NCG020616_MONITORING INFO_20141007

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/VC�
DOC TYPE
❑HISTORICAL FILE
C�MONITORING REPORTS
DOC DATE
❑ p'`DI �I I D D �
YYYYMMDD

STAIr
[; 1, `F I •,! I _�'11i�
OCT 0 72014
Stormwater Discharge Outfall (SDO)REN�s
401
Qualitative Monitoring Report
For guidance onfilling out this form, please visit: L)ocuments,him#m'iscforms
Permit No.: NlcliVl 61 AI 61616l61 or Certificate of Coverage No.: NIC1G1 d1.g1 d7-IL161
Facility Name:
County: Phone No. .r—_9eSlL- 9XAX -d
Inspector:
Date of Insp ion: 3'- A6 - Z0=
Time of Ins10 pection: :16f ff/y
Total Event Precipitation (inches):
Was this a Representative Storm Event? (See information below) ❑ Yes 0 No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or
1. Outfall Description:
Outfall No. A4d4e. St cture ( 'pe, ditch etc.
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
Page 1 of 2
5 WU-242-1 12608

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 3 4 5
6. Susperided'Solids: • Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
S WU-242-112608

ANNUAL SUMMARY DMR -WASTEWATER
SEND TO CENTRAL OFFICE*
PROCESS MINEMEWATERING WASTEWATER
GENERAL PERMIT NO. NCGO20000
*.Report All Wastewater -discharge momtonng;data on,this:form (including No Flgry and`No'Discharge and Permit L►mitsVrolatrons) by MARCH1 of each.year. If'
you;have.limit violations,',you.must also have turned'in' a Limit-Violation':DMR to`vour focal Regional"Office within 30`d ys.of.receivinQ sample results from a lab.
CERTIFICATE OF COVERAGE N .O. NCG02 D 1,- -L
FACILITY NAME: a,4 Z/ .S �7
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY: Lab #
Lab #
LIMIT VIOLATIONS? YES ❑ NO ❑
'art A. Wastewater Monitoring Requirements
SAMPLE COLLECTION YFAR: =oil
COUNTY: j4 .-4,w r
PHONE NO. (ZX,2) 961Z -
ADD TO LISTSERVE? YES ❑ NO❑ EMAIL:
INDUSTRIAL SAND'? ❑ DISCHARGING TO SA WATERS"? ❑
,`k. ,�:_ w8 '. �`r� 'i v; ,., - -. .-fi i ,� _ is ��r -'�� `�. ", � � � aM t r y'3 s � � Y � � f �r^• %tom: �. r� �, . -
el
Q 1 '� - I 1 a �- �• 1 1 t �4 �
y } 1� ZM 1 .'. a�r - ,�"- 1.>. Gr:� a .A•L '�"; y' •=a,.
M-''-�:a
' All mines must monitor WW discharges for TSS. Only industrial sand mine discharges are subject to TSS limits.
2 If an effluent limit is exceeded, the permittee is required to institute monthly monitoring for that parameter for the remaining permit term.
3The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: t0 NTU for freshwater streams, lakes, and reservoirs
designated as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the
Stormwater Discharge Outfall. Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the discharge.
Only facilities discharging to SA waters are required to monitor for Fecal coliforms.
Permit Date: 1/1/2010-12/3112014 Last Revised 0 1 -2 1 -11
Page 1 of 2

Part A, Continued: Wastewater Monitoring Requirements
Outfall No.
_ Date Sample
t
Collected
Total Flow
-
Total Suspended
- Solids '
Turbidity,. '
Settleable Solids
� -
pH
Fecal' Coliforms
'
mm/ddlyr
MG i
`mg/l.r .
NTU:
l/l M".,.'
Standard
col/riil
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH I OF EACH YEAR TO: '
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center ;
Raleigh, North Carolina 27699-1617
E
[phone]
YOU MUST SIGN THIS.CERTIFICATION FOR ANY INFORMATION REPORTED: y '
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am aware that there are significant penaltiesrfpr submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Date)
Permit Date: 1/1/2010-12/3112014 Last Revised 0 1 -2 1 -11
Page 2 of 2

Print this form to PDF Return PDF of this form to DLR CO by email. cc DLR RO, DWQ SPU. Send a copy to the permittee.
`- MINING PERMIT APPLICATION REVIEW FORM
for the
DIVISION OF WATER QUALITY
THIS SECTION TO BE FILLED OUT BY DLR:
Project Name: Davis Mine DLR Permit # 07-48 County: Beaufort Applicant's Email: ni's
Applicant's Mailing Address: 521 Foreman Lane, Belhaven, NC 27810 Mine Physical Address: 1661
Shavalla Rd.. Belhaven, NC 27810
YES NO Date Commencing
Is this mine a new mine? r" r2003
Have land disturbing activities
started? Date? 1 r 2003
Latitude: 35.4784 Longitude:-76.6739
Please return comments to (at DLR CO): Judy Wehner
Comments due by: 8/16/13
SECTION BELOW TO BE FILLED OUT BY DWQ:
Is the RO concerned that the operation, as proposed, would violate standards of water quality? No
Comments: No modification of previous mining permit, just a renewal and ownership change. The new owner
Mr. Davis needs to be familiar with the O&M plan for dewatering.
Watershed/Stream Name & Classification: Tar -Pam lico River Basin /Jack Creek SC; NSW Index # 29-34-35-4
DWQ Compliance Status of Mine: Compliant
Does this mine (or previous owner) have DWQ back fees to pay? due 8/9/2013 If yes, amount: $100
Is this mine an active permit in BIMS? Yes , NCG020616 & has been transferred to James M. Davis by Ken
Pickle
YES NO
4N f ''✓ 1. J: i'� f
'.NPDES required? h�.'
<r, r N
'
permifi
,
NPDES permit existing?
(Permit#NCG020616)
if an NPDES'permit is'_not required;Js DWQj
:still"c'oricerned aboutiwetlan'd degradations;
iby, dewatering?
Should permittee contact DWQ RO
immediately? (e.g. to schedule a site visit if
RO Contact Name:
mine has already begun digging or is
Contact Reason:
dewatering without DWQ permit)
o.Y
401�Wetland Cent. required?
p ` 5
401 Wetland Cert. existing?
ri , Permit #
Rau SPntPmhar Pnin

'rent this form to PDF Return PDF of this form to DLR CO by email. cc DLR RO, DWQ SPU. Send a copy to the permittee
i•
FDoes'EDWQ.RO have,enough information to
determme.if a 401 ce rtifi cationi is required? a
Rov Cantamhar ?mn

Print this form to PDF Retum PDF of this form to DLR CO by email. cc DLR RO, DWQ SPU. Send a copy to the pennittee.
YES NO
Are wetlands disturbed,at'this site?, �
Ci ''rrVj
Does DWQ RO suspect or know of nearby
76, adiacent to Jack Creek
r
wetlands to the site?
r IJD '
r
Is a wetland delineation required prior to'
ConsultantWJ
..DWQ issuing the' perms �:,;
Onsite?
-
r' Offsite?
Stream Determination Needed?
ri
r
Stream Determination. Completed? •
Does DWQ RO need a statement that no
wetlands/streams are disturbed
r
r
for this project from applicant?
Buffer Determination Needed?
j'
Buffer Determination Completed?
r
Recycle system•permit existing?*'.
r permit #
I✓�
New Recycle System permit required?*
r
r
Enough information to determine?
.Non -discharge permit existing?*
r Permit #
r ,
Does this applicant need to contact the
regional of Central DWQ Office to
! ±
r
determine if a State Stormwater Permit is
needed?
F , Unknown.
Will wastewaters discharge to HQW waters
I—
r 7Q10
Permittee
must
with a 7Q10=07 **
Flow:
determine.
G , Has•Violation
r'
r O&M Requirements
ri HQW17Q10 Concerns'.;'
r '
Does'DWQ require. DLR to hold the permit,':
r Pay back fees or renew
(e.g. so DWQ can review -it further or
DWQ permit
ED Other'
because DWQ.requires more information)?
Please describe the reason to •
hold the permit:
RO contact:
. - • Y 1 '' �Fa,.
ll,] I �iF `. •i
Hold.
' •
5
r - New Owner needs to be
Enest waitto dewater until an O&M plan is
familiar with O&M plan ford?
dewaterin .
'The NPDES SW and WW permit NCG020000 covers closed -loop recycle systems, designed to exclude all stormwater run-off from
the system and operate at or below two -feet of freeboard. These systems may be permitted by a Non -discharge Recycle System
Permit from the Aquifer Protection Section (APS), OR may instead be permitted under NCG020000 to eliminate an additional permit.
Rev Cantpmh4-r 2nin

Print this form to PDF Return PDF of this form to DLR CO by email. cc DLR RO, DWQ SPU. , Send a copy to the permittee.
a
Recycle systems that do not meet those criteria are considered dischatging systems, and are subject to the NCG020000 discha e
permit.
**To obtain 7Q10 flows, permittees must contact the DWQ Stormwater Permitting Unit. If DWQ does not have a flow estimate for a
specific stream, permittees will be asked to obtain one. Permittees should contact J. Curtis Weaver at the USGS: 919-571-4043, for
more information on obtaining a 7Q10 flow. USGS will not determine a 7Q10 flow for tidally influenced water bodies.
*`* If there is not enough information to give a complete answer, write in the space provided what you will need to answer this question
completely. If you reouire DLR to hold the permit until further notice, indicate that in the question below.
Reviewed by:
DWQ RO Surface Water: Scott Vinson Regional Office: Washington Date: 8-23-13
RO Aquifer Protection Section: Regional Office: Date:
SPU DWQ Central Office Reviewer (if applicable):
Rau Sanfamhar 7Mrl

RECEIVED
�D
JUL 2 9 2013
DW4WAR0
J. S. FARMS, INC.
DBA SELBY LAND CONCEPTS
5724 SIDNEY ROAD
BELHAVEN, NC 27810
252-964-4171
RECEIVED
April 11, 2013
NC Dept. of Environment and Natural Resources
LAND QUALITY SECTION
Division of Land Resources
Land Quality Section
1612 Mail Service Center
Raleigh, NC 27699
Reference: Davis Mine
1
Beauforl County
G
JUL" 2 9 2013
Tar River Basin
Permit No. 07-48
To Whom It May Concern:
--
LAND QUALITY� '
wAs-HjNcTON
This letter is being submitted to request that the above referenced Sand Mine be transferred to
the following proposed new permitee: James Michael Davis
Thank you,
?Jerol Selby, President
J. S. Farms, Inc.
DBA Selby Land Concepts
RECCiV�:D
JUL L
nWQ -' ;
, r I

�S jut
JU4

NORTH CAROLINA
MINING PERMIT APPLICATION
State of North Carolina
Department of Environment
and Natural Resources
Division of Land Resources
Land Quality Section
2013
WASr- ICE
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
[phone]
\\ C,
Revised: February 24, 2012
ej � 3

APPLICATION FOR A MINING PERMIT
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
LAND QUALITY SECTION
APPLICATION FOR A MINING PERMIT
(PLEASE PRINT OR TYPE)
Name of Mine
/I/J1S
fr "1 ":�L
County 'e&,041l-!
River Basin
- ', J
e�: "'<4 ;" ; / 1
Latitude (decimal degrees to four places)
Of
Longitude (decimal degrees to four places)
2. Name of Applicant*._... j `r != zE.l ,S" _
3. Permanent address for receipt of official mail * *
Telephone j��— _ Alternate No. L" ; r
4. Mine Office Address
.2 7 ,`r % G`' Telephone s 2 � � ^.•Z r%
5. Mine Manager �i �
_ � 14- � � � .�, � oaf
We hereby certify that all details contained in this Permit Application are true and correct to the best of our
knowledge. We fully understand that any willful misrepresentation of facts will be cause for permit
revocation_
* * * Signa
Print
Title . '- f �1 ...
Date Z — ,,7- `.,f ?, ,...
This will be the name that the mining permit will be issued to and the name that must be indicated on the
reclamation bond (security) that corresponds to this site.
** The Land Quality Section must be notified of any changes in the permanent address or telephone number.
* * * Signature of com�pMy officer required.
G.S. 74-51 provides that the Department shall grant or deny an application for a permit within 60 days of receipt of a
complete application or, if a public hearing is held, within 30 days following the hearing and the filing of any
supplemental information required by the Department. All questions must be addressed and all required maps
provided before this application can be considered complete. Attach additional sheets as needed.

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:
❑ 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 thattfie "new permit" fee will be based upon):
Of this acreage, how much is owned and how much is leased? Acres owned:
Acres leased: Property owner if leased:
KA
If this is an application for RENEWAL of a mining permit, indicate the mining permit number and
the total (overall) acreage covered y the existing permit: Mining Permit No.: 4 C z-49_
Total permitted acreage (this is the acreage that the "renewal" fee will be based upon): ;zo
❑ 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 app roved permitted boundary?
Yes ❑ No El. 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 ❑. 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 portio 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 coveredy e existing permit.
Mining Permit No.: G 7-j�r 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: Y;4nd' Z. al..r7L
3. Mining method:
Hydraulic Dredge � Front-end Loader & Truck kN Shovel & Truck
Dragiine & Truck Self -loading Scraper
Other (explain):
4. a. Expected maximum depth of mine (feet)
De th 's relative tp what benchmark? e.., natpral ground level, mean sea level, road elevation, etc.
b. Expected average depth of mine (feet)
-2-

APPLICATION FOR A MINING PERMIT
5. Has any area(s) at this site been mined in the past? Yes No ❑
If yes, when and by whom was this activity conducted?r l-vs'IS p'2y__: cZl /-6 ¢4,v I 6.sr�`rh
6. Number of years for which the permit is requested (10 years maximum): !0
B. MAPS
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) co -pies 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 Mail Service Center OR 512 North Salisbury Street, 5`h Floor
Raleigh, North Carolina 27699-1612 Raleigh, North Carolina 27604
[phone]
•i!pY . t"1;i;.it..ai:,i'l.t('� 11:;:'' . _... 'sty ,il,;i ';i;!};.
County highway maps may be obtained from the N.C. Department of Transportation:
North Carolina Department of Transportation -- Geographic Information Systems (GIS)
Mailing_ Address:
NCDOT GIS Unit
1587 Mail Service Center
Raleigh, North Carolina 27699-1587
Physical Address:
NCDOT GIS Unit
3401 Carl Sandburg Court
Raleigh, North Carolina 27610
[phone]
2. Mine maps must be accurate and appropriately scaled drawings, aerial photographs or enlarged
topographic maps of the entire mine site. All aspects of the mine site must be clearly labeled on the
maps along with their corresponding (approximate) acreage. As a reminder, mining permits can
only be issued for up to 10 years; thus, all mine and reclamation maps must only denote those
activities that are intended to be conducted during the life of the mining permit: All maps must be
of a scale sufficient (see minimum requirements listed below) to clearly illustrate the following, at a
minimum:
a. Property lines of the tract or tracts of land on which the proposed mining activity is to be located
including easements and rights -of -way.
b. Existing or proposed permit boundaries.
c. Initial and ultimate limits of clearing and grading.
d. Outline and width of all buffer zones (both undisturbed and unexcavated).
e. Outline and acreage of all pits/excavations.
f. Outline and acreage of all stockpile areas.
gg Outline and acreage of all temporary and/or permanent overburden disposal areas.
h. Location and acreage of all processing plants (processing plants may be described as to location and
distance from mine if sufficiently far remov).
i. Locations and names of all streams, rivers and lakes.
j. Outline and acreage of all settling and/or processing wastewater ponds.
k. Location and acreage of all planned and existing access roads and on -site haul roads.
1. Location of planned and existing on -site buildings.
m. Location and dimensions of all proposed sediment and erosion control measures.
n. Location of 100-year floodplain limits and wetland boundaries.
o. Names of owners of record, both public and private, of all tracts of land that are adjoining the mining
permit boundary; if an adjoining tract is owned or leased by the applicant or is owned by the lessor of
the mine tract, names of owners of record of tracts adjoining these tracts, that are within 1,000 feet of
the mining permit boundary, must be provided on the mine map.

APPLICATION FOR A MINING PERMIT
p. Names of owners of record, both public and private, of all tracts of land that are adjoining the mining
permit boundary which lie directly across and are Contiguous to any highway, creek, stream, river, or
other watercourse, railroad track, or utility or other public right-of-way. If an adjoining tract is owned
or leased by the applicant or is owned by the lessor of the mine tract, names of owners of record of
tracts adjoining these tracts, that are within 1,000 feet of the mining permit boundary, must be
provided on the mine map(s). NOTE: "Highway" means a road that has four lanes of travel or less
and is not designated as an Interstate Highway.
q. Map legend:
i . Name of applicant
2. Name of mine
3. North arrow
4. County
5. Scale
6. Symbols used and corresponding names
7. Date prepared and revised
8. Name and title of person, preparing map
Map scales should meet the following guidelines:
PERMITTED ACREAGE MAP SCALE
0-49 Acres I inch = 50 feet
50-199 Acres 1 inch =100 feet
200+ Acres I inch = 200 feet
(NOTE: Smaller scaled maps may be acceptable if they clearly illustrate the above items)

APPLICATION FOR A MINING PERMIT
A table/chart must be provided on the mine map that clearly lists the approximate acreage of tailings/sediment
ponds, stockpiles, wastepiles, processing area/haul roads, mine excavation and any other major aspect of the
mining operation that is proposed to be affected/disturbed during the life of the mining permit. A table/chart
similar to the following will be acceptable:
CATEGORY
AFFECTED ACREAGE
Tailings/Sediment Ponds
d �-
Stockpiles
Wastepiles
Processing Area/Haul Roads
Mine Excavation
Other (Explain) ;u.F4_ t--
3 Q
Total Disturbed AcreageO
NOTE:
IN ADDITION TO THE ABOVE, THE MAPS MUST ALSO INCLUDE ANY SITE -SPECIFIC
INFORMATION THAT IS PROVIDED IN THE ANSWERS TO THE FOLLOWING QUESTIONS IN
THIS APPLICATION FORM (PLEASE NOTE THE ITALICIZED QUESTIONSISTATEMENTS
THROUGHOUT THE FORM). THIS APPLICATION WILL NOT BE CONSIDERED COMPLETE
WITHOUT ALL RELEVANT ITEMS BEING ADEQUATELY ADDRESSED ON THE MINE MAPS.
-5-

APPLICATION FOR A MINING PERMIT
C. PROTECTION OF NATURAL RESOURCES
1. Describe in detail the sequence of events for the development and operation of the mine and reference the
sequence to the mine map(s). Attach additional sheets as needed.
�62.' IAI el1/L /'-C)I
ne/
2. Describe specific erosion control measures to be installed prior to land disturbing activities and during
mining to prevent offsite sedimentation (include specific plans for sediment and erosion control far mine
excavation(s), waste piles, access/mine roads and process areas), and give a detailed sequence of
installation and schedule for maintenance of the measures. Locate and label all sediment and erosion
control measures on the mine map(s) and provide typical cross-sections/construction details of each
measure. Engineering designs and calculations are required to justify the adequacy of any proposed
measures.
10
l� 7 y
3. a. Will the operation involve washing the material mined, recycling process water, or other waste water
handling? Yes ❑ No X. If yes, briefly describe all such processes including any chemicals to be used.
b. Will the operation involve discharging fresh or waste water from the mine or plant as a point discharge to
the waters of the State? Yes SJ No ❑. If yes, briefly describe the nature of the discharge and locate
all proposed discharge points (along with their method of stabilization) on your mine map(s).
Xil All -5*
-6-

APPLICATION FOR A MINING PERMIT
c. Will any part of the proposed mine excavation(s) extend below the water table? Yes .l No ❑.
If yes, do you intend to dewater the excavation(s)? Yes © No ❑.
If yes, what impact, if any, will mine dewatering have on neighboring wells? Estimated withdrawal rate
in gallons per day: ,l% n cL . Locate all existing wells on the mine map(s) that lie within
500feet ohe proposed excavation area. Provide data to support any conclusions or statements made,
including any monitoring well data, well construction data and current water withdrawal rates. Indicate
whether the proposed mine locale is served by a public water system or private wells.
7 -A
6 G/c-5 .5 �S %j i`i/ A11f1,(
d. If you answered yes to any of the above questions, provide evidence that you have applied for or
obtained the appropriate water quality permit(s) (i.e., non -discharge, NPDES, Stormwater, etc.) from the
Division of Water Quality, Water Quality Section. In addition, the applicant is required to register water
use with the Division of Water Resources if the operation withdraws more than 10,000 gallons per day
and needs a capacity use permit from the Division of Water Resources if the operation lies in a capacity
use area and withdraws more than 100,000 gallons per day. ,t� /
"j,C J4'w'-Ov eel le4v j /' , ,nS "V14'd
e,!11 e—r g-�a i W o*
4. a. Will the operation involve crushing or any other air contaminant emissions? Yes ❑ No ®.
If yes, indicate evidence that you have applied for or obtained an air quality permit issued by the
Division of Air Quality or local governing body.
b. How will dust from stockpiles, haul roads, etc., be controlled?
l �} Di'1 J'C�1-� ✓4"� lle✓eQlea . A /re S
f1!r
af��r t ,t9�
Are
ld'd A-C
-7-

APPLICATION FOR A MINING PERMIT
5. a. A buffer will be required between any mining activity and any mining permit boundary or right-of-
way. It may be an unexcavated buffer (no excavation, but roadways, berms and erosion &
sedimentation control measures may be installed within it), an undisturbed buffer (no disturbance
within the buffer whatsoever), or a combination of the two, depending upon the site conditions. Note
that all buffers must be located within the mining permit boundaries.
How wide a buffer will be maintained between any mining activity and any mining permit boundary
or right-of-way at this site? A minimum buffer of 25 feet is recommended, although a wider buffer
may be needed depending on site conditions. Show all buffer locations and widths on the mine
map(s).
-2xe�77 er"'-
`
/,P/f J,
b. A minimum 50 foot wide undisturbed buffer will be required between any land disturbing activities
within the mining permit boundaries and any natural watercourses and wetlands unless smaller
undisturbed buffers can be justified. Depending on site conditions, a buffer wider than 50 feet may
be needed.
How wide an undisturbed buffer will be maintained between any land disturbing activities within the
mining permit boundaries and any natural watercourses and wetlands at this site? Show all buffer
locations and widths on the mine map(s).
6. a. Describe methods to prevent landslide or slope instability adjacent to adjoining permit boundaries
during mining. Minimum 2 horizontal to 1 vertical slopes or flatter for clayey material and
minimum 3 horizontal to 1 vertical slopes or flatter for sandy material are generally required, unless
technical justification can be provided to allow steeper slopes.
`..1 >
j % 1 cl.

APPLICATION FOR A MEANG PERMT
b. Provide a cross-section on the mine map(s) for all fill slopes (berms, wastepiles, overburden
disposal areas, etc), clearly indicating the intended side slope gradient, installation ofany benches
and/or slope drains (with supporting design information) if needed, and the method of final
stabilization.
c. In excavation(s) of unconsolidated (non -rock) materials, specify the angle of all cut slopes including
specifications for benching and sloping. Cross-sections.ir all cut slopes must be provided on the
mine map(s).
1 r
d. In hardrock excavations, specify proposed bench widths and heights in feet. Provide cross -sections
of the mine excavation clearly noting the angles of the cut slopes, widths of all safety benches and
mine benches, and the expected maximum depth of the excavation.
7. Describe other methods to be taken during mining to prevent physical hazard to any neighboring dwelling
house, public road, public, commercial or industrial building from any mine excavation. Locate all such
structures on the mine map if they are within 300 feet of any proposed excavation.
8. Describe what kind of barricade will be used to prevent inadvertent public access along any high wall area
and when it will be implemented. Vegetated earthen berms, appropriate fencing and adequate boulder
barriers may be acceptable high wall barricades. A construction detail/cross-section and location of each
type of barricade to be used must be indicated on the mine map(s).
i
-9-

APPLICATION FOR A NIINING PERMIT
9. Are acid producing minerals or soils present? Yes ❑ No ®.
If yes, how will acid water pollution from the excavation, stockpiles and waste areas be controlled?
10. a. Describe specific plans (including a schedule of implementation) for screening the operation from
public view such as maintaining or planting trees, bushes or other vegetation, bwlding berms or other
measures. Show the location of all visual screening on the mine maps) and provide cross -sections
through all pro used berms or proposed spacing, sizes and species for tree/plantings.
%'✓fi¢ I"1 / / es1:
�iehrre�f1,f��c�,-s1;'�'oDfhiyl�
b. Could the operation have a significantly adverse effect on the purposes of a publicly owned park,
forest or recreation area? If so, how will such effects (i.e., noise, visibility, etc.) be mitigated?
f f lr� l �rf1rc3f
11. Will explosives be used? Yes ❑ No M.
If yes, specify the types of explosive(s) and describe what precaution(s) will be used to prevent physical
hazard to persons or neighboring property from flying rocks or excessive air blasts or ground vibrations.
Depending on the mine's location to nearby structures, more detailed technical information may be
required on the blasting program (such as a third -party blasting study). Locate the nearest offsite occupied
structures) to the proposed excavation(s) on the mine map and indicate its approximate distance to the
proposed excavation.
12. Will fuel tanks, solvents, or other chemical reagents be stored on -site? Yes ❑ No N
Ifyes, describe these materials, how they will he stored and method ofcontainment in case ofspill. Indicate
the location(s) of all storage facilities on the mine map(s).
-to-

APPLICATION FOR A MINING PERMIT
D. RECLAMATION PLAN
l . Describe your intended plan for the final reclamation and subsequent use of all affected lands and indicate
the sequence and general methods to be used in reclaiming this land. This must include the method of
reclamation of scttlinp ponds and/or sediment control basins and the method of restoration or establishment
of any permanent drainage channels to a condition minimizing erosion, siltation and other pollution. This
information must be illustrated on a reclamation map and must correspond directly with the information
provided on the mine map(s). In addition, design information, including typical cross -sections, of any
permanent channels to be constructed as part of the reclamation plan and the location(s) of allpermanent
channels must be indicated on the reclamation map.
nA.
��
Z'�,�-rs��'��`.�-y
�
/�' ��/ �"� q ter'; %mod �� e >``-�`� �� ���' r�-�l�s��•�-�' ��iy�/,,�1.
2. Is an excavated or impounded body of water to be left as a part of the reclamation? Yes ® No ❑.
If yes, illustrate the location of the body(s) of water on the reclamation map and provide a scaled
crass -sections) through the proposed body(s) of water. The minimum water depth must be at least 4 feet,
measured from the normal low water table elevation, unless information is provided to indicate that a more
shallow water body will be productive and beneficial at this site.
Will the body(s) of water be stocked with fish? Yes.0 No [.
If yes, specify species.
3. Describe provisions for safety to persons and to adjoining property in all completed excavations in rock
including what kind of permanent barricade will be left. Acceptable permanent barricades are appropriate
fencing, large boulders placed end -to -end, etc. Construction details and locations of all permanent
barricades must be shown on the reclamation map.
-11-

APPLICATION FOR A MINING PERMIT
4. Indicate the method(s) of reclamation of overburden, refuse, spoil banks or other such on -site mine waste
areas, including specifications for benching and sloping. Final cross -sections and locations for such
areas must be provided on the reclamation map.
ll
•���:/�� ��`�`f.� �� rJ.v G�i�y� �1tf/''Cc�� fig;, � �1r�-����° :;,,,�.�%.� ��` t'/�
f �
�; ,; .�� �i✓'"y'4-: i" �� , "�'f' �� 7 /.�J�l �'�' df%' %'7 � �{ C C fj1��r� Tom'. •� - i�y� ,
rir�/ f41S /i t-F-. �Gi' ��' -- �/i•4 �11� %�©� ��`C7 I �"%`' Td�/ Sly � / -i �%��f
i
�f}` %/f ///�y-.�G!•r.'ti�-� ��• G'/YIJ�-J��� � S" -S4l c'� S"� 1��
S. a. Describe reclamation of processing facilities, stockpile areas, and on -site roadways.
b. Will any on -site roadways be left as part of the reclamation? Yes ❑ No ®.
If yes, identify such roadways on the reclamation map and provide details on permanent road and ditch
line stabilization.
6. Describe the method of control of contaminants and disposal of scrap metal, junk machinery, cables, or
other such waste products of mining. (Note definition of refuse in The Mining Act of 1971.)
No off -site generated waste shall be disposed of on the mine site without prior written approval
from the NC Department a Environment and Natural Resources, Land Quality Section and either
the Division of Waste Management (DWM) or local governing body. If a disposal permit has been
issued by DWM for the site, a copy of said permit must be attached to this application. All
temporary and permanent refuse disposal areas must be clearly delineated on the mine map(s) and
reclamation map, along with a list of items to he disposed in said areas.

APPLICATION FOR A MINING PERMIT
7. Describe your plan for revegetation or other surface treatment of the affected areas. This plan must
include recommendations for year-round seeding, including the time of seeding and the amount and type
of seed, fertilizer, lime and mulch per acre. The recommendations must include general seeding
instructions for both permanent and temporary revegetation. Revegetation utilizing only tree plantings is
not acceptable. Recommendations can be sought from:
a. Authorized representatives of the local Soil and Water Conservation District;
b. Authorized representatives of the Division of Forest Resources, Department of Environment and
Natural Resources;
c. Authorized county representatives of the North Carolina Cooperative Extension Service, specialists
and research faculty with the Colleges of Agriculture and Life Sciences and Forest Resources at
North Carolina State University;
d. North Carolina licensed landscape architects;
e. Private consulting foresters referred by the Division of Forest Resources, Department of
Environment and Natural Resources;
f. N.C. Erosion and Sedimentation Control Planning and Design Manual;
g. N.C. Surface Mining Manual: A Guide for Permitting, Operation and Reclamation;
h. Others as may be approved by the Department.
LIME - RATE OF APPLICATION (tons/acre):'4
FERTILIZER - ANALYSIS AND RAT,E//�yOjF� APPLICATION (pounds/acre):
c.-
SEED - TYPE(S) AND RATE(S) OF APPLICATION INCLUDING YEAR-ROUND SEEDING
SCHEDULE (pounds/acre): [NOTE: Include Legumes]
Seed Types: Seeding Dates: Seeding Rates:
MULCH - TYPE AND RATE OFF A�PPLICATIIjON (pounds/acre) AND
,�METHOD
/ O�FfJANCHORING: 'al
OTHER VEGETATIVE COVERS — TYPE (S) AND/RATE (S) OF APPLICATION INCLUDING
SEEDING SCHEDULE (pounds/acre, trees/acre, spacing of trees/shrubs, etc):
Signature
J
Print Nan
Title /
Agency
plan approved by:
P-,- C41 J�%''`
Date % A4.3
11

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 affectedduring the life of the miningpermit. Please insert the g2proximate_acreage for each
CATEGORY
Tailings/Sediment Ponds:
Stockpiles:
Wastepiles:
Processing Area/Haul Roads:
Mine Excavation:
Other:
TOTAL AFFECTED AC.:
AFFECTED
ACREAGE
Ac. X
/ Ac.
—�
Ac.
Ac.
Ac.
—C —
Ac.
Z7 -,Ac.
(TOTAL PERMITTED AC.: ;-G _ Ac.)
X
RECLAMATION
COST/ACRE*
$ :' %IAc.
$ t IAc.
X
$
e)
IAc. =
X
$
1 f 4" /)
IAc. =
X
$
IAc. =
X
$
G>
IAc. =
RECLAMATION
COST
$ 7i 6
Temprary o& 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 offshe sedimentation and sedimentation to onsite watercourses and wetlands.
a) Internal Drainage %•ri Ac.
b) Positive Drainage _� Ac. X $1,500.00 = $
Inflation Factor:
SUBTOTAL COST: $_ _ f 6
0.02 X SUBTOTAL COST: $ &-/ A. 6 Z Z X Permit Life (1 to 10 years):
INFLATION COST: $ 3 •� e
TOTAL COST = SUBTOTAL COST + INFLATION COST = $
Total Reclamation Bond Cost: $ laCdum _
(round down to the nearest $100.00)
,A

APPLICATION FOR A MINING PERMIT
F. NOTIFICATION OF ADJOINING LANDOWNERS
The "Notice" form, or a facsimile thereof, attached to this application must be sent certified or registered mail,
return receipt requested, to:
(1) the chief administrative officer of each county and municipality in which any part of the permitted
area is located as indicated on the mine map(s);
(2) all owners of record, both public and private, of all tracts of land that are adjoining the mining
permit boundary; if an adjoining tract is owned or leased by the applicant or is owned by the lessor
of the mine tract, all owners of record of tracts adjoining these tracts must be notified (that are
within 1,000 feet of the mining permit boundary) as indicated on the mine map(s); and
(3) all owners of record, both public and private, of all tracts of land that are adjoining the mining
permit boundary which lie directly across and are contiguous to any highway, creek, stream, river,
or other watercourse, railroad track, or utility or other public right-of-way. If an adjoining tract is
owned or leased by the applicant or is owned by the lessor of the mine tract, all owners of record of
tracts adjoining these tracts must be notified (that are within 1,000 feet of the mining permit
boundary) as indicated on the mine map(s). "Highway" means a road that has four lanes of travel
or less and is not designated as an Interstate Highway.
The only exception to the above method of giving notice is if another means of notice is approved in advance by
the Director, Division of Land Resources.
A copy of a tax map (or other alternative acceptable to the Department) must be mailed with the completed
"Notice" form (the proposed overall permit boundaries and the names and locations of all owners of
record of lands adjoining said boundaries must be clearly denoted on the tax map).
The "Affidavit of Notification" attached to this application must be completed, notarized and submitted to the
Department, with the remainder of the completed application form, before the application will be considered
complete.
THIS SECTION MUST BE COMPLETED FOR ALL APPLICATIONS FOR NEW MINING PERMITS
AND ALL MODIFICATIONS OF A MINING PERMIT TO ADD LAND TO THE PERMITTED AREA, AS
REQUIRED BY NCGS 74-50(bl).
SEE THE NEXT TWO PAGES FOR THE "NOTICE" FORM AND THE "AFFIDAVIT OF
NOTIFICATION"
-15-

NOTICE
Pursuant to provisions G.S. 74-50(bl) of The Mining Act of 1971, Notice is hereby given that
has applied on
(Applicant Name) (Date)
to the Land Quality Section, Division of Land Resources, North Carolina Department of Environment
and Natural Resources, 1612 Mail Service Center, Raleigh, North Carolina 27699-1612, for (check one):
❑ a new surface mining permit,
❑ a modification of an existing surface mining permit to add land to the permitted area; or
❑ a modification of an existing surface mining permit to add land to the permitted area with no disturbance
in the area proposed. Please note that future modification(s) may be submitted by the applicant to
allow disturbance within this area without re -notification of adjoining landowners.
The applicant proposes to mine on acres located
(Mineral, Ore) (Number) (Miles)
of off/near road
(Direction) (Nearest Town) (Number/Name)
in _ - County.
*SEE ATTACHED MAP FOR PROPOSED PERMIT BOUNDARIES AND CORRESPONDING
ADJOINING LANDOWNER NAMES AND LOCATIONS*
In accordance with G.S. 74-50(bl), the mine operator is required to make a reasonable effort, satisfactory to the
Department, to notify all owners of record, both public and private, of all tracts of land that are adjoining the mining
permit boundary; if an adjoining tract is owned or leased by the applicant or is owned by the lessor of the mine tract,
all owners of record of tracts adjoining these tracts must be notified (that are within 1,000 feet of the mining permit
boundary). In addition, the mine operator must also notify the chief administrative officer of the county or
municipality in which any part of the permitted area is located. Any person may file written comment(s) to the
Department at the above address within thirty (30) days of the issuance of this Notice or the filing of the application
for a permit, whichever is later. Should the Department determine that a significant public interest exists relative to
G.S. 74-51, a public hearing will be held within 60 days of the end of the 30-day comment period specified above.
A copy of the permit application materials is on file and available for public review during normal business
hours at the above listed address as well as at the appropriate regional office. For information regarding I
specifics of the nr000sed minim activity. nlease contact the applicant at the following telenhnne numl
r or uuormauon on me mining
#mat [phone]. Please note that 1
(Addressee/Owner of Record's
Name and Address)
(Date of Issuance of this Notice/
Mailed to Addressee/Owner of Record)
review
(Name of Applicant: Include Contact Person
& Company Name, if Applicable)
contact
(Address of Applicant)

APPLICATION FOR A MINING PERMIT
AFFIDAVIT OF NOTIFICATION
1, , an applicant, or an agent, or employee of an applicant, for a
new Mining Permit, or a modification of an existing Mining Permit to add land to the permitted area, from the N.C.
Department of Environment and Natural Resources, being first duly sworn, do hereby attest that the following are all
known owners of record, both public and private, of all tracts of land that are adjoining the mining permit boundary
(including, where an adjoining tract is owned or leased by the applicant or is owned by the lessor of the mine tract,
all owners of record of tracts adjoining these tracts, that are within 1,000 feet of the mining permit boundary) and
that notice of the pending application has been caused to be mailed, by certified or registered mail, return receipt
requested, to said owners of record at their addresses shown below, such notice being given on a form provided by
the Department:
(Adjoining Landowner Name) (Address)
(Attach additional list if necessary)
I do also attest that the following individual is the chief administrative officer of the county or municipality in which
any part of the permitted area is located and that notice of the pending application has been caused to be mailed, by
certified or registered mail, return receipt requested, to said office at the following address:
(Chief Administrative Officer Name) (Address)
[i.e.: City Manager, County Manager, Mayor, etc.]
The above attestation was made by me while under oath to provide proof satisfactory to the Department that a
reasonable effort has been made to notify all known owners of record, both public and private, of all tracts of land
that are adjoining the mining permit boundary (including, where an adjoining tract is owned or leased by the
applicant or is owned by the lessor of the mine tract, all owners of record of tracts adjoining these tracts, that are
within 1,000 feet of the mining permit boundary) and the chief administrative officer of the county or municipality in
which any part of the permitted area is located in compliance with N.C.G.S. 74-50(b1) and 15A NCAC 513.0004(d).
I understand that it is the responsibility of the applicant to retain the receipts of mailing showing that the above
notices were caused to be mailed and to provide them to the Department upon request.
Signature of Applicant or Agent
Date
If person executing Affidavit is an agent or employee of an applicant, provide the following information:
Name of applicant:
Title of person executing Affidavit
I,
a Notary Public of the County of ,
State of North Carolina, do hereby certify that
appeared before me this day and under oath acknowledged that the above Affidavit was made by him/her.
Witness my hand and notarial seal, this day of 20
Notary: my Commission expires:
- 17-

APPLICATION FOR A MINING PERMIT
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:
Signature:
17
Print Name:.��'
,(Title, if applicable)
' Company .
(If applicab e) ,
(oO iAddress:
Telephone:
Date Signed: f 1
APPLICANT:
Signature:*
Print Name: •�i1i� !%l! �'! �' ,l/��(�`.�
Title:
--T
Company:
Mine Name: .S Ri'Pe-
Telephone: V,,P) ,yam y z41P0
Date Signed: !� ` ��/3
*Signature must be the same as the individual who signed Page 1 of this application.
i
six (6) conies of all
and reclamation maps, and the appropriate rocessin fee (see next page for fee schedule) in the form a check
or money order payable to the North Carolina Department of Environment and Natural Resources must be
sent to the Land Oualitv_Section 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
[phone].
-18-

APPLICATION FOR A MINING PERMIT
MINING FEE SCHEDULE
A nonrefundable permit application processing fee when filing for anew mining permit, a major permit modification or a renewal permit is
required as follows:
New Permit Applications
Permit Modifications
Permit Renewals
Transfers/Minor Modifications*
0-25 acres
$3,750.00
$750.00
$750.00
$100.00
26+acres
$5,000.00
$1,000.00
$1,000.00
$100.00
* A nonrefundable S1if0.00 permit application processing fee is required for minor permit modifications. Minor permit modifications include ownership transfers, name
changes, bond substitutions and permit renewals where the mine is inactive and fully stabilized. A minor permit modification also includes lands added to a permitted area,
outside of the minimum permit buffer zone requiremeots, where no plans for mining related disturbance of the added lands have been approved. All other changes are
considered major permit modifications.
Acres for new permits and renewal permits means the total acreage at the site. Acres for major modification of permits means that area of land affected by the modification
within the permitted mine area, or any additional land that is to be disturbed and added to an existing permitted area, or both.

APPLICATION FOR A MINING PERMIT
There are seven Land Quality Section (LQS) Regional Offices. Use the map below to locate the Regional Office
serving your county.
'�A t� 1 0
,., Mparville,
jl .F
f��.fltakgi9hl�-y•' �'�r ti �4�����
■ � r
Asheville Regional Office
• Counties: Avery, Buncombe, Burke, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey
• Address: 2090 U.S. Highway 70, Swannanoa, NC 28778
• Voice:828.296.4500
• FAX:[phone]
Fayetteville Regional Office
• Counties: Anson, Bladen, Cumberland, Harnett, Hoke, Montgomery, Moore, Richmond, Robeson, Sampson,
Scotland
• Address: 225 Green Street, (Systel Building), Suite 714, Fayetteville, NC 28301-5094
• Voice:910.433.3300
• FAX:[phone]
Mooresville Regional Office
• Counties: Alexander, Cabarrus, Catawba, Cleveland, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Stanly,
Union
• Address: 610 East Center Ave., Suite 301, Mooresville, NC 28115
• Voice:704.663.1699
• FAX:[phone]
Raleigh Regional Office
• Counties: Chatham, Durham, Edgecombe, Franklin, Granville, Halifax, Johnston, Lee, Nash, Northampton,
Orange, Person, Vance, Wake, Warren, Wilson
• Address: 1628 Mail Service Center, Raleigh, NC 27699-1628 or 3800 Barrett Drive, Raleigh, NC 27609
• Voice:919.791.4200
• FAX:[phone]
Washington Regional Office
• Counties: Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Greene, Hertford, Hyde, Jones,
Lenoir, Martin, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell, Washington, Wayne
• Address: 943 Washington Square Mall, Washington, NC 27889
• Voice:252.946.6481
• FAX:[phone]

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