NCG560027_Regional Office Historical File 20200518

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North Carolina Department of Environment and Natural.Resotrdes f
Division of Water Quality
Beverly Eaves Perdue Charles Wakild,P.E. . . Dee Freeman
Govemor Director -. ;-.-. m �, ;Secretary
March 22, 2012 �
-
Mr. Steven Karby <. Ui MAR 2 9 2012 ti
Mountain Lake&Pond Management, Inc. j
371 Mountain Forest Estates J
Sylva, N.C. 28779
Subject: Issuance of Certifica ,df Coverage NCC566027 . ..�'``"
Haywood County
Dear Permittee:
The Division has received and approved your for coverage under General Permit
NCG560000. The Division hereby issues Certificate of Coverage (CoC) NCG560027 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 for
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 Jeff Poupart [919 807-6309 or jeff.poupart@,ncmail.netl.
S' er y,
Charles Wakild, P.E.
NPDES Unit
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 Internet:http:/Avww.ncwaterquality.org
512 North Salisbury Street,Raleigh,North Carolina 27604. Phone: [phone]/FAX [phone]
[e-mail]
An Equal Opportunity/Affirmative Action Employer 50%RecycW10%Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG560000
CERTIFICATE OF COVERAGE NCG560027
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
Mountain Lake & Pond Management, Inc.
is hereby authorized to discharge pesticides related to
Aquatic Weed/Algae 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 29, 2012.
This Certificate of Coverage shall expire October 31, 2016.
Signed this day March 22, 2012
for CliWes Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Bevedy Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
NOTICE OF INTENT
Application for coverage under General Permit NCG560000
(Please print or type)
1) Mailing address*of applicant':
Company Name NdUA 41A
Owner Name J /zy �6V ��/e l9\1
Street Address �41k7wX) �
City 0�/464- State A ZIP Code c2 B`✓9
Telephone Number_ :nOl- Fax:
Email address A*4) 0a00 0 40.1. COAfd.
"Address to which all permit correspondence should be mailed.
1
'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:
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 Acres
Aquatic Weed/Algae control .Linear miles: O
El Aquatic Nuisance Animal Control Acres: nn
❑Aquatic Nuisance Animal Control Linear miles: U
❑ Forest Canopy Pest Control Acres: 19 2012
❑ Intrusive Vegetation Control Linear miles: 'ER QUALITY
POINT SOURCE BRANCH
3) Have you prepared a Pesticide Discharge Management Plan? XYes ❑ 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 applicatio»
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:
Title:
(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:
charles weaver@ncdenr.e:ov
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? ❑Yes ❑ No
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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