2023_Annual Reclamation Report_10-63

Action History(UTC-05:00)
Submit by Anonymous User 10/1/2024 5:30:12 PM (Start)
Approve by Kelly Jonas 10/8/2024 3:02:43 PM(ARR Review- 10-63 Old Shallotte Mine)
• The task was assigned to DEMLR Mining ARR Team.The due date is:October 15,2024 5:00 PM
10/1/2024 5:30:26 PM
• Kelly Jonas assigned the task to Kelly Jonas 10/8/2024 2:46:02 PM
• Kelly Jonas released the task 10/8/2024 2:53:10 PM
• Kelly Jonas assigned the task to Kelly Jonas 10/8/2024 2:57:08 PM

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.(?)
10-63
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:
01/13/2003 07/30/2024
Legal Corporate/Owner Name"
Wayne's Backhoe Service Inc
Mine Name*
Old Shallotte Mine
Mine Address(You Must Enter)*
(The 911 Address)
Street Address
265 Buttercup Lane
Address Line 2
City State/Province/Region
Shallotte NC
Postal/Zip Code
28470
County* River Basin*
Brunswick Lumber
Dropdown list Dropdown list
County Prefix Code*
10
Variable available for repository routing
Facility Coordinates:
Latitude:* Longitude:
33.96370 -78.44310
Responsible Official/Authorized Contact Information:
Name and Title*
Wayne Smith,President

Mailing Address*
150 Beaver Pond Lane NW Shallotte NC 28470
Primary Phone No.* Secondary Phone No.
910 4433929
E-mail Address*
[e-mail]
Invoice Contact Information:
(Contact info from above is carried below-please revise if needed)
Name and Title*
Wayne Smith,President
Mailing Address*
150 Beaver Pond Lane NW Shallotte NC 28470
Primary Phone No.* Secondary Phone No.
910 4433929
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?*
08/01/2007 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*
0.0 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*
10/01/2024
0a w C'7�squ mt
Type Name* Title
Wayne J Smith President
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 221235.