2023_Annual Reclamation Report_80-17

Action History(UTC-05:00)
Submit by Anonymous User 9/16/2024 6:27:23 PM (Start)
Approve by Adam.Parr 10/8/2024 2:57:44 PM (ARR Review-80-17 Sand Pit#40)
• The task was assigned to DEMLR Mining ARR Team.The due date is:September 30,2024 5:00 PM
9/16/2024 6:27:48 PM
• Adam.Parr reassigned the task to Adam.Parr 10/8/2024 1:44:09 PM

2023 Annual Reclamation Report
Complete and submit by September 1,2024 AN
N.C. Department of Environmental Quality-Division of Energy,Mineral,and Land Resources
GENERAL INFORMATION
Mining Permit No.(?)
80-17
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:
04/01/1983 07/30/2024
Legal Corporate/Owner Name*
Carolina Sand Company Inc
Mine Name*
Sand Pit#40
Mine Address(You Must Enter)*
(The 911 Address)
Street Address
875 Hannah Ferry Rd
Address Line 2
City State/Province/Region
Salisbury NC
Postal/Zip Code
28144
County* River Basin*
Rowan Yadkin-PeeDee
Dropdown list Dropdown list
County Prefix Code*
80
Variable available for repository routing
Facility Coordinates:
Latitude:* Longitude:
35.74060 -80.46150
Responsible Official/Authorized Contact Information:
Name and Title*
Wayne A.Cassavaugh,Owner

Mailing Address*
2086 Craig Mountain Rd.Lenoir,NC 28645
Primary Phone No.* Secondary Phone No.
828-312-4425
E-mail Address*
[e-mail]
Invoice Contact Information:
(Contact info from above is carried below-please revise if needed)
Name and Title*
Dennis Burns,Office Mgmt.
Mailing Address*
2086 Craig Mountain Rd.Lenoir,NC 28645
Primary Phone No.* Secondary Phone No.
828-758-0617
E-mail Address*
[e-mail]
Is the site Active?*
Yes No
Was new land affected in 2023?*
Yes No
Is the map on file current?*
Yes No
Check here if no reclamation was completed in 2023
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*
0.3 1.0 0.3
Acres Acres Acres(WASTE PILES should include
overburden storage/disposal areas and
berms)
Plant Area* Mine Excavation* TOTAL DISTURBED AREA*
0.6 18.9 21.1
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*
09/16/2024
V541jis �V"s
Type Name* Title*
Dennis Burns Office Mgmt.
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 217921.