78-52_Routing_DWR

Return PDF of this form to DEMLR CO by email. cc DEMLR RO, DWR SPU. Send a copy to the permittee.
DIVISION OF WATER RESOURCES
MINING PERMIT APPLICATION REVIEW FORM
SECTIONTHIS TO BE OUT BY DEIVILR
DEMLR PERMIT: 78-52 Project Action New Modification Transfer Release
Applicant Name: Hole of Hope LLC X
Applicant's Email: [e-mail] County: Robeson
Project Name: Williams Dirt and Sand YES NO Date Commencing
Have land disturbing activities started?? X
Latitude: 34.8664 Longitude: -79.0440
Please return comments to (at DEMLR CO): Corey Clayton [e-mail]
Comments due by: = 11/21/2024
SECTION • TO BE FILLED OUT BY DWR
YES NO
Is this mine an active permit in BIMS? El F-1
Is the RO concerned that the operation, as proposed, would violate standards of water quality?
Comments:
Does this mine (or previous owner) have DWR back fees to pay?
(If Yes, amount):
Watershed/Stream Name & Classification:
DWR Compliance Status of Mine:
401 Wetland Cert. required? I I ❑
401 Wetland Cert. existing? I ❑
(If Yes, Permit#):
Does DWR RO have enough information to determine if a 401 certification is required?
Central Coastal Plain Capacity Use Area (CCPCUA). Required? Ll
Central Coastal Plain Capacity Use Area (CCPCUA). Existing? I I ❑
(If Yes, Permit#):
Does DWR RO have enough information to determine if a CCPCUA is required?
Is an O & M Plan needed? ❑
Are wetlands disturbed at this site? I ❑
Does DWR RO suspect or know of nearby wetlands to the site?
Is a wetland delineation required prior to DWR issuing the permit?
JD
Consultant
Onsite
Offsite
Stream Determination Needed?
Stream Determination Completed?
Does DWR RO need a statement that no wetlands/streams are disturbed for this project
from applicant?
Rev November 2021 r0

Return PDF of this form to DEMLR CO by email. cc DEMLR RO, DWR SPU. Send a copy to the permittee.
Buffer Determination Needed?
Buffer Determination Completed?
Recycle system permit existing?
(If Yes, Permit#):
New Recycle System permit required?
Enough information to determine?
Non-discharge permit existing?
(If Yes, Permit#):
Will wastewaters discharge to HQW waters with a 7Q10=0?
7Q10 Flow:
Unknown Permittee must determine
Does DWR require DEMLR to hold the permit (e.g. so DWR can review it further or ❑ I ❑
because DWR requires more information)?
Has Violation
O&M Requirements ❑
HQW/7Q10 Concerns
IT-
Pay back fees or renew DWR permit ❑
Other
Please describe
the reason to
hold the permit:
RO contact: Hold Until:
Mine must wait to dewater until an O&M plan is approved?
( -
CentralOffice Date Regional Office I Date
DWR RO Surface Water
RO Aquifer Protection Section
Rev November 2021 r0