NCG560063_Payment Acknowledgement_20190118

ROY COOPER 1 - 2
Governor qt. i
MICHAEL S.REGAN *=� 'Y;_,4 0`
Secretary r
LINDA CULPEPPER NORTH CAROLINA
Director Environmental Quality
January 18, 2019
Debbie S. Smith, Mayor
Town of Ocean Isle Beach
3 W 3rd St
Ocean Isle Beach, NC 28469
Subject: Permit Application
Application No. NCG560063
Town Of Ocean Isle
Brunswick County
Dear Applicant:
The Water Quality Permitting Section acknowledges receipt of your application for a new NPDES WW permit, including
supporting documentation and your check number 3213 in the amount of$100.00 as payment of the application fee.
These items were received in our offices on January 17, 2019. Your application will be assigned to a permit writer within
the Section's NPDES WW permitting branch.The permit writer will contact you if additional information is required to
complete evaluation of your application. Your timely and direct response to any such request will help to expedite the
review process. Please note that acceptance of the application does not guarantee a NPDES permit will be issued for the
proposed activity. A permit will only be issued following a complete review of the application, concluding the proposed
discharge is allowable per applicable statutes and rules.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
Xit.0Y10•1;ifri-50
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
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` National Pollutant Discharge Elimination System(NPDES) Date Received
, Year Month Day
-
Application for Coverage Under e9c5l61 of P7
' '. General Permit NCG560000
NORTH CAROLINA Certificate of Coverage
Environmental Quality Pesticide Applications N C G 5 6 ,0040
Check# Amount
NOTICE OF INTENT 5a/ (��'
Assigned To:
Required by 15A NCAC 02H.0127(d);term definition see 15A NCAC 02H.0103(19)
(Please print or type)
1) Mailing address of applicant'(address to which all correspondence should be mailed):
Company Name low1 4c Oaean I-sle l3e-act
Owner Name Debl;e 5.
Street Address c s k 1 Tii;rcl 5- .
City b e eaan L 51e. be State N C ZIP Code 2 8 4(09
Telephone# °l l 6 - 579 - .216 6 Fax# q I b 5 7 9 - 88 6 4
Cell# 9[0 - 4a9 - Z 319 Email 5pc,n Ccr ED o i b 0ov . GOrvt
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: [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: l7/ 460 # All Op aO 18
(adulticide applications only)
❑ Aquatic Weed/Algae control Acres:
❑ Aquatic Weed/Algae control Linear miles:
❑ Aquatic Nuisance Animal Control Acres:
❑ Aquatic Nuisance Animal Control Linear miles:
❑ Forest Canopy Pest Control Acres:
❑ Intrusive Vegetation Control Linear miles:
3) Have you prepared a Pesticide Discharge Management Plan? Yes ❑ No
[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: bavn;e t Spe neer I VlnrvlAbdl
Title: ?ubt*i e. Works SupGr V►sc r-
(Please —
review 15A NCAC 02H.0106(e)for authorized signing officials)
4°.u.� G12 i / /7 /
(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)(lb)1
made payable to:
NC DEQ
♦ ♦ ♦ • ♦
Mail this application and the fee payment to:
NC DEQ/DWR/NPDES
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: [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 per G.S. § 143-215.3(a)(lb).
ELECTRONIC RECEIPT OF CoC
Do you wish to receive your CoC electronically? Er 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.