20210504_application_correction

APPLICATION FOR A MINING PERMIT
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
APPLICATION FOR A MINING PERMIT
(PLEASE PRINT OR TYPE)
1. Name of Mine Ballance Tract Mine County Currituck
River Basin Pasquotank RECEIVED
Latitude(decimal degrees to four places) 36.4596
Longitude(decimal degrees to four places) -76.1198 MAY 0 4 2021
2. Name of Applicant* APVA, LLC
3. Permanent address for receipt of official mail** 417 Caratoke Hwy., Unit D
Moyock, NC 27958
Telephone [phone] Alternate No. [phone]
4. Mine Office Address Caratoke Highway Moyock,NC 27958
Telephone [phone]
5. Mine Manager Countryscaves, LLC c/o Daniel Clay Cartwricht
6. E-mail Address: countrysopesclayna.hotmail.com
I certify that all details contained in this XtSpuit Application are true and correct to the best of our
knowledge. We fully understand th llful misrepresentation of facts will be cause for permit
revocation.
***Signature Date `Y z7 Z
Print Nam usti d
Title Reeistered Agent
* 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.
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APPLICATION FOR A MINING PERMIT
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 carry
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:
Signatu Si ature:*
Print ustin M. Old,Agent Print N e: n M. Old
(Title,if applicable)
Company APVA LLC Title: Registered Agent
(If applicable)
Address: 417 Caratoke Highway,Unit D Company: APVA,LLC
Moyock,NC 27958 Mine Name: Ballance Tract Mine
Telephone: [phone] Telephone: [phone]
Date Signed: 4v Z7 L/ Date Signed: `1 Z
*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(see next page for fee schedule)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
[phone].
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