3800-PM-BCW0094a Rev. 7/2017
Application Instructions
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1. Complete and submit one (1) signed permit application form for each water body to be treated to the Pennsylvania
Department of Environmental Protection (DEP). If aquatic plant management is proposed for a free flowing stream
or if use of a fish control chemical is proposed in any water body, one signed permit application must be submitted
to DEP and one signed application must be submitted to the Pennsylvania Fish and Boat Commission (PFBC).
The applications should be submitted at the same time to both agencies. For aquatic plant management in
standing water bodies such as ponds, lakes, reservoirs, canals, etc., a permit application must be submitted to
DEP only.
DEP’s Mailing Address
depends on the county where the treatment(s) will occur:
DEP Mailing Address
Counties Served
DEP Southeast Regional Office
Clean Water Program
2 E. Main Street, Norristown, PA 19401
Phone: 484.250.5970
Bucks, Chester, Delaware, Montgomery, and
DEP Northeast Regional Office
Clean Water Program
2 Public Square, Wilkes-Barre, PA 18701-1915
Phone: 570.826.2511
Carbon, Lackawanna, Lehigh, Luzerne, Monroe,
Northampton, Pike, Schuylkill, Susquehanna,
Wayne, and Wyoming
DEP Southcentral Regional Office
Clean Water Program
909 Elmerton Avenue, Harrisburg, PA 17110
Phone: 717.705.4707
Adams, Bedford, Berks, Blair, Cumberland,
Dauphin, Franklin, Fulton, Huntingdon, Juniata,
Lancaster, Lebanon, Mifflin, Perry, and York
DEP Northcentral Regional Office
Clean Water Program
208 West Third Street, Suite 101, Williamsport, PA 17701
Phone: 570.327.3664
Bradford, Cameron, Centre, Clearfield, Clinton,
Columbia, Lycoming, Montour, Northumberland,
Potter, Snyder, Sullivan, Tioga, and Union
DEP Southwest Regional Office
Clean Water Program
400 Waterfront Drive, Pittsburgh, PA 15222
Phone: 412.442.4000
Allegheny, Armstrong, Beaver, Cambria, Fayette,
Greene, Indiana, Somerset, Washington, and
DEP Northwest Regional Office
Clean Water Program
230 Chestnut Street, Meadville, PA 16335
Phone: 814.332.6942
Butler, Clarion, Crawford, Elk, Erie, Forest,
Jefferson, Lawrence, McKean, Mercer, Venango,
and Warren
PFBC’s Mailing Address
Division of Environmental Services
595 E Rolling Ridge Drive
Bellefonte, PA 16823
Phone: 814.359.5147

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Application Instructions
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2. A National Pollutant Discharge Elimination System (NPDES) permit for discharges associated with pesticides may
be required under the following circumstances:
a. The applicant is a state or federal government agency (“government entity”) with pest management as an
integral part of the agency’s mission.
b. The applicant is not a government entity and either (1) will be treating for mosquitoes or other flying insects
over an area of at least 6,400 acres, or (2) will be treating for weeds, algae or animal pests over at least
80 acres of water.
Please contact the applicable DEP regional office if you have questions. DEP coordinates the issuance of NPDES
permits with the DEP/PFBC joint permit for the use of an algicide, herbicide or fish control chemical. If DEP does
not receive an NPDES permit application where required, issuance of the DEP/PFBC joint permit may be delayed.
3. One application is required for a water body receiving several treatments by the same applicant; however, the
number of treatments and amount of pesticide to be used in each treatment must be clearly stated.
4. Permits are valid for three (3) years if the water body being treated is classified under Chapter 93 as High Quality
or Exceptional Value and five (5) years if the water body being treated is not classified as High Quality or
Exceptional Value, as long as there are none of the following changes in comparison to the application submitted
to DEP:
a. Changes to the water bodies being treated.
b. Increases in the maximum dose or to the number of annual treatments for any water body.
c. Changes in the pesticide(s) used for treatment, unless the new pesticide(s) contain the same active
ingredient(s) and the same or a lower percent composition in comparison to the pesticide(s) for which approval
was issued by PFBC and DEP.
If any of these changes are proposed, a new application must be submitted to DEP and a new permit must be
received prior to implementing the proposed changes.
5. Helpful websites for aquatic herbicide treatments include:
Pennsylvania Fish and Boat Commission -
Penn State / PFBC Pond Website -
These instructions include numbers that correspond to the numbers identified on the application.
Please indicate whether the type of application by checking the appropriate box:
New Permit
– check this box if either of the following apply: (1) you have received a joint permit from
DEP/PFBC in the past, but the permit was for a single calendar year or (2) you have never received a joint
permit before.
– check this box if you have received a 3 or 5-year joint permit from DEP/PFBC in the past and are
seeking to renew the joint permit for a new 3 or 5-year permit term.
– check this box if one of the conditions in Section I.4a-c of these instructions apply.
If the application is for a Renewal or Amendment provide the current permit number.
1. Indicate name of person or group responsible for the water body for which treatment is requested. You must have
valid legal standing to request treatment. If you are an officer or agent for the applicant, please include your title in
the signature block in item #16. Check if you own or lease the water body. Provide additional information in

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Application Instructions
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item #15 if clarification is needed. Provide your legal address to which you would like a permit to be sent. Provide
your daytime telephone number or the telephone number of a designated contact person and a fax number
(if available).
2. Indicate the name of the person or company providing treatment if other than the applicant in item #1, along with
the daytime telephone number, fax number (if available), and mailing address. Certified applicators must provide
their PA Department of Agriculture pesticide certification number.
3. Indicate the name of the water body to be treated. Permits are issued for a specific water body (or portion thereof).
4. Indicate the county and municipality where the water body is located. This may differ from the address in item #1.
5. Indicate the water body type to be treated. Note that stream treatments are not ordinarily approved, so this option
is not listed.
6. Check all uses of the water body that apply. Separate categories are provided for water supply and other uses. In
addition, identify the Chapter 93 classification for the water body. Designated uses for water bodies are identified
in DEP’s Chapter 93 regulations, which may be accessed at
(select “Browse”, select
“25 Environmental Protection”, select “Chapter 93. Water Quality Standards”). However, the applicant should also
check DEP’s existing use website to determine whether the water body has received a new classification that has
not yet been recorded in Chapter 93 (go to
, select “DEP Programs A-Z”, select “E”, select
“Existing Use”).
7. Indicate if the water body contains fish or other aquatic organisms. If fish are present, indicate if warmwater or
coldwater species or triploid grass carp are present. This answer is important because trout, warmwater fish and
triploid grass carp have varying tolerances for different chemicals.
8. Indicate whether the water body is open to public fishing. If so, PFBC may have objections to treatment or
otherwise require limitations on treatment. Confirm whether or not the water body is stocked by PFBC.
9. Does the water body overflow at least part of the year? If overflow occurs, indicate the time of year in the space
provided. This will help us determine the effectiveness of the pesticide proposed in your water body, as well as
potential impact on aquatic life downstream.
10. Name the receiving stream if overflow ever occurs. If the stream is unnamed, indicate “Unnamed tributary to
Creek” (next stream with a name). This will help us determine the characteristics of the aquatic
community in the receiving waters.
11. Provide the water body’s total surface area in acres. This is a critical measurement that has a direct bearing on the
amount of pesticide to properly use. (
Helpful hints: 43,560 sq. feet = 1 acre. Determine the shape of your pond
and use one of the following area formulas. Area of circle = 3.14 (radius)
, Area of rectangle = Length X Width,
Area of triangle = 0.5 X base X height (base is usually the distance across the dam, height is typically the pond
Attach an 8.5” x 11” photocopy of a topographical map to show the location of the water body to be
This map can be printed from a site on the internet such as
or a photocopy of a 7.5 minute USGS topographical quadrangle. The body of water should be clearly marked with
a circle and a notation of its name. The map should also contain the name of the 7.5 minute USGS quadrangle
which shows the body of water. This information will be used to compare the proximity of the treated body of water
to receiving streams, other permitted treatment areas and other water users such as public water supplies. In
addition, provide the latitude and longitude of the outlet of the water body in either degrees/minutes/seconds format
or decimal format.
13. Proposed treatment.
For each pesticide proposed for use, provide the following information. Pesticides
must, by federal law, be used as specified in their product label.
Pesticide name. This is the name of the product to be purchased (example
, do not list the active
diquat dibromide
). Product proposed for use must be registered with the U.S. EPA, labeled for
aquatic use and listed with the PA Department of Agriculture.

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Application Instructions
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Manufacturer is the company that produces the pesticide proposed for use.
The U.S. EPA registration number for the product proposed for use.
The proposed dose for the product. The dose listed must be within the dose range on the product label.
Include units of measurement for each dose.
Dose for products labeled to treat
is usually pounds or gallons per surface acre.
Dose for products used to treat water
is usually expressed as pounds or gallons per acre-foot.
One acre-foot is one acre of water is one acre of water one foot deep. The pond or pond section volume is
calculated by multiplying the area in acres times the average depth in feet.
Area to be treated. Copper sulfate product labels state that no more than ½ the total area can be treated at a
Average depth of area to be treated.
Amount of pesticide to be used for a single treatment.
Number of treatments proposed each year. If the number will vary by year, indicate the maximum number in
any year.
Target organism(s) to be controlled by the pesticide. List all you expect to be controlled by the product.
14. Proposed treatment dates. This can be a range of times in which multiple treatments are to be made.
Additional information
can be provided for the benefit of the permit reviewers. Examples are “Higher algicide dose
is to control Pithophora, a resistant algae” or “Overflow will be stopped for 48 hours following treatment”.
16. If potential users of treated water may possibly be affected by treatment, notification at least one day in advance is
required. Recognize that products applied to water can drift to non-target areas or be discharged downstream.
Indicate if notification has occurred by the time the application is submitted or will occur prior to treatment. Indicate
if you are aware of any objections to treatment from potential users of treated water. If you are aware of
objections, describe them in the space provided or on a page attached to the application.
17. Sign and date the application. Include your title if you are an officer or legally recognized agent for the applicant.

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Application Instructions
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Revision Reason
July 2017
Updated PFBC address

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