WQ0036755_Application_20130828

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15A NCAC 02T.1000
Closed Loop Recycle System Permit Application
Mason's Ruby and Sapphire Mine
6961 Upper Burningtown Rd, Franklin, NC 28734
Prepared for
Permit Applicant
,:.Mason Sapphire Mine, LLC
Prepared by
HydroCycle
Engineering, PC
16 Broad St
Asheville, NC 28801
828.989.8075
August 28, 2013
RECEIVED
OCT - 3 2013
DWOfflwfhx WaterIRoteetten Se
Asheville R ional Office
0
RECEIVEDIVENR1DWO
SEP .ag 2013
Aquifer Protection Section

HydroCycle
Engineering, PC
August 28, 2013
Mr. Jon Risgaard, Unit Supervisor
North Carolina Dept. of Environment and Natural Resources
Division of Water Resources
Land Application Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
Subject: Mason's Ruby and Sapphire Mine, 6961 Upper Burningtown Rd, Franklin, NC 28734
15A NCAC 02T.1000 Closed Loop Recycle System Permit Application
Dear Mr. Risgaard:
Mr. Ernest (Al) Klatt of Mason's Ruby and Sapphire Mine (Mason's Mine) in Macon County,
North Carolina has retained the services of HydroCycle Engineering (HydroCycle) to prepare an
application permit for the existing closed loop recycled water system at Mason's Mine.
Subsequent to my phone discussion with Ms. Beverly Price of the Asheville Regional Office on
July 19, 2013, 1 conducted a site visit and inspection of the recycled water system on July 29,
2013 and have prepared this cover letter and permit application.
History and Background
The original mine dates back to 1895 when it was operated by the American Prospecting and
Mining Company of New York, during which time abrasive grade corundum was primarily
mined. In 1942, the Mason family bought the property and established the present day tourist
gem mine. Mason's Mine has been under the ownership of the Klatt family since June 2011.
According the NC Department of Environment and Natural. Resources (NCDENR) website,
Mason's Mine received a mining permit as a gemstone mine on August 21, 1992 (Permit No.
57-11). The Mason's Mine parcel encompasses 23.55 acres in the northwestern portion of
Macon County. Burningtown Creek flows through the central portion of the Mason's Mine
property.
Recycled Water System Description
The recycled water system for Mason's Mine consists of two earthen excavated sediment ponds
with steep side slopes. These two ponds are interconnected by a 15-inch diameter corrugated
plastic pipe culvert. Portable gas powered trash pumps are used to convey water via 2-inch
diameter flexible plastic lines from the lower sediment pond, up to four flumes at which patrons
of Mason's Mine pan for gems. The return wash water is then conveyed to the upper sediment
pond where the larger sediment is settled out. Overflow from the upper sediment pond is
conveyed to the lower sediment pond. Water from the lower sediment pond, which is the
secondary settling pond, is used as the water source for the wash water to the flumes.
Groundwater is added to the sediment ponds periodically to augment water which is primarily
lost through infiltration and evaporation from the unlined and open air ponds. The ponds are
situated in a generally flat area with berms such that any stormwater runoff draining into the
ponds is minimal.
HydroCycle Engineering 9 16 Broad Street, Asheville, NC 28801 • 828.989.8075 • www.hydrocycle-eng.com

i'
Mason's Ruby and Sapphire Mine, Closed Loop Recycle System Permit Application
August 28, 2013
There have been no observed overflows from system during the tenure of the current owners.
Sediment is regularly dredged from the upper sediment pond and placed in an adjacent upland
area to be dewatered and dried. The system conveys only water and sediment and no
chemicals used in the washing process. Table 1 below summarizes the system features. The
values in the table were estimated based on field measurements taken on July 29, 2013.
Similarly, for the earthen impoundment section of Form CLRS 08-11, values were estimated
based on field measurements and typical conditions.
Table 1. Summary of Closed Looa Recvcle System Features at Mason's Ruby and Sapphire Mine
Characteristic
Upper Sediment Pond
Lower Sediment Pond
Est. Average Length (ft)
55
81
Est. Average Width ft
44
24
Estimated Surface Area ft2
2,420
1,940
Est. Average Depth ft *
6
6
Est. Maximum Pond Volume ft3)
14,520
11,640
Est. Maximum Pond Volume c
540
430
Est. Maximum Pond Volume ac-ft
0.33
0.27
Primary Function of Pond
Receives spent wash water from
flumes and allows heavier
sediment to settle out
Supplies wash water to flumes and
receives overflow from upper
sediment pond. Allows settlement of
finer particulates.
Pump Description
-
Red Lion 150 qpm trash um
Conveyance Description
--
2-inch flexible plastic line
*Depth varies as sediment gradually fills ponds and is later excavated.
Figure 1 shows a layout of the system with a photo index indicating direction of the photo.
Photos of the system with descriptions are also provided below.
Page 2

i
Mason's Ruby and Sapphire Mine, Closed Loop Recycle System Permit Application
August 28, 2013
FOOT BRIDGE —•��•♦�,..♦�•••
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/• 8 1 POD
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POND:
1
ELEC. HOOK UP
IL
l
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tiA ELEC. HOOK LIP
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Figure 1. Layout of Closed Loop Recycle System and Photo Index.
Page 3

Mason's Ruby and Sapphire Mine, Closed Loop Recycle System Permit Application
August 28, 2013
Photo 2. Berm on north side of upper sediment pond.
Page 5

Mason's Ruby and Sapphire Mine, Closed Loop Recycle System Permit Application
August 28, 2013
Photo 3. Lower sediment pond, looking north toward 15-inch diameter equalization culvert.
Page 6

Mason's Ruby and Sapphire Mine, Closed Loop Recycle System Permit Application
August 28, 2013
Photo 4. Lower sediment pond, looking south.
Page 7

Mason's Ruby and Sapphire Mine, Closed Loop Recycle System Permit Application
August 28, 2013
�1. r
' .� ? � � 1� �*i \ 4 . � "4- a l V •'
Photo 5.15-inch diameter equalization culvert flowing into lower sediment pond.
Page 8

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Mason's Ruby and Sapphire Mine, Closed Loop Recycle System Permit Application
August 28, 2013
Page 10

Mason's Ruby and Sapphire Mine, Closed Loop Recycle System Permit Application
August 28, 2013
Photo 8. Wash water conveyed from lower sediment pond to flume via 2-inch line.
Permit Application
The closed loop recycled water system at Mason's Ruby and Sapphire Mine is a small,
simplified system with flow conveyed by portable trash pumps and gravity fed through flumes
and an equalization pipe. The total maximum storage in the system is estimated to be
approximately 0.6 acre-feet (26,000 ft), but is frequently lower because of the gradual and
continual input of sediment from the flume washing process.
The closed loop recycle system has been operational in its current manner for decades. No
engineering plans or as-builts were prepared for this system when it was constructed. Because
it is a small, simplified and portable pump system, it has been presumed that the previous
owners had the system constructed by a contractor without any engineering design.
Based on a previous discussion with Ms. Beverly Price of NCDENR Asheville Regional Office
regarding the required information for Mason's Mine, the response to the sections of the closed -
loop recycle system permit application sections are summarized in Table 2.
Page 11

Mason's Ruby and Sapphire Mine, Closed Loop Recycle System Permit Application
August 28, 2013
Table 2. Resaonses to Closed Loop Recycle System Permit Sections
Section
Response
A. Cover Letter
Completed and attached
B. Application Fee
Enclosed check for $360.00
C. Closed Loop Recycle System
Application
Completed and attached
D. Property Ownership Documentation
Attached
E. Water Balance
Not included (existing system without modifications)
F. Engineering Plans
Not included (exemption requested), Survey dated 7/6/2011 attached.
G. Specifications
Not included (exemption requested).
H. Engineering Calculations
Not included (exemption requested).
I. Site Map
Survey dated 7/6/2011 attached.
I Power Reliability Plan
Not included (exemption requested).
K. Operation and Maintenance Plan
Simplified plan consisting of monitoring of freeboard levels in lower
sediment pond on a weekly basis.
.L. Residuals Management Plan
Not included (exemption requested).
M. Additional Documentation
Not included (exemption requested).
Requested Permitting Action
Given the history of the site and the simplicity of the system of two small sediment ponds with
portable trash pumps, conveying water and sediment only with no discharge, the requested
permitting action is to grant a closed loop recycled water system permit with the appropriate
exemptions, as determined by the NCDENR. As an operational requirement of this permit,
Mason's Mine will install a freeboard meter and record freeboard levels in the lower sediment
pond on a weekly basis.
The following attachments are included in support of this permit application.
Attachment A - Permit Application, Form CLRS 08-11
Attachment B — Property Ownership Documentation
Attachment C — Mining Permit Survey, dated July 6, 2011
Attachment D — Proposed Freeboard Marker and Freeboard Log Sheets
Attachment E — Professional Engineer's Certification
Page 12

Mason's Ruby and Sapphire Mine, Closed Loop Recycle System Permit Application
August 28, 2013
On behalf of Mr. Al Klatt and Mason's Ruby and Sapphire Mine, thank you for your review of this
permit application. If you have any questions or need additional information, please contact me
at tonnond _hydrocycle-enter cone or 828.989.8075.
Sincerely,
Timothy C mond, P.E.
Principal Engineer
copy: Mr. Ernest Al Klatt, Mason's Ruby and Sapphire Mine
encl.: Permit application fee
Page 13

ATTACHMENT A - Permit Application, Form CLRS 08-11

�oF W ATF9�
State of North Carolina
�O G Department of Environment and Natural Resources
r
y Division of Water Quality
O 15A NCAC 02T .1000 — CLOSED -LOOP RECYCLE SYSTEMS
FORM: CLRS 08-11
L APPLICANT INFORMATION:
1. Applicant's name: Mason's Ruby and Sapphire Mine
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
3. Signature authority's name: Ernest Klatt per 15A NCAC 02T .0106(b) Title: Owner
4. Applicant's mailing address: 6961 Upper BurninQtown Road
City: Franklin State: NC Zip: 28734-
5. Applicant's contact information:
Phone number: 828 369-9742 Email Address: [e-mail]
II. FACILITY INFORMATION:
1. Facility name: Mason's Ruby and Sapphire Mine
2. Facility status: Existing
If this facility is existing, was it originally permitted prior to September 1, 2006? ❑ Yes or ® No
If yes, does this facility meet the criteria in 15A NCAC 02T .1003? ❑ Yes or ® No
If yes, discontinue use of this form (CLRS 08-11) and complete the Closed -Loop Recycle System Rescission Request
(FORM: CLRSRR)
3. Facility type: Major (> 10,000 GPD or> 300 disposal acres)
4. Facility's physical address: 6961'Upper Burningttown Road
City: Franklin State: NC Zip: 28734- County: Macon
5. Wastewater Treatment Facility Coordinates (Decimal Degrees): Latitude: 35.2152' Longitude:-83.5289'
Datum: Unknown Level of accuracy: Nearest second Method of measurement: Address matching
6. USGS Map Name: Wayah Bald
III. CONSULTANT INFORMATION:
1. Professional Engineer: Timothy P. Ormond, P.E.
Mailing address: 16 Broad Street
License Number: 032956Firm: H dy roCycle Engineering
City: Asheville State: NC Zip: 28801-
Phone number: 828 989-8075 Email Address: [e-mail]
2. Soil Scientist: License Number: Firm:
Mailing address:
City: State: Zip: -
Phone number: (_) _- Email Address: _
3. Geologist: License Number:
Mailing address:
City: State: Zip: -
Phone number: (—) = Email Address: _
Firm:
FORM: CLRS 08-11 Page 1 of 7

IV. GENERAL REQUIREMENTS —15A NCAC 02T .0100:
1. Application type: ® New ❑ Major Modification ❑ Minor Modification
If a modification, provide the existing permit number: WQ00 and most recent issuance date:
2. Application fee: Select $360.00
3. Does this project utilize public monies or lands? ❑ Yes or ® No
If yes, was an Environmental Assessment required under 15A NCAC 01 C? ❑ Yes or ❑ No
If yes, which final environmental document is submitted? ❑ Finding of No Significant Impact or ❑ Record of Decision
Briefly describe any mitigating factors from the Environmental Assessment that may impact this facility: N/A
4. What is the status of the following permits/certifications applicable to the subject facility?
Permit/Certification
Date
Submitted
Date
Approved
Permit/Certification
Number
Agency Reviewer
Collection System (O >_ 200,000 GPD)
Dam Safety
Erosion & Sedimentation Control Plan
Nationwide 12 / Section 404
Pretreatment
Sewer System
Stormwater Management Plan
Wetlands 401
Other: Gemstone Mining
8/21/92
57-11
5. What is the wastewater type? ❑ Domestic or Industrial (See 15A NCAC 02T .0l 03(20))
Is there a Pretreatment Program in effect? ❑ Yes or ® No
Has a wastewater chemical analysis been submitted? ❑ Yes or ® No
6. Wastewater flow: 81,000 GPD
Limited by: ❑ Treatment, ❑ Storage or ® Recycle Quantity
7. Explain how the wastewater flow was determined: ❑ 15A NCAC 02T .0114 or ® Representative Data
Hasa flow reduction been approved under 15A NCAC 02T .0114(f) ❑ Yes or ❑ No
Establishment Type
Daily Design Flow'
No. of Units
Flow
Tourist gemstone mine
150 gal/min
540
81,000 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
81,000 GPD
a See 15A NCAC 02T .0114(b), U, (e)(1) and foo for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G.S. 42A-4).
FORM: CLRS 08-11 Page 2 of 7

IV. GENERAL REQUIREMENTS —15A NCAC 02T .0100 (continued):
8. What is the nearest 100-year flood elevation to the facility? 2029 feet mean sea level. Source: Burningtown Creek
Are any treatment, storage or disposal facilities located within the 100-year flood plain? ❑ Yes or ® No
If yes, which facilities are affected and what measures are being taken to protect them against flooding?
If yes, has the Applicant submitted written documentation of compliance with § 143 Article 21 Part 6? ❑ Yes or ❑ No
9. Has the Applicant provided documentation of the presence or absence of threatened or endangered aquatic species utilizing
information provided by the Department's Natural Heritage Program? ❑ Yes or ® No
10. Does the facility have a proposed or existing groundwater monitoring well network? ❑ Yes or ® No
If no, provide an explanation as to why a groundwater monitoring well network is not proposed: washwater only; no
industrial or other chemicals used in the process
If yes, complete the following table (NOTE — This table may be expanded for additional wells):
Well Name
Status
Latitude a
Longitude a
Gradient
Location
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
a Provide the following latitude and longitude coordinate determination information:
Datum: Select Level of accuracy: Select Method of measurement: Select
11. Is the Applicant a Privately -Owned Public Utility? ❑ Yes or ® No
If yes, has the Applicant submitted a Certificate of Public Convenience and Necessity? ❑ Yes or ❑No
12. Demonstration of historical consideration for permit approval —15A NCAC 02T .0120:
Has the Applicant or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.613? ❑ Yes or ® No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ® No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or ® No
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or ® No
e. Has unpaid annual fees in accordance with l 5A NCAC 02T .0105(e)(2)? ❑ Yes or ®No
V. CLOSED -LOOP RECYCLE FACILITY DESIGN CRITERIA —15A NCAC 02T .1005:
1. How does the Applicant propose to prohibit public access to the closed -loop recycle facilities? Locked gate
2. Is potable water proposed to supplement the closed -loop recycle system? ® Yes or ❑ No
If yes, is there an air gap separation between the potable water system and the closed -loop recycle system? ® Yes or ❑ No
3. Can the closed -loop recycle system: ❑ Stop production of effluent?
❑ Return the effluent back to the treatment facility?
® Store the effluent?
❑ Discharge the effluent to another permitted wastewater treatment facility?
" Permit number:
❑ None of the above
" Are essential treatment units provided in duplicate? ❑ Yes or ❑ No
4. If the wastewater treatment and storage systems are located within the 100-year flood plain, are there water -tight seals on all
treatment/storage units or a minimum of two feet protection from the 100-year flood plain elevation? ❑ Yes or ❑ No
FORM: CLRS 08-11 Page 3 of 7

V. CLOSED -LOOP RECYCLE FACILITY DESIGN CRITERIA —15A NCAC 02T .1005 (continued):
5. If open atmosphere storage units are present, are they capable of containing the accumulation of water from a 25-year, 24-
hour storm event? ❑ Yes or ® No
6. If an influent pump station is part of the proposed facility (i.e., within the wastewater treatment plant boundary), does the
influent pump station meet the design criteria in 15A NCAC 02T .0305(hl? ❑ Yes, ❑ No, ❑ N/A — To be permitted
separately, or ❑ N/A — Gravity fed
7. If septic tanks are part of the wastewater treatment facility, do the septic tanks adhere to the standards in 15A NCAC 18A
.1900? ❑ Yes, ❑ No or ® N/A
8. Provide the requested treatment unit and mechanical equipment information:
a. TREATMENT:
Treatment Unit
No. of
Units
Manufacturer or
Material
Dimensions (ft) /
Spacings in(gallons)
Volume
Plan Sheet
Reference
Specification
Reference
b. PUMPS
Location
No. of
Pumps
Purpose
Manufacturer /
T e
Plan Sheet
Reference
Specification
Reference
—Capacity
GPM
TDH
Lower Sediment
Pond
1
Provide wash water
to flumes
Red Lion
150
See photo
N/A
c. BLOWERS
Location
No. of
Blowers
Units Served
Manufacturer /
IKEe
Capacity
C
Plan Sheet
Reference
Specification
Reference
d. MIXERS
Location
No. of
Mixers
Units Served
Manufacturer /
Type
Power
h
Plan Sheet
Reference
Specification
Reference
e. RECORDING DEVICES & RELIABILITY
No. of
Maximum
Plan Sheet
Specification
Device
Location
Manufacturer
Units
Capac&
Reference
Reference
Freeboard Meter
1
Lower Sediment
Ben Meadows
4 feet
Figure 1
N/A
Pond
FORM: CLRS 08-11 Page 5 of 7

VI. EARTHEN STORAGE IMPOUNDMENT DESIGN CRITERIA —15A NCAC 02T .1005:
IF MORE THAN ONE EARTHEN STORAGE IMPOUNDMENT, PROVIDE ADDITIONAL COPIES OF THIS PAGE AS
NECESSARY.
1. What is the earthen impoundment type? Other
2. Storage Impoundment Coordinates (Decimal Degrees): Latitude: 35.2153' Longitude:-83.5290'
Datum: NAD83 Level of accuracy: Nearest second Method of measurement:
Aerial photography with ground control
3. Do any impoundments include a discharge point (pipe, spillway, etc)? ® Yes or ❑ No
4. Are subsurface drains present beneath or around the impoundment to control groundwater elevation? ❑ Yes or ® No
5. Is the impoundment designed to receive surface runoff? ❑ Yes or ® No
If yes, what is the drainage area? flz, and was this runoff incorporated into the water balance? ❑ Yes or ❑ No
6. If a liner is present, how will it be protected from wind driven wave action? N/A
7. Will the earthen impoundment water be placed directly into or in contact with GA classified groundwater? ❑ Yes or ® No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not result in a
contravention of GA groundwater standards? ❑ Yes or ❑ No
8. What is the depth to bedrock from the earthen impoundment bottom elevation? Unknown ft
If the depth to bedrock is less than four feet, has the Applicant provided a liner with a hydraulic conductivity no greater than
1 x 10_7 cm/s? ❑ Yes, No or ® N/A
Has the Applicant provided predictive calculations or modeling demonstrating that surface
water or groundwater standards will not be contravened? ❑ Yes or ❑ No
If the earthen impoundment is excavated into bedrock, has the Applicant provided predictive calculations or modeling
demonstrating that surface water or groundwater standards will not be contravened? ❑ Yes, ❑ No or ® N/A
9. If the earthen impoundment is lined and the mean seasonal high water table is higher than the impoundment bottom
elevation, how will the liner be protected (e.g., bubbling, groundwater infiltration, etc.)? N/A
10. If applicable, provide the specification page references for the liner installation and testing requirements: N/A
11. If the earthen impoundment is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain elevation) been provided? ❑ Yes or ❑ No lNot Applicable
12. Provide the requested earthen impoundment design elements and dimensions:
Earthen Impoundment Design Elements
Earthen Impoundment Dimensions
Liner type:
❑ Cl a
❑ S nthetic
Top of embankment elevation:
2,414 ft
❑ Other
® Unlined
Liner hydraulic conductivity:
Unknown x - cm/s
Freeboard elevation:
2,412 ft
Hazard class:
Not Applicable
Toe of slope elevation:
N/A ft
Designed freeboard:
2.0 ft
Impoundment bottom elevation:
2,408 ft
Total volume:
26,200 ft3
196,000 gallons
Mean seasonal high water table depth:
Unknown ft
Effective volume:
15,800 ft3
118,000 gallons
Embankment slope:
0.5 : 1
Effective storage time:
2 days
Top of dam water surface area:
4,360 W
Plan Sheet Reference:
N/A
Freeboard elevation water surface area:
3,960 ftz
Specification Section:
N/A
Bottom of impoundment surface area:
3,210 fe
NOTE — The effective volume shall be the volume between the two foot freeboard elevation and the: (1) pump intake pipe
elevation; (2) impoundment bottom elevation or (3) mean seasonal high water table, whichever is closest to the two foot
freeboard elevation.
FORM: CLRS 08-11 Page 6 of 7

VIl. SETBACKS —15A NCAC 02T .1006:
1. Does the project comply with all setbacks found in the river basin rules (15A NCAC 02B .0200)? ® Yes or ❑ No
If no, list non -compliant setbacks:
2. Have any setback waivers been obtained in order to comply with 15A NCAC 02T .1006? ❑ Yes or ® No
If yes, have these waivers been written, notarized and signed by all parties involved and recorded with the County Register of
Deeds? ❑ Yes or ❑ No
3. Provide the minimum field observed distances (ft) for each setback parameter to the disposal system and treatment/storage
units (NOTE: Distances greater than 500 feet may be marked N/A):
Setback Parameter
Treatment /
Stora a Units
Any habitable residence or place of assembly under separate ownership or not to be maintained as part
of the projectsite
N/A
Any private or public water supply source
N/A
Surface waters (streams — intermittent and perennial, perennial waterbodies, and wetlands)
N/A
Any well with exception of monitoring wells
N/A
Any property line
N/A
FORM: CLRS 08-11 Page 7 of 7

ATTACHMENT D - Property Ownership Documentation

C201118600222 T
SOSID: 1211177
Date Filed: 7/5/20113:56:00 PM
Elaine F. Marshall
State of North Carolina North Carolina Secretary of State
C201118600222
Department of the Secretary of State
Limited Liability Company
ARTICLES OF ORGANIZATION
Pursuant to §57C-2-20 of the General Statutes ofNorth Carolina, the undersigned does hereby submit
these Articles of Organization for the purpose of forming a limited liability company.
The name of the limited liability company is: Mason Sapphire Mine LLC
2. If the limited liability company is to dissolve by a specific date, the latest date on which the
limited liability company is to dissolve: (If no date for dissolution is specified, there shall be no
limit on the duration of the limited liability company.)
3. The name and address of each person executing these articles of organization is as follows:
(State whether each person is executing these articles of organization in the capacity of a
member, organizer or both. Note: This document must be signed by all persons listed here).
Steven E Philo, Organizer
2" Porter St
Franklin,N C 28734
4. The street address and county of the initial registered office of the limited liability company is:
Number and Street 25 Patton Ave
City, State, Zip Code Franklin, N C 28734 County Macon
5. The mailing address, if different from the street address, of the initial registered office is:
6. The name of the initial registered agent is: Lila Klatt
7. Principal office information: (Select either a or b)
a. []✓ The limited liability company has a principal office.
The street address and county of the principal office of the limited liability company is:
Number and Street 25 Patton Ave
City, State, Zip Code Franklin N C 28734 County Macon
The mailing address, if dWerent from the street address, of the principal office of the corporation is:
b. ❑ The limited liability company does not have a principal office.

C201118600222
8. Check one of the following:
✓ (i) Member managed LLC: all members by virtue of their status as members shall be
managers of this limited liability company.
(ii) Manager -managed LLC: except as provided by N.C.G.S. Section 57C-3-20(a), the
members of this limited liability company shall not be managers by virtue of their status as
members.
9. Any other provisions which the limited liability company elects to include are attached.
10. These articles will be effective upon filing, unless a date and/or time is specified:
This is the 1st day of July , 20 11
Steven E Philo (Organizer)
Type or Print Name and Title
NOTES:
1. Filing fee is $125. This document must be flied with the Secretary of State.
CORPORATIONS DIVISION P.O. Box 29622 RALEIGH, NC 27626-0622
(Revised January 2002) (Form L-01)
Instructions for Filing

LIMITED LIABILITY COMPANY
ANNUAL REPORT
NAME OF LIMITED LIABILITY COMPANY: Mason Sapphire Mine LLC
REPORT FOR THE YEAR: 2013
SECRETARY OF STATE L.L.C. ID NUMBER: 1211177
NATURE OF BUSINESS: Gemstone mining
REGISTERED AGENT: Klatt, Ernest Jr
REGISTERED OFFICE MAILING ADDRESS: 6961 Upper Burningtown Rd
Franklin, NC 28734
E-Filed Annual Report
9790568
Do not data enter manually.
STATE OF INCORPORATION: NC
REGISTERED OFFICE STREET ADDRESS: 6961 Upper Burningtown Rd
Franklin, NC 28734 Macon County
PRINCIPAL OFFICE TELEPHONE NUMBER: [phone]
PRINCIPAL OFFICE MAILING ADDRESS
PRINCIPAL OFFICE STREET ADDRESS:
MANAGERS/MEMBERS/ORGANIZERS:
Name: Ernest Klatt Jr
Title: Member
Address:
459 Burningtown Falls Rd
Franklin, NC 28734
6961 Upper Burningtown Rd
Franklin, NC 28734
6961 Upper Burningtown Rd
Franklin, NC 28734
Name: Michael Klatt
Title: Member
Address:
52 Nebraska St
Asheville, NC 28806
Name: Lila Klatt
Title: Manager
Address:
130 East Main Street
Franklin, NC 28734
Name: Cindy Carrigan Name: Charles Klatt Name: Laura House
Title: Member Title: Member Title: Member
Address: Address: Address:
264 Forest Hills Drive 158 Woodland Hills Dr 9100 Tealby Place
Franklin, NC 28734 Franklin, NC 28734 Raleigh, NC 28615
CERTIFICATION OF ANNUAL REPORT MUST BE COMPLETED BY ALL LIMITED LIABILITY COMPANIES
Ernest Klatt Jr
FORM MUST BE SIGNED BY A MANAGER/MEMBER
Ernest Klatt Jr
4/4/2013
DATE
Member
TYPE OR PRINT NAME TYPE OR PRINT TITLE
ANNUAL REPORT FEE: E-Paid MAIL TO: Secretary of State • Corporations Division • Post Office Box 29525 • Raleigh, NC 27626-0525

ATTACHMENT C - Mining Permit Survey, dated July 6, 2011

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Near CaudT N(ND SCALE) 1 6lc RWATudmr&Amt PA
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. datl� f
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FJWWOMM 5.19 ACS TOTAL
�DAM \
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MINING PERMIT SURVEY ON SR 1392
JULEANN G osm
(UPPER BURNINGTOWN RD)
`' a
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LILA LEE KLATT
JULEANNSSRGWNIN0
aalet �`
BURNINGTOWN TOWNSHIP, MACON COUNTY, NC
DATE 08.01-11 SCALE:1"=59
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DEEDREFERENCE
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ROY J. TUCKER 8 ASSOCIATES PA., C-224, 38 EAST SYLVA SHOPPING CENTER, SYLVA, NORTH CAROLINA 28779 (828) 5865743 lgq.leN

ATTACHMENT D - Proposed Freeboard Marker and Freeboard Log Sheets

Mason's Ruby and Sapphire Mine, Franklin, North Carolina
Settling Pond Freeboard Log
A
B
C
D
E
F
Date
Time
Water Level
(ft)
Top of Pond
(ft)
Freeboard (ft)
[D minus C]
Initials
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0

8/19/13 ' BEN MEADOVVSTm Fiberglass Stream Gauge, * W, English, 04, 1251141 Ben Meadows
(, BEN MEADOWS $0.00 ,a,
When the attdoors is Your Office8' Sign In ( Register I W Account l 1-800-241-6401
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BEN MEADOWS- Fiberglass Stream Gauge, 4"W, English, 04
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Item #: 125114
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DETAILS
BEN MEADOWSTm Fiberglass Stream Gauge, 4"W, English, 04
Fiberglass Stream Gauge Makes the Best Permanent Marking Device
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ponds and swamps. Easy to read at long distances. Protected by a nonglare coating. Measures
4"W. English measuring system is numbered in feet, tenths and hundredths; 0.4'.
Choose Mounting Hardware (No. 125139), sold separately, to anchor the Stream Gauge.
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This item appears on page 139 of the Ben Meadows Company (.183) catalog. View in
ocritaloa.
3.1
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vwwvbenmeadows.comlben-meadows-fiberglass-strearrt-gauge-4vv-english-Q4 s_125114/ 1/2

ATTACHMENT E - Professional Engineer's Certification

Professional Engineer's Certification:
I, ( b { i P. 00h OLD attest that this application for
(Professional Engineer's name from Application Item M.1.)
M kso&� u,8VAN O SA-PPH I I? Owe
(Facility name from Application Item 11.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best of my
knowledge the proposed design has been prepared in accordance with this application package and its instructions, as well as all
applicable regulations and statutes. Although other professionals may have developed certain portions of this submittal package,
inclusion of these materials under my signature and seal signifies that I have reviewed this material and have judged it to be consistent
with the proposed design. *Please see footnote
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
*As described In the cover letter, this simplified system, consisting of two small excavated sediment ponds and portable trash pumps to
provide wash water for Mason's Mine (tourist gem mine), was constructed decades ago, presumably without any engineering design or
plans. Therefore, I can only attest to the field observations and estimated measurements I made during a site visit conducted on July 29,
2013. 1 cannot attest to any plans, engineering calculations, or other supporting documentation, since none was provided or available.
.•N���rorrr,._
Applicant's Certification per 15A NCAC 02T .0106(b):
I,
o �•
3 AL
p '•NGINEEQ'' Z
from Application Item H.1.)
that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that any discharge of wastewater
from this non -discharge system to surface waters or the land will result in an immediate enforcement action that may include civil
penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Quality should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if all
required supporting information and attachments are not included, this application package will be returned to me as incomplete. I
further certify that the Applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater
facility without proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are
compliant with any active compliance schedule, and do not have any overdue annual fees per 15A NCAC 02T .0105(e).
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000asas well as civil penalties up to $25,00000pper violation.
Signature: Signature: �!` --�—�C ` - Date:
FORM: CLRS 08-11 N Page 8 of 7
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