20210910_ADI_Received

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:
X 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): 5.90
Of this acreage, how much is owned and how much is leased? Acres owned:
Acres leased: 5.90 Property owner if leased: William E. Clark ETUX
❑ 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.: Total permitted acreage:
Does the modification involve acreage within the previously approved permitted boundary?
Yes ❑ 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):
Does the modification involve acreage outside the previously approved permitted boundary?
Yes ❑ No El. 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, ground cover removed) by the mining operation? Yes ❑ No ❑ (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:
SEE THE FEE SCHEDULE AT THE END OF THIS FORM FOR THE PROPER FEE AMOUNT TO
BE PAID FOR THE REQUESTED PERMIT ACTION(S) AND CORRESPONDING ACREAGE
NOTED ABOVE
2. Name of all materials mined: SAND
3. Mining method:
❑ Hydraulic Dredge HSelf-loading
Front-end Loader & Truck X Shovel& Truck
Dragline &Truck Scraper
Other (explain):
4. a. Expected maximum depth of mine (feet) 35 FT.
Depth is relative to what benchmark? (e.g., natural ground level, mean sea level, road elevation, etc.)
b. Expected average depth of mine (feet)
—3—

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
nrranno f r oi.!•h no.,.,nt .,F' *L.., .,.,.,,..,,.,, ..«,.....s:...,. •1_-.a _._.. .--`---J `- -�--. �_ .. r .• .. .
WAN
AFFECTED
RECLAMATION
RECLAMATION
CATEGORY
ACREAGE
COST/ACRE*
COST
Tailings/Sediment Ponds:
0 Ac.
X
$
500
/Ac.
_ $
0
Stockpiles:
0 Ac.
X
$
1800
/Ac.
_ $
0
Wastepiles:
Ac.
X
$
/Ac.
_ $
Processing Area/Haul Roads:
6.63 Ac.
X
$
1800
/Ac.
_ $
11,934
Mine Excavation:
2.90 Ac.
X
$
500
/Ac.
_ $
1,450
Other: (buffers)
3.00 Ac.
X
$
500
/Ac.
_ $
1,500
TOTAL AFFECTED AC.:
12.53 Ac.
(TOTAL PERMITTED AC.:
12.53 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 12.53 Ac.
b) Positive Drainage 9.63 Ac. X $1,500.00 = $ 14,445
Inflation Factor: SUBTOTAL COST: $_ 29,329
0.02 X SUBTOTAL COST: $ 586.58 X Permit Life Provided by Applicant (Life of the Mining
Operation or Life of Lease from Public Entity (in Years)):
INFLATION COST: $ 5866
Total Reclamation Bond Cost: $__ 35,195
(round down to the nearest $100.00)
(NOTE: The reclamation bond cannot exceed $1 million per GS 74-54)
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