NCG560058_20180420_Application

Akn_'�AWA Division of Water Resources
National Pollutant Discharge Elimination System (NPDES)
NCDENRApplication for Coverage Under General Permit
NCG560000
Pesticides
NOTICE OF INTENT
Required by 15A NCAC 02H .0127(d); term definition see 15A NCAC 02H .0103(19)
(Please print or type)
FOR AGENCY USE ONLY
Date Received
Year
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Certificate of Coverage
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1) Mailing address of applicant' (address to which all correspondence should be mailed):
Company Name NC Department of Agriculture and Consumer Services
Owner Name
Street Address 1060 Mail Service Center
City Raleigh
Telephone # [phone]
r 1-1
State NC ZIP Code 27699-1060
Fax #
Cell # Email [e-mail]
'Applicants 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: [Required by 15A NCAC 02H .0105(c)(1)]
a) For what type[s] of pesticide -related discharge are you requesting coverage?
❑ Mosquito / flying insect pest control Acres:
(adulticide applications only)
❑ Aquatic Weed / Algae control
❑ Aquatic Weed / Algae control
❑ Aquatic Nuisance Animal Control
❑ Aquatic Nuisance Animal Control
® Forest Canopy Pest Control
❑ Intrusive Vegetation Control
Acres:
RECEIVED/DENR/DWR
Linear miles:
APR 19 2018
Acres:
Water Resources
Linear miles: Permitting Section
Acres: 121638
Linear miles:
3) Have you prepared a Pesticide Discharge Management Plan? ® Yes ❑ No
(The plan must be prepared no later than April 1, 2012.)
[certification and signature shall be completed on the following page]

NCG560000 New 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: Chris Elder
Title:
(Please review 15A NCAC 02H .0106(e) for authorized signing officials)
4/19/2018
(Signature of Applicant) (Date Signed)
North Carolina General Statute & 143-215.6B 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 this
Article or a rule implementing this Article; or who knowingly makes a false statement of a material
fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or
knowingly renders inaccurate any recording or monitoring device or method required to be operated
or maintained under this Article or rules of the Commission implementing this Article, shall be guilty
of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). 18
U.S.C. Section 1001 provides a punishment by a fine or imprisonment not more than 5 years, or both,
for a similar offense.
Application must be accompanied by a check or money order for $100.00 [per G.S. § 143-215.3(a�lbl]
made payable to:
NCDENR
Mail this application and one copy of the entire package (with check) to:
NC DENR / DWR / Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attn: Charles Weaver
ELECTRONIC SUBMISSIONS:
If you wish to complete and submit this application electronically, submit it to: charles.weaverAncdenr.gov
Your application can be received and reviewed electronically. However, the Certificate of Coverage (CoC) cannot
be issued until the application fee is received per G.S. 4 143-215.3(a)(1b).
ELECTRONIC RECEIPT OF CoC
Do you wish to receive your CoC electronically? ® Yes - CoC will be sent to the e-mail address provided above.
❑ No - CoC and a copy of permit NCG560000 will be sent via USPS.
Page 2 of 2 Revised 911113

PESTICIDE DISCHARGE MANAGEMENT PLAN (PDMP) TEMPLATE
The information indicated herein represents the minimum requirements for a complete PDMP. Please
note: The use of this template, or another version that provides the same elements of information, is
acceptable in meeting the PDMP submission requirements of the NPDES Pesticide General Permit.
A PDMP must be completed prior to submitting a Notice of Intent (NOI) for coverage under the
general NPDES permit.
Please refer to Part 5 of NCG560000 for the specific requirements related to a PDMP for reviewing
updating and modifying a PDMP, or incorporating by reference other documents in the PDMP.
PDMP updates shall include revisions to information on actual pesticide applications after the
application (dates of application, total amounts and rates of pesticide application) if they differ from
the information included in the original PDMP.
5.1 PDMP TEAM:
A. Name of Operator Responsible Parties (see permit section 5. 1.1 for details of responsible parties):
North Carolina Department of Agriculture and Consumer Services, Plant Industry Division
B. Name and Title of Authorized Person signing the PDMP: Chris Elder
C. Responsible Parties Street address: 216 West Jones Street, Raleigh, NC
D. Responsible Parties mailing address: 1060 Mail Service Center, Raleigh, NC 27699-1060
E. Telephone number: 919-707-3743
F. E-mail address: [e-mail]
G. Name of entity/ organization performing application: Al's Aerial Spraying
H. Address: 3473 N Shepardsville Rd City: Ovid State: MI Zip: 48866
J. Name of certified Applicator performing the application: Al Schiffer
K. Certified Applicator Identification number: unknown
L. Certified Applicator telephone and E-mail: 989-834-5067 [e-mail]
M. List the name, address, and role of any other individuals involved with the pesticide application, as
indicated in Part 5 of the general NPDES permit.
5.1.2 PEST MANAGEMENT AREA DESCRIPTION:
In cases where the PDMP addresses multiple pest management areas or treatment areas under a
single NOI, each pest management area or treatment area must be documented in the PDMP. Use
additional sheets with all required information, as necessary.
A. Target Pest(s):
Gypsy moth, Lymantria dispar

B. Waterbodies present in pest management area.
1) Waterbody Type (Lake, Pond, Stream, wetland):
Numerous small ponds and streams
2) Waterbody name (where known):
C. County:
Alleghany, Watauga, Surry, Stokes, Rockingham, Person, Granville, Vance, Dare, 11 total spray
blocks covering 121638 acres
D. Town:
Many (see G below)
E. USGS Quad:
Many (see G below)
F. Total waterbody size (acres or linear miles):
Unknown; applied mainly to forests, not bodies of water.
G. Location and total size of treatment area(s):
121638 total acres in 11 blocks across North Carolina, one application each.
H. Delineate the following information on a map. The map can be hand drawn, or can be copied from
a published mapsheet. It should be of adequate scale for all required information to be readily
identifiable. If the pesticide discharge will occur in a large waterbody, i.e., one that
cannot be shown easily on a single map drawing with sufficient scale, then an area should be
depicted to enable an adequate indication of the location of the discharge relative to the surrounding
area
The water body wherein the discharge will occur;
The location of the target pest species;
The treatment area(s), including location within waterbody.
See attachment for maps. Small bodies of water are present within the blocks, which are centered
over suspected reproducing gypsy moth populations, but pilots turn off spray booms over bodies of
water that aren't under a tree canopy.
5.1.3 SCHEDULES AND PROCEDURES:
5.1.3.1 Control Measures
A. Describe procedures and maintenance activities, done to prevent spills. All equipment is cleaned
and maintained daily during operations. Equipment is inspected between loads to verify proper
operation.
B. Application Equipment: List and describe equipment to be used to apply the pesticide. Include the
date of the last routine maintenance or servicing and the date last calibrated. Describe schedule and
procedures for equipment maintenance.
Regular maintenance is performed by contract applicator. Equipment is inspected and certified by
NCDA&CS Pesticide Division prior to calibration and commencement of treatments.

C. Pest Surveillance/Monitoring: Describe schedules and procedures of visual assessments for
adverse incidents of the pest management area and treatment areas, including those conducted during
any pesticide application, when considerations for safety allow, and during any post -application
surveillance or efficacy check that is conducted by the operator, or under the operator's supervision
or direction.
Ground personnel with constant radio/cell phone contact are stationed within the blocks during
treatment for monitoring of ground conditions and application deposition (on windshields, etc.).
Efficacy of treatment is determined by follow up trapping for male moths in following seasons.
D. Identification of the problem or impacts that the pest is causing.
Gypsy moth populations are detected by intensive male moth trapping. Populations are eradicated
before visual damage can occur. Were treatment not to occur, the population would rapidly grow in
intensity and localized defoliation of host trees (oaks and other hardwoods) would occur, stressing
and possibly killing the trees. Additionally, great numbers of crawling larva and their waste create
potential health and other problems for humans.
E. Describe any additional control measures that are currently being used, or have been used in the
past to minimize the discharge of pesticides.
Pesticides are used only when persisting populations are detected through male moth trapping.
Pesticide type used is mating disruption, using a material containing the female pheromone, which
acts as a confusant, hampering male moths from detecting and mating with female moths. Pesticide is
specific only to target pest.
5.1.3.2 Actions necessary to minimize Discharges
A. Spill response procedures, Including:
1. Procedures for expeditiously stopping containing and cleaning up leaks, spills, and other
releases. Employees who may cause, detect, or respond to a spill or leak must be trained in
these procedures and have necessary response equipment available. One of these individuals
should be a member of your PDMP team.
Contract applicator is responsible for leak prevention and cleanup. Spilled material would be
immediately contained and cleaned up, then disposed of in a proper manner.
2. Procedures for notification of appropriate facility personnel, emergency response agencies,
and regulatory agencies.
Were an aerial discharge to occur, ground personnel would immediately secure the location
as personnel at the airport where operations are based would contact law enforcement for
assistance. Appropriate agencies such as the NCDA&CS Pesticide Division would be
notified and their procedures would be followed.
B. Adverse incident response procedures — at a minimum you must have:
1. Procedures for responding to any incident resulting from pesticide applications;
See A. (2) above.

2. Procedures for notification of the incident, both internal to your agency/organization and
external. Contact information for state/federal permitting agency, nearest emergency medical
facility, and nearest hazardous chemical responder must be in locations that are readily
accessible and available.
Paper copies of a safety plan containing phone numbers for all of the above are provided to
all personnel participating in treatments.
C. Pesticide Monitoring Procedures — You must document procedures for monitoring consistent with
the requirements in Part 4 including:
1. The person (or position) responsible for conducting monitoring
Operator (myself) performs monitoring of output during applications by measuring amount of
material applied with each load to ensure proper calibration of equipment.
2. Procedures for documenting any observed impacts to non -target organisms resulting from
your pesticide discharge.
Treatment material is specific only to gypsy moth. However, ground personnel will be in the
treatment blocks during treatment to monitor for any off -target impacts.
5.1.4 SIGNATORY:
In accordance with Penal Law §210.45, I certify under penalty of perjury that information on this
plan is true to the best of my knowledge and belief.
Signature of Operator:
Title: Gypsy Moth Program Manager
Date: 4/19/2018
Date plan last updated/reviewed:
Signatory has read and understand the permit and application
5.2 PESTICIDE DISCHARGE MANAGEMENT PLAN MODIFICATIONS. You must modify
your PDMP whenever necessary to address any of the triggering conditions for corrective action or
when a change in pest control activities significantly changes the type or quantity of pollutants
discharged. Changes to your PDMP must be made before the next pesticide application that results in
a discharge, if practicable, or if not, as soon as possible thereafter. The revised PDMP must be signed
and dated in accordance with Appendix B, Subsection B.11. You must review your PDMP at a
minimum once per calendar year and whenever necessary to update the pest problem identified and
pest management strategies evaluated for your pest management area.

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