20241030_ADI_Received

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699.1612
Division of Energy,Mineral,and Land Resources [phone]
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: APPLICANT:
Signature A Signature'
Print Name j Print Name '
Title(if applicable) � � Title 0 c- °
Company(if applicable) Company
Address Mine Name n h a
Telephone
KC
Telephone R t j Z, J' , Date Signed
.L 44 - c r1
Date Signed f5/23/1-1
'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 to 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(919)707-9220.
rrj .; � 2Di4
IL11Niiv�_z ut, -�-:
.CJ7_iiy�illr�
Revised September 2.7.,2021 P age 19

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources (91g)707-9220
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 5eld 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: APPLICANT:
Signature Signature'
Print Name �/ /77/ Print Name
-{lGU)5 � �itr►,��.--- 1';:�..�. /ice �o.ice_
Title(if applicable) her Title
c> a
Company(if applicable) U3� Company l�Af>•��e3 IBC
Address (/(�} � j Mine Name
--I 11V cpr�m� Lln,�.4�i DK n 6 ei.-
4�t 6o � ,�A61 Telephone - N�� s - (v 7� Jr6.SLY
Telephone j � �) Date Signed —0 _
Date Signed c
d Z
'Signature must be the same as the individual who signed Page 1 of this application.
One orioinal and five 15)copies of the completed application.six(6)copies of all location maps, mine maps and
reclamation traps,and the appropriate processing fee 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 forth
Inquiries regarding the status of the review of this application should be directed to the Mining Program staff at(919)707-9220.

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
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 Mall Service Center 512 N,Salisbury St.,511 Floor
Raleigh,NC 27699.1612 Raleigh,NC 27604
Htto:llnortal ncdear orolvrebllrlgeological home [phone]
County highway maps may be obtained from the N.C.Department of Transportation:
Mailino Address Physical Address
NCDOT GIS Unit NCDOTGIS Unit
1587 Mail Service Center 3401 Carl Sandburg Court
Raleigh,NC 27699-1587 Raleigh,NC 27610
httpalwww ncdot.rofit!gis [phone]
2. A tablelchart must be provided on the mine map that Geary lists the approximate acreage of tailingstsediment ponds,
stockpiles,waste piles,processing areaslhaul roads,mine excavations and any other major aspect of the mining
operation that is proposed to be affectedidisturbed during the life of the mining permit,A tabWehart similar to the
following will be acceptable:
AFFECTED ACREAGE TABLE:
For new permits,complete only the total affected acreage column.
For modifications,complete all columns.
CATEGORY CURRENT AFFECTED PROPOSED CHANGE TO TOTAL AFFECTED
ACREAGE AFFECTED ACREAGE ACREAGE
TallingstSadiment Ponds Zac,
Stockpiles 76M
Waste piles
ae-
Processing Areas/Haul Roads 'J z,
Mine Excavations a G
Other(Please explain)
Total Affected Acreage 7
Total Permitted Acreage 7
Revised September 21.2021 P a g e 14