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Checklist for Aquatic Pesticides Permit Form AQV (04/09)

Checklist for Form Number AQV (04/09) Application for a Permit to Use a Pesticide for the Control of an Aquatic Pest Title 6 NYCRR Part 327/328

The following documents and other items must be submitted with the completed "Application for a Permit to Use a Pesticide for the Control of an Aquatic Pest" in order for the application to be considered complete for purposes of review:

  1. Submit _______ additional copies of the application AND all required attachments.
  2. Complete application must be submitted at least 3 months before the proposed treatment
  3. A check in the amount of $100.00 per application, made payable to "Commissioner, NYSDEC".
  4. If the applicant is an association of riparian owners/lessees, a copy of the Board of Directors resolution in support of the proposed treatment must be attached.
  5. A copy of the pesticide product labeling intended for treatment must accompany this application.
  6. A copy of the relevant portion of the 7 ½ " U.S.G.S. quadrangle map containing the water body or stream(s) proposed for treatment must be attached to this application.
  7. An expanded scale drawing on 8 ½ " x 11" paper showing in detail the items required in Number 8 of the application instructions (if necessary, more than one such drawing may be submitted).
  8. A copy of the letter describing the proposed treatment and associated water use restrictions that has been sent to all affected riparian owners/users must be attached to this application. Refer to further guidance relating to riparian notification given in item Number 33 of the application instructions. In cases of personal notification (door to door), a notification letter showing the original signatures and a listing of those unable to be personally contacted, must be sent in place of postal receipts (addresses must still be included in the packet). An example of this riparian letter is included as Attachment A.
  9. A list of all affected riparian owners/users who may be required to restrict their usage of the water as a result of the proposed treatment and who must be given the right to consent or object to the proposed treatment, must be attached to this application. Lists should include names, addresses and phone numbers.
  10. A "Certificate of Notification of Riparian Owners and Users" form, or postal receipt, must be attached. The applicant must certify that all affected riparian owners/users have been notified of the proposed aquatic pesticide application. If the proposed treatments is to a water body under sole ownership, check off the appropriate box on this form, sign, and submit with the application. This form is Attachment B in this packet.
  11. Some pesticide products contain water use restrictions as either label requirements or in regulation. If the applicant proposes to hold water from the outlet, the applicant must also include a draw down study outlining how the water will be contained for the restriction period. The study should include formulas and drawings of outlets, dams, etc. and clearly indicate how the water will be retained. If there will be outflow, data will be needed to demonstrate how far the outlet waters will flow during the use restriction period in order to identify potentially affected downstream riparian owners, together with an estimate of outflow in cfs.
  12. If proposing to apply an aquatic pesticide by aircraft, a discussion of environmental preferability for aerial application is required. The environmental preferability discussion must be submitted with this application.

If you are unable to submit any of these documents, or if you have any questions regarding the above, you must contact your local DEC office.


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    Division of Materials Management
    Bureau of Pest Management
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    Albany, NY 12233-7254
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