20210224_Application

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APPLICATION FOR A MINING PERMIT
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
APPLICATION FOR A MINING PERMIT
(PLEASE PRINT OR TYPE)
1. Name of Mine Bent River Mine, Permit# 8-22 County Bertie
River Basin Roanoke
Latitude (decimal degrees to four places) 36.0955 RECEIVED
Longitude(decimal degrees to four places) -77.2573 F[B 2 4 1011
2. Name of Applicant* Commercial Ready Mix Products Inc. i pND QUALITY
MINING
3. Permanent address for receipt of official mail** PO Box 189, Winton,NC 27986
Telephone ( ) 252-358-5461 Alternate No. ( 1
4. Mine Office Address
Telephone ( )
5. Mine Manager Tim Newsome
6. E-mail address: Timn(aa)cnnpinc.com
I certify that all details contained in this Permit Application are true and correct to the best of our
knowledge.. We fully understa d that any willful misrepresentation of facts will be cause for permit
revocation.
***Signature Date 2-
Print Name %er-, N'Zws&-o k-
Title 0 1�
* 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
NOTE: All of 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 of the following that apply:
❑ If 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 that 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:
X If this is an application for a MODIFICATION to a mining permit, indicate the mining permit
number and the total (overall) acreage covered by the existing permit.
Mining Permit No.: 8-22 Total permitted acreage: 230
Does the modification involve acreage within the previously approved permitted boundary?
Yes X No❑. If yes,indicate the acreage to be covered by this modification(this is the acreage
that the "major modification" fee will be based upon): 0
Does the modification involve acreage outside the previously approved permitted boundary?
Yes No X. 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 this acreage to be added to the permit,will any portion of this acreage be affected(i.e.:disturbed,
round cover removed)by the mining operation? Yes No X(If no,a"minor modification"fee of
100.00 is required,despite the"undisturbed"acreage to be added). If yes,indicate the acreage to be
affected within the acreage to be added to the permit(the total acreage to be added to the permit is
the acreage that the "major modification" fee will be based upon):
If this is an application for TRANSFER of a mining permit,indicate the mining permit number and
the total (overall) acreage covered by the existing permit.
Mining Permit No.: Total permitted acreage: 230
SEE THE FEE SCHEDULE AT THE END OF THIS FORM FOR THE PROPER FEE AMOUNT TO BE
PAID FOR THE REQUESTED PERMIT ACTIONS) AND CORRESPONDING ACREAGE NOTED
ABOVE
2. Name of all materials mined: sand, soil
3. Mining method:
Hydraulic Dredge X Front-end Loader&Truck ❑ Shovel&Truck
Dragline &Truck ❑ Self-loading Scraper
Other(explain):
4. a. Expected maximum depth of mine(feet) 40
Depth is relative to what benchmark? (e.g., natural ground level, mean sea level, road elevation, etc.)
natural ground level
b. Expected average depth of mine (feet) 20
5. Has any area(s) at this site been mined in the past? Yes X No ❑
If yes, when and by whom was this activity conducted? under current permit
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APPLICATION FOR A MILTING PERMIT
6. Number of years for which the permit is requested (Life of the Mining Operation or Life of Lease from
Public Entity): 35
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 OR 512 North Salisbury Street, 5`h Floor
Raleigh, North Carolina 27699-1612 Raleigh, North Carolina 27604
[phone]
http://portal.ncdenr.org/web/lr/geological_ home
County highway maps may be obtained from the N.C. Department of Transportation:
North Carolina Department of Transportation—Geographic Information Systems (GIS)
Mailing Address: Physical Address:
NCDOT GIS Unit NCDOT GIS Unit
1587 Mail Service Center 3401 Carl Sandburg Court
Raleigh, North Carolina 27699-1587 Raleigh, North Carolina 27610
[phone]
http://www.ncdot.org/it/gis/
2. 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(see minimum requirements listed below)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.
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(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. Location 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.
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APPLICATION FOR A MINING PERMIT
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.
y. Map legend:
1. Name of applicant
2. Name of mine
3. North arrow
4. County
5. Scale
6. Symbols used and corresponding names
7. Date prepared and revised
S. Name and title of person preparing map
Map scales should meet the following guidelines:
PERMITTED ACREAGE MAP SCALE
0-49 Acres 1 inch=50 feet
50-199 Acres 1 inch= 100 feet
200+Acres 1 inch=200 feet
(NOTE: Smaller scaled maps may be acceptable if they clearly illustrate the above items)
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APPLICATION FOR A MINING PERMIT
A table/chart must be provided on the mine map that clearly lists the approximate acreage of tailings/sediment
ponds, stockpiles, wastepiles,processing area/haul roads,mine excavation 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:
CATEGORY AFFECTED ACREAGE
Tailings/Sediment Ponds
Stockpiles
Wastepiles
Processing Area/Haul Roads
Mine Excavation
Other(Explain)
Total Disturbed Acreage
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 IN
THIS APPLICATION FORM (PLEASE NOTE THE ITALICIZED QUESTIONS/STATEMENTS
THROUGHOUT THE FORM). THIS APPLICATION WILL NOT BE CONSIDERED COMPLETE
WITHOUT ALL RELEVANT ITEMS BEING ADEQUATELY ADDRESSED ON THE MINE MAPS.
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APPLICATION FOR A MINING PERMIT
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 is an active sand mine with mining already established. Mining will continue as per
current permit requirements. This modification request only allows discharge of pit water.
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 map(s) and provide typical cross-sections/construction details of each
measure. Engineering designs and calculations are required to justify the adequacy of any proposed
measures.
All stormwater runoff is held within the pit.
3. a. Will the operation involve washing the material mined, recycling process water, or other waste water
handling? Yes X No❑. If yes,briefly describe all such processes including any chemicals to be used.
Simple washing with water from the pit. Wash water is recycled through ponds
b. Will the operation involve discharging fresh or waste water from the mine or plant as a point discharge to
the waters of the State? Yes X No ❑. If yes,briefly describe the nature of the discharge and locate
all proposed discharge points(along with their method of stabilization) on your mine map(s).
This modification request will allow for occasional discharge of fresh water.
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APPLICATION FOR A MINING PERMIT
c. Will any part of the proposed mine excavation(s)extend below the water table?Yes X No ❑.
If yes, do you intend to dewater the excavation(s)? Yes X No ❑.
If yes,what impact,if any,will mine dewatering have on neighboring wells? Estimated withdrawal rate
in gallons per day: 1 million (max) . 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 statements
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.
There will be no impact on any water supply wells due to the relatively shallow excavation and
distance to any water supply wells.
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.
Application will be made for NPDES General Stormwater Permit for Mining,NCG020
4. a. Will the operation involve crushing or any other air contaminant emissions?Yes ❑ No X.
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.
b. How will dust from stockpiles, haul roads, etc.,be controlled?
Periodic spray with water as necessary
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APPLICATION FOR A MINING PERMIT
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).
A 50 foot buffer will be maintained between mining activity and permit boundaries. This is
divided into a 20 foot undisturbed and 30 foot unexcavated,as shown on mine map.
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).
A 50 foot buffer is maintained between any land disturbance and wetlands/watercourses.
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.
Slopes will be 3:1 or flatter,or in accordance with current Mining Permit requirements.
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APPLICATION FOR A MINING PERMIT
b. Provide a cross-section on the mine map(s)for all fill slopes (berms, wastepiles, 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.
There are no fill slopes in this plan
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 slopes,or as required in current permit requirements
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.
N/A
7. Describe other methods to be taken during mining to prevent physical hazard to any neighboring dwelling
house, public road,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.
There are no such structures within 300 feet of the excavation
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 detaillcross-section and location of each
type of barricade to be used must be indicated on the mine map(s).
Existing vegetation,buffers,and fencing prevent inadvertent public access
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APPLICATION FOR A MINING PERMIT
9. Are acid producing minerals or soils present? Yes ❑ No X.
If yes, how will acid water pollution from the excavation, stockpiles and waste areas be controlled?
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.
Natural vegetation and remote location prevent any 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 explosives be used? Yes ❑ No X.
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 excavation(s)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 X No .
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).
Any fuel storage tanks have required secondary containment
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APPLICATION FOR A MINING PERMIT
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.
As detailed in the existing mine plan/mining permit,the excavation will be left as a lake. All
disturbed areas will be graded to force runoff into lake and seeded according to schedule.
All requirements and provisions in the existing mining permit regarding reclamation will remain
2. Is an excavated or impounded body of water to be left as a part of the reclamation?Yes X No El.
If yes, illustrate the location of the body(s) of water on the reclamation map and provide a scaled
cross-section(s)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 more
shallow water body will be productive and beneficial at this site.
Will the body(s) of water be stocked with fish? Yes ❑ No X.
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.
N/A
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APPLICATION FOR A MILTING PERMIT
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.
N/A
5. a. Describe reclamation of processing facilities, stockpile areas, and on-site roadways.
N/A
b. Will any on-site roadways be left as part of the reclamation? Yes ❑ No X.
If yes, identify such roadways on the reclamation map and provide details on permanent road and ditch
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 materials will be temporarily stored on site and periodically hauled away.
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APPLICATION FOR A MINING PERMIT
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 (tons/acre):
FERTILIZER-ANALYSIS AND RATE OF APPLICATION(pounds/acre):
SEED - TYPE(S) AND RATE(S) OF APPLICATION INCLUDING YEAR-ROUND SEEDING
SCHEDULE(pounds/acre): [NOTE: Include Legumes]
Seed Types: Seeding Dates: Seeding Rates:
AS PER CURRENT REVEGETATION PLAN IN PERMIT
MULCH-TYPE AND RATE OF APPLICATION(pounds/acre)AND METHOD OF ANCHORING:
OTHER VEGETATIVE COVERS—TYPE (S)AND RATE(S) OF APPLICATION INCLUDING
SEEDING SCHEDULE (pounds/acre, trees/acre, spacing of trees/shrubs,etc):
Revegetation and/or reforestation plan approved by:
Signature Date
Print Name
Title
Agency
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APPLICATION FOR A MINING PERMIT
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, or each
aspect of the mining operation, that you intend to affect during the life of this mining permit(in addition,please
insert the appropriate reclamation costlacre for each category from the Schedule of Reclamation Costs
provided with this application form)OR you can defer to the Department to calculate your bond for you based
upon your ps and standard reclamation costs:
AFFECTED RECLAMATION RECLAMATION
CATEGORY ACREAGE COST/ACRE* COST
Tailings/Sediment Ponds: Ac. X $ /Ac. _ $
Stockpiles: Ac. X $ /Ac. _ $
Wastepiles: Ac. X $ /Ac. _ $
Processing Area/Haul Roads: 7.7 Ac. X $ 1,800 /Ac. _ $ 13,860
Mine Excavation: 183.84 Ac. X $ 500 /Ac. _ $ 91,920
Other: mined area above water 16.24 Ac. X $ 1,800 /Ac. _ $ 29,232
TOTAL AFFECTED AC.: 207.78 Ac.
(TOTAL PERMITTED AC.: 230 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 207.78 Ac.
b) Positive Drainage Ac. X $1,500.00 = $
SUBTOTAL COST: $ 135,012
Inflation Factor:
0.02 X SUBTOTAL COST: $ 2,700 X Permit Life Provided by Applicant(Life of the Mining
Operation or Life of Lease from Public Entity (in Years)): 35
INFLATION COST: $ 94,508
Total Reclamation Bond Cost: $ 229,520
(round down to the nearest$100.00)
(NOTE: The reclamation bond cannot exceed$1 million per GS 74-54)
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APPLICATION FOR A MINING PERMIT
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(bl).
SEE THE NEXT TWO PAGES FOR THE "NOTICE" FORM AND THE "AFFIDAVIT OF
NOTIFICATION"
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NOTICE
Pursuant to provisions G.S. 74-50(bl) of The Mining Act of 1971,Notice is hereby given that
has applied on
(Applicant Name) (Date)
to the Division of Energy, 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
❑ 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) (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(bl), 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:
919-499-4272 . 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 of Applicant: Include Contact Person
Name and Address) &Company Name, if Applicable)
(Date of Issuance of this Notice/ (Address of Applicant)
Mailed to Addressee/Owner of Record)
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APPLICATION FOR A MINING PERMIT
AFFIDAVIT OF NOTIFICATION
I, ,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 sworn,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(bl) 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:
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Q
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: APPLICAN •
Signature: Signature:*
000
Print Name: %iem w-conn g (� . tom- _ Print Name: `r/;n-• '�1�ySa
(Title, if applicable)
Company �o Mcw G� 20-tjt-1 S 1vt Title: V .�.
(If applica e)
Address: PO T 6 X- 1,99 Company: A%;�� 0;t 5 (mac
(Aj1 Q--(6 N N 279 p(o Mine Name: ��l MA
Telephone: (�a Z) 3`�-5`�'(Q l Telephone:4s7- 35v°
Date Signed: 7— -22 --207- t Date Signed: "Z.-2Z—ZUZ 1
*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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