2023_Annual Reclamation Report_94-17

Action History(UTC-05:00)
Submit by Anonymous User 8/19/2024 4:45:52 PM (Start)
Approve by Adam.Parr 8/22/2024 9:57:08 AM (ARR Review-94-17 Cross Road Sand Pit)
• The task was assigned to DEMLR Mining ARR Team.The due date is:September 2,2024 5:00 PM
8/19/2024 4:46:06 PM
• Adam.Parr reassigned the task to Adam.Parr 8/22/2024 8:28:09 AM

2023 Annual Reclamation Report
Complete and submit by September 1,2024
N.C. Department of Environmental Quality-Division of Energy,Mineral,and Land Resources
GENERAL INFORMATION
Mining Permit No.(?)
94-17
Once the permit number is entered,click outside the field box to prompt more information to pre-populate
Release Date(If Applicable) Original Issued Date Mine Data Current as of:
06/21/1999 07/30/2024
Legal Corporate/Owner Name"
David Keith Davenport
Mine Name*
Cross Road Sand Pit
Mine Address(You Must Enter)*
(The 911 Address)
Street Address
Off Cross Road SR 1301
Address Line 2
City State/Province/Region
Roper NC
Postal/Zip Code
27970
County* River Basin*
Washington Pasquotank
Dropdown list Dropdown list
County Prefix Code*
94
Variable available for repository routing
Facility Coordinates:
Latitude:* Longitude:
35.91920 -76.63170
Responsible Official/Authorized Contact Information:
Name and Title*
Ken Elliott,consultant

Mailing Address`
PO Box 112,Aydlett,NC 27916
Primary Phone No.* Secondary Phone No.
252-339-9021
E-mail Address*
[e-mail]
Invoice Contact Information:
(Contact info from above is carried below-please revise if needed)
Name and Title*
David Keith Davenport
Mailing Address*
P O Box 164,Plymouth,NC 27962
Primary Phone No.* Secondary Phone No.
252-809-2172
E-mail Address*
[e-mail]
Is the site Active?*
Yes No
If the mine is now inactive,when did mining stop?* Is this stoppage permanent?*
01/03/2013 Yes No
(If yes)Do you wish to have this mine site released from your reclamation bond?*
Yes No
Is the map on file current?*
Yes No
Check here if no reclamation was completed in 2023
State and describe the amount and type of reclamation carried out in 2023 calendar year:
1.0 acre to complete reclamation of site.
List by category the total amount of disturbed and unreclaimed land present at this site at the end of the 2023 calendar year:
Tailings Ponds* Stock Piles* Waste Piles*
0.0 0.0 0.0
Acres Acres Acres(WASTE PILES should include
overburden storage/disposal areas and
berms)

Plant Area* Mine Excavation* TOTAL DISTURBED AREA*
0.0 0.0 0.0
Acres Acres Acres(Calculated Sum)
Is there any other supplemental information you want to upload to submit with this report?
Must be.pdf format(Max size 100 MB each)
(If applicable)Please explain additional attachments that were uploaded:
NEW DISTURBANCE ESTIMATES FOR 2024
Check here if no new acreage to be affected in 2024
Certification and Signature*
By checking the box and signing box below, I certify that:
• I have given true,accurate,and complete information on this Annual Reclamation Report form and in the uploaded map document(s);
• I agree that submission of this Annual Reclamation Report Upload form is a"transaction"subject to Chapter 66,Article 40 of the NC
General Statutes(the"Uniform Electronic Transactions Act');
• I agree to conduct this transaction by electronic means pursuant to Chapter 66,Article 40 of the NC General Statutes(the"Uniform
Electronic Transactions Act');
• I understand that an electronic signature on this form has the same legal effect and can be enforced in the same way as a written
signature;
• I intend to electronically sign and submit this Annual Reclamation Report form;AND
• I have the authority to submit this Annual Reclamation Report on behalf of this Mining Permittee.
Signature of Responsible Official/Authorized Contact:* Date*
08/19/2024
G�Vwwmr &ZZ"_
Type Name* Title
Kenneth Elliott Consultant
Email Confirmation will be sent to:
[e-mail],[e-mail]
Additional E-mail Contact for Confirmation(if desired)
This submission is associated with Business Process Instance ID 213206.