamation and subsequent use of all affected lands and indicate the
sequence and general methods to be used in reclaiming this land.This must include the method of reclamation of
settling ponds and/or sediment control basins and the method of restoration or establishment of any permanent
drainage channels to a condition minimizing erosion,siltation and other pollution. This information must be illustrated
on a reclamation map and must correspond directly with the information provided on the mine map(s).In addition,
design information,including typical cross-sections,of any permanent channels to be constructed as part of the
reclamation plan and the location(s)of all permanent channels must be indicated on the reclamation map.
Mining areas to be reclaimed as a lake. Side slopes will be graded to 4:1 or
flatter above water and 2:1 (or natural angle of repose) below water level. Any
disturbed areas will be graded to drain into ponds and seeded according to
schedule
2. Is an excavated or impounded body of water to be left as part of the reclamation?
X YES ]NO
If yes,illustrate the location of the body(s)of water on the reclamation map and provide a scaled cross-sections)
through the proposed body(s)of water.The minimum water depth must be at least 4 feet,measured from the normal
low water table elevation,unless information is provided to indicate that a shallower water body will be productive and
beneficial at this site.
Will the body(s)of water be stocked with fish?
YES FXINO
If yes,specify species.
3. Describe provisions for safety to persons and to adjoining property in all completed excavations in rock including what
kind of permanent barricade will be left.Acceptable permanent barricades are appropriate fencing,large boulders
placed end-to-end,etc.Construction details and locations of all permanent barricades must be shown on the
reclamation map.
NIA
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NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
4. Indicate the method(s)of reclamation of overburden,refuse,spoil banks or other such on-site mine waste areas,
including specifications for benching and sloping.Final cross-sections and locations for such areas must be provided
on the reclamation map.
No waste piles to be left in this operation
5. A)Describe reclamation of processing facilities,stockpile areas,and on-site roadways.
Graded and seeded according to revegetation plan
B)Will any on-site roadways be left as part of the reclamation?
RYES aNO
!f yes,identify such roadways on the reclamation map and provide details on permanent road and difch line
stabilization.
6. Describe the method of control of contaminants and disposal of scrap metal,junk machinery,cables,or other such
waste products of mining.(Note definition of refuse in The Mining Act of 1971.)
No off-site generated waste shall be disposed of on the mine site without prior written approval from the NC
Department of Environmental Quality,Division of Energy,Mineral,and Land Resources and either the Division
of Waste Management(DWM)or local governing body.If a disposal permit has been issued by DWM for the
site,a copy of said permit must be attached to this application.All temporary and permanent refuse disposal
areas must be clearly delineated on the mine map(s)and reclamation map,along with a list of items to be disposed in
said areas.
Any such waste will be removed from site
Revised July 13, 2021 Page 112

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
7. Describe your plan for revegetation or other surface treatment of the affected areas.This plan must include
recommendations for year-round seeding,including the time of seeding and the amount and type of seed,fertilizer,
lime and mulch per acre.The recommendations must include general seeding instructions for both permanent and
temporary revegetation.Revegetation utilizing only tree plantings is not acceptable.Recommendations can be sought
from:
a. Authorized representatives of the local Soil and Water Conservation District;
b. Authorized representatives of the NC Forest Service,Department of Agriculture and Consumer Services;
c. Authorized county representatives of the North Carolina Cooperative Extension Service,specialists and
research faculty with the Colleges of Agriculture and Life Sciences and Forest Resources at North Carolina
State University;
d. North Carolina licensed landscape architects;
e. Private consulting foresters referred by the NC Forest Service,Department of Agriculture and Consumer
Services;
f. N.C.Erosion and Sedimentation Control Planning and Design Manual;
g. N.C.Surface Mining Manual:A Guide for Permitting,Operation and Reclamation;
h. Others as may be approved by the Department.
Lime Rate of Application(tonslacre): see mine map
Fertilizer Analysis and Rate of Application(Ibs/acre): see mine map
Seed type(s)and rate(s)of application included year-round seeding schedule(ibslacre):
NOTE:Include legumes
SEED TYPES SEEDING DATES SEEDING RATES
see mine map
Mulch Type,Rate of Application(lbslacre),and Method of Anchoring:
Other Vegetative Cover(s)Type(s)and Rate(s)of Application Including Seeding Schedule(lbs/acre,trees/
acre,spacing of trees/shrubs,etc.):
Revegetation and/or reforestation plan approved by:
Signature Date
Print Name
Title
Agency
Revised July 13, 2021 P a g e 113

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
E.DETERMINATION OF AFFECTED ACREAGE AND BOND
The following bond calculation worksheet is to be used to establish an appropriate bond(based upon a range of$500 to$5,000
per affected acre)for each permitted mine site based upon the acreage approved by the Department to be affected during the
life of the mining permit.Please insert the approximate acreage,for each aspect of the mining operation,that you intend to affect
during the life of this mjgkg permit fin addition,please insert the appropriate reclamation cost(acre for each category from the
Schedule of Reclamation Costs provided with this application font)OR you can defer to the Department to calculate your bond
for you based upon your maps and standard reclamation costs:
CATEGORY AFFECTED RECLAMATION RECLAMATION
ACREAGE COSTIACRE COST
Tailings/Sediment Ponds 0.08 Ac. X $ 11500 /Ac. _ $ 120.00
Stockpiles 0.02 Ac. X $ 1,800 /Ac. _ $ 36.00
Waste Plies 1.38 Ac. X $ 2,000 /Ac. _ $ 2,760.00
Processing Area/Haul Roads 0.92 Ac. X $ 1,800 /Ac. _ $ 1,656.00
Mine Excavation 24.85 Ac. X $ 500 /Ac. _ $ 12,425.00
Other 3.80 Ac. X $ 19800 /Ac. _ $ 6,840.00
TOTAL AFFECTED AC.: 31.05 Ac.
TOTAL PERMITTED AC.: 33.70 Ac.
Temporary&Permanent Sedimentation&Erosion Control Measures:
Divide the TOTAL AFFECTED AC.above into the following two categories:a)affected acres that drain into proposed/existing
excavation and/or b)affected acres that will be graded for positive drainage where measures will be needed to prevent offsite
sedimentation and sedimentation to onsite watercourses and wetlands.
a) Internal Drainage 31.05 Ac.
b) Positive Drainage 0.00 Ac. X $1,500.00 = $ 0.00
SUBTOTAL COST:$ 23,837.00
Inflation Factor:
SUBTOTAL COST LIFE OF MINING OPERATION OR LIFE INFLATION COST
OF LEASE(YEARS)
0.02 X $ 23,837.00 X 5 = $ 2,383.70
Total Reclamation Bond Cost:
TOTAL RECLAMTION BOND COST= SUBTOTAL+INFLATION = $ 26,200.00
Round down to the nearest$100.00
NOTE:The reclamation bond cannot exceed$1 million per GS 74-54
Revised July 13, 2021 Page 114

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
SCHEDULE OF RECLAMATION COSTS
Based upon range of$500-$5,000 per affected acre
COMMODITY CODES:
SG Sand and/or Gravel DS Dimension Stone PF Pyrophyllite CL Clay/Shale
GS Gemstone FS Feldspar OL Olivine PE Peat
Borrow Borrow/fill dirt MI Mica KY Kyanite/Sillimanite/Andalusite AU Gold
CS Crushed Stone LI Lithium PH Phosphate TI Titanium
OT Other
TYPE T!S PONDS STOCKPILES WASTE PILES P.AREA/H.R. MINE EXCAVATION
SG,GS,Borrow $500/ac.(L) $1800/ac. $2000/ac. $1800/ac. $500/ac.(L)
1500(FI) 2000(PD)
CS,DS,FS,MI,Lit 500(L) 500(L)
PF,OL,KY 1500(FI) 1800 2000 2000 2500(PD)
1000(L) 2000(L)
PH 2500(FI) 2500 5000 5000 5000(PD)
1000(L) 2000(L)
CL 2500(FI) 2500 5000 5000 3700(PD)
1000(L) 2000(L)
PE,AU,TI,OT 2500(FI) 2500 3000 3500 5000(PD)
(L}=Reclamation to a lake and revegetating side slopes
(FI)=Reclamation by filling in and revegetating
(PD)=Reclamation by grading for positive drainage&revegetating
AS PER NCAC 15A 5B.0003,IF YOU DISAGREE WITH THE BOND AMOUNT DETERMINED BY THE BOND CALCULATION
WORKSHEET,YOU MAY SUBMIT AN ESTIMATE OF RECLAMATION COSTS FROM A THIRD-PARTY CONTRACTOR.
SAID ESTIMATE MUST BE PROVIDED WITHIN 30 DAYS TO THE FOLLOWING ADDRESS: Mining Program,1612 Mail
Service Center,Raleigh,North Carolina 27699.1612
ALL ESTIMATES MUST INCLUDE THE FOLLOWING,AS A MINIMUM:
•FINAL GRADING COSTS PER ACRE
•LIME AND FERTILIZER COSTS PER ACRE
•YEAR-ROUND SEEDING MIXTURE COSTS PER ACRE(FROM APPROVED REVEGETATION PLAN IN
APPLICATION/PERMIT DOCUMENT)
•MULCH AND ANCHORING COSTS PER ACRE
•ANY OTHER RECLAMATION COSTS NECESSARY TO COMPLY WITH THE APPROVED RECLAMATION PLAN
FOR THE SITE IN QUESTION
YOU WILL BE NOTIFIED AS SOON AS POSSIBLE OF THE DIRECTOR'S FINAL BOND DETERMINATION.
Revised July 13, 2021 Page 115

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
F.NOTIFICATION OF ADJOINING LANDOWNERS
The"Notice"form,or a facsimile thereof,attached to this application must be sent certified or registered mail,return receipt
requested,to:
(1)the chief administrative officer of each county and municipality in which any part of the permitted area is located as
indicated on the mine map(s);
(2)all owners of record,both public and private,of all tracts of land that are adjoining the mining permit boundary;if an
adjoining tract is owned or leased by the applicant or is owned by the lessor of the mine tract,all owners of record of
tracts adjoining these tracts must be notified(that are within 1,000 feet of the mining permit boundary)as indicated on
the mine map(s);and
(3)all owners of record,both public and private,of all tracts of land that are adjoining the mining permit boundary
which lie directly across and are contiguous to any highway,creek,stream,river,or other watercourse,railroad track,
or utility or other public right-of-way.If an adjoining tract is owned or leased by the applicant or is owned by the lessor
of the mine tract,all owners of record of tracts adjoining these tracts must be notified(that are within 1,000 feet of the
mining permit boundary)as indicated on the mine map(s)."Highway"means a road that has four lanes of travel or less
and is not designated as an Interstate Highway.
The only exception to the above method of giving notice is if another means of notice is approved in advance by the Director,
Division of Energy,Mineral,and Land Resources.
A copy of a tax map(or other alternative acceptable to the Department)must be mailed with the completed"Notice"form(the
proposed overall permit boundaries and the names and locations of all owners of record of lands adjoining said
boundaries must be clearly denoted on the tax map).
The"Affidavit of Notification"attached to this application must be completed,notarized and submitted to the Department,with the
remainder of the completed application form before the application will be considered complete.
NOTES:
THIS SECTION MUST BE COMPLETED FOR ALL APPLICATIONS FOR NEW MINING PERMITS AND ALL MODIFICATIONS
OF A MINING PERMIT TO ADD LAND TO THE PERMITTED AREA,AS REQUIRED BY NCGS 74-50(b1).
SEE THE NEXT TWO PAGES FOR THE"NOTICE"FORM AND THE"AFFIDAVIT OF NOTIFICATION"
Revised July 13, 2021 Page 116

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
NOTICE
Pursuant to provisions G.S.74-50(b1)of The Mining Act of 1971,Notice is hereby given that
has applied on to the Division of Energy,
(Applicant Name) (Date)
Mineral,and Land Resources,North Carolina Department of Environmental Quality,1612 Mail Service Center,Raleigh,North
Carolina 27699-1612,for(check one):
a new surface mining permit,
a modification of an existing surface mining permit to add land to the permitted area;or
F�a modification of an existing surface mining permit to add land to the permitted area with no disturbance in
the area proposed. Please note that future modification(s)may be submitted by the applicant to allow
disturbance within this area without re-notification of adjoining landowners.
The applicant proposes to mine on acres located
(Mineral,Ore) (Number) (Number)
miles of off/near road
(Direction) (Nearest town) (Number,Name)
in County.
*SEE ATTACHED MAP FOR PROPOSED PERMIT BOUNDARIES AND CORRESPONDING ADJOINING LANDOWNER
NAMES AND LOCATIONS*
In accordance with G.S.74-50(b1),the mine operator is required to make a reasonable effort,satisfactory to the Department,to notify all
owners of record,both public and private,of all tracts of land that are adjoining the mining permit boundary;if an adjoining tract is owned or
leased by the applicant or is owned by the lessor of the mine tract,all owners of record of tracts adjoining these tracts must be notified(that are
within 1,000 feet of the mining permit boundary).In addition,the mine operator must also notify the chief administrative officer of the county or
municipality in which any part of the permitted area is located. Any person may file written comment(s)to the Department at the above address
within thirty(30)days of the issuance of this Notice or the filing of the application for a permit,whichever is later. Should the Department
determine that a significant public interest exists relative to G.S.74-51,a public hearing will be held within 60 days of the end of the 30-day
comment period specified above.
A copy of the permit application materials is on file and available for public review during normal business hours at the above listed address as
well as at the appropriate regional office.For information regarding the specifics of the proposed mining activity,please contact the
applicant at the following telephone number:
For information on the mining permit application review process,please contact the Mining Program staff at(919)707-9220. Please note that
the Department will consider any relevant written comments/documentation within the provisions of the Mining Act of 1971 throughout the
application review process until a final decision is made on the application.
Addressee/Owner of Record's Name and Address Name of Applicant.Include Contact Person&Company Name,if Applicable
Date of Issuance of this Notice/Mailed to Addressee/Owner of Record Address of Applicant
Revised July 13, 2021 Page 117

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
AFFIDAVIT OF NOTIFICATION
10 ,an applicant,or an agent,or employee of an applicant,for a
new Mining Permit,or a modification of an existing Mining Permit to add land to the permitted area,from the N.C.Department of
Environmental Quality,being first duly swom,do hereby attest that the following are all known owners of record,both public and
private,of all tracts of land that are adjoining the mining permit boundary(including,where an adjoining tract is owned or leased
by the applicant or is owned by the lessor of the mine tract,all owners of record of tracts adjoining these tracts,that are within
1,000 feet of the mining permit boundary)and that notice of the pending application has been caused to be mailed,by certified or
registered mail,return receipt requested,to said owners of record at their addresses shown below,such notice being given on a
form provided by the Department:
Adjoining Landowner Name Address
Attach additional list if necessary.
I do also attest that the following individual is the chief administrative officer of the county or municipality in which any part of the
permitted area is located and that notice of the pending application has been caused to be mailed,by certified or registered mail,
return receipt requested,to said office at the following address:
Chief Administrative Officer Name Address
(i.e.:City Manager,County Manager,Mayor,etc.)
The above attestation was made by me while under oath to provide proof satisfactory to the Department that a reasonable effort
has been made to notify all known owners of record,both public and private,of all tracts of land that are adjoining the mining
permit boundary(including,where an adjoining tract is owned or leased by the applicant or is owned by the lessor of the mine
tract,all owners of record of tracts adjoining these tracts,that are within 1,000 feet of the mining permit boundary)and the chief
administrative officer of the county or municipality in which any part of the permitted area is located in compliance with N.C.G.S.
74-50(b1)and 15A NCAC 5B.0004(d).I understand that it is the responsibility of the applicant to retain the receipts of mailing
showing that the above notices were caused to be mailed and to provide them to the Department upon request.
Signature of Applicant or Agent Date
If person executing Affidavit is an agent or employee of an applicant,provide the following information:
Name of Applicant
Title of person executing Affidavit
I, ,a Notary Public of the County of ,
State of North Carolina,do hereby certify that appeared before me this
day and under oath acknowledged that the above Affidavit was made by him/her.
Witness my hand and notarial seal,this day of 20
Notary: My commission expires:
Revised July 13, 2021 P a g e 118

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
G.LAND ENTRY AGREEMENT
We hereby grant to the Department or its appointed representatives the right of entry and travel upon our lands or operation
during regular business hours for the purpose of making necessary field inspections or investigations as may be reasonably
required in the administration of the Mining Act of 1971 pursuant to G.S.74-56.
We further grant to the Department or its appointed representatives the right to make whatever entries on the land as may be
reasonably necessary and to take whatever actions as may be reasonably necessary in order to cant'out reclamation which the
operator has failed to complete in the event a bond forfeiture is ordered pursuant to G.S.74-59.
LANDOWNER: APPLICANT:
Signature Signature*
1
Print Name Berkl Gillikin Print Name Berkley Gillikin
Title(if applicable) owner Titre owner
Company(if applicable) Otway Sand Mine, Inc Company Otway Sand Mine, Inc
Address 171 Alvie Ln Mine Name Otway Sand Mine
Beaufort, NC 28516 Telephone 4 1 - 3
Telephone �2S2 2 It F0 4 Date Signed / _ 2 3
Date Signed 1 , 3 2
*Signature must be the same as the individual who signed Page 1 of this application.
One original and five(5)copies of the completed application,six(6)copies of all location maps,mine maps and
reclamation maps,and the appropriate processing fee in the form a check or money order payable to the North Carolina
Department of Environmental Quality must be sent to the Raleigh Central Office at the address listed on the front cover
of this application form.
Inquiries regarding the status of the review of this application should be directed to the Mining Program staff at(919)707-9220.
Revised July 13, 2021 Page 119

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