NCG560050_Application_20150302

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NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R.van der Vart
Governor Secretary
March 02,2015
Mr. Travis Bode
Surry-Yadkin Electric Membership Corp.
510 South Main Street
Dobson,NC 27017
Subject: Acknowledgement of New Permit Application
Permit#: NCG560050
510 South Main Street
Dear Mr.Bode:
The Division of Water Resources received your application for coverage under NPDES General
. Permit NCG556000 (Check#7346 in the amount of$100.00)on February 25,2015. The
application has been assigned number NCG560050, and has been given to Charles Weaver for
review.
The reviewer will perform a detailed review and contact you with a request for additional
information if necessary. To ensure the maximum efficiency in processing permit applications,the
division requests your assistant in providing a timely and complete response to any additional
information requested.
Please refer to the above application number when making inquiries on this project. If you have
any questions,please contact Mr. Weaver at 919-807-6391, or via e-mail at
[e-mail].
Sincerely,
W rem T!h-e obfo-rO1
Wren Thedford
Wastewater Branch
cc: Winston-Salem Regional Office
Permit File NCG560050
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Phone:[phone] Internet:www.ncwaterquality.org
An Equal Opportunity\Affirmative Action Employer—Made in part by recycled paper

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NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R.van der Vaart
Governor Secretary
March 11, 2015
Mr. Travis Bode
Surry-Yadkin Electric Membership Corporation
510 S Main St
Dobson, NC 27017
Subject: Issuance of Certificate of Coverage NCG560050
Surry-Yadkin Vegetation Control
Surry County
Dear Permittee:
The Division has received and approved your for coverage under General Permit
NCG560000. The Division hereby issues Certificate of Coverage (CoC) NCG560050 pursuant to the
requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between North Carolina and the US Environmental Protection agency dated October 15, 2007 [or
as subsequently amended].
If any parts, measurement frequencies or sampling requirements contained in this General
Permit are unacceptable to you, you have the right to request an individual permit by submitting
an individual permit application. Unless such demand is made, the CoC shall be final and
binding.
If you have any questions concerning the requirements of the General Permit, please
contact John Hennessy [919 807-6307 or [e-mail]].
Sincere y,
i/ G
ir
S. Jay Zimmerman, Director
Division of Water Resources
cc: Winston-Salem Regional Office
NPDES Unit
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 Internet:http://www.ncwaterquality.org
512 North Salisbury Street,Raleigh,North Carolina 27604 Phone: [phone]/FAX [phone]
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
GENERAL PERMIT NCG560000
CERTIFICATE OF COVERAGE NCG560050
TO DISCHARGE PESTICIDE PRODUCTS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and
the Federal Water Pollution Control Act, as amended, the
Surry-Yadkin Electric Membership Corporation
Surry-Yadkin Vegetation Control
is hereby authorized to discharge pesticides related to
Intrusive Vegetation Control
to waters of the State in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, II, III and IV hereof.
This Certificate of Coverage covers all pesticide discharge events after March 11, 2015.
This Certificate of Coverage shall expire October 31, 2016.
Signed this day March 11, 2015
for ay Zimmerman
Director, Division of Water Resources
By Authority of the Environmental Management Commission

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
NOTICE OF INTENT
Application for coverage under Genera Permit NCG560000
(Please print or typ 7(QOC O
1) Mailing address* of applicants:
Company Name Surry-Yadkin Electric Membership Corporation
Owner Name Travis Bode
Street Address 510 South Main Street
City Dobson State NC ZIP Code 9 ,52 70 I
Telephone Number [phone] Fax:
Email address [e-mail]
*Address to which all permit correspondence should be mailed.
1Applicants generally include both(1)the entity with control over the financing for,or the decision to perform pesticide applications,including the
ability to modify those decisions,that results in a discharge to waters of the State and(2)the entity with day-to-day operational control of or who performs
activities(e.g.,the application of pesticides)that are necessary to ensure compliance with the permit(e.g.,they are authorized to direct workers to carry out
activities required by the permit or perform such activities themselves).
2) Description of Discharge: RECEIVED/DENR/DWR
a) For what type[s] of pesticide-related discharge are you requesting coverage?
❑ Mosquito/flying insect pest control Acres:
(adulticide applications only) Water Quality
Permitting Section
❑ Aquatic Weed/Algae control Acres
❑ Aquatic Weed/Algae control Linear miles:
❑ Aquatic Nuisance Animal Control Acres:
❑ Aquatic Nuisance Animal Control Linear miles:
0 Forest Canopy Pest Control Acres:
ErIntrusive Vegetation Control Linear miles: 1350 -1850 Miles Annually
3) Have you prepared a Pesticide Discharge Management Plan? jYes o No
(The plan must be prepared no later than April 1, 2012.)
[certification and signature shall be completed on the following page]
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NCG560000 application
Certification
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: Travis Bode
Title: Right-of-Way Maintenance Coordinator
Qom- a/4 3/ i 6- "
(Signature of Applicant) (Date Signed)
North Carolina General Statute 143-215.6 b (i) provides that:
Any person who knowingly makes any false statement, representation,or certification in any application, record, report, plan or other document
filed or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article,or who
falsifies,tampers with or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under
Article 21 or regulations of the Environmental Management Commission implementing that Article,shall be guilty of a misdemeanor punishable by
a fine not to exceed$25,000,or by imprisonment not to exceed six months,or by both.(18 U.S.C.Section 1001 provides a punishment by a fine
of not more than$25,000 or imprisonment not more than 5 years,or both,for a similar offense.)
Mail this original and one copy, along with a check payable to NC DENR for
$100.00, to:
Mr. Charles H. Weaver
NC DENR / DWQ / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
ELECTRONIC SUBMISSIONS:
If you wish to complete and submit this application electronically, submit it to:
[e-mail]
Your application can be received and reviewed electronically. However,the Certificate of
Coverage (CoC) cannot be issued until the application fee is received.
ELECTRONIC RECEIPT OF COC
Do you wish to receive your CoC electronically? o Yes INo
If Yes, your CoC will be sent to the e-mail address your provide.
If No,the CoC and a copy of permit NCG560000 will be sent to you via U.S. Mail.
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