AQUATICS ONLINE


Chemical Use Application


SOUTH DAKOTA DEPARTMENT OF GAME, FISH & PARKS

APPLICATION FOR PERMIT TO CHEMICALLY CONTROL AQUATIC VEGETATION IN SOUTH DAKOTA WATERS


APPLICANT INFORMATION
Name:        
   Last Name   First Name   MI     
Lake Home:     
  Street, Box Number, Rural Route   City   State   Zip  
Mailing Address:     
  Street, Box Number, Rural Route   City   State   Zip  
Phone #:  Email  
  (###) ###-####    Email Address 
Have you ever applied for an Aquatic Vegetation Control Permit before? 
  If yes, list permit number:    
   Previous Permit Number 

WATERBODY INFORMATION
Water Body Details:   
  Name/Description   County
In feet, the amount of shoreline that you own:  
  feet  
Is all the land surrounding this waterbody owned by the applicant?  
Does the waterbody have an outlet?  
Can the applicant control the water flow out of the waterbody?  
  If yes, by what method and for how long?   
   Method and Duration  
Uses of the waterbody by shoreline property owners and public: 
  Public Water Supply  Watering Livestock  Irrigation  Boating   
  Private Water Supply  Swimming  Fishing  Other:  

TREATMENT INFORMATION

1. TYPE / SPECIES OF VEGETATION TO BE TREATED (SPECIES IS REQUIRED):
 
Submerged Vegetation (LIST SPECIES)
  
 
Floating Leaf Vegetation (LIST SPECIES)
  
 
Emergent Vegetation (LIST SPECIES)
  
  Plankton Algae  Filamentous Algae  Duckweed  

2. DIMENSIONS OF PROPOSED TREATMENT AREA:
 I propose to control vegetation in an area that extends  feet along shore and 
  In Feet 
 into the lake a distance of  feet, where the lake is approximately  feet deep. 
  In Feet  In Feet 
 
PLEASE NOTE: YOU WILL ONLY BE PERMITTED TO TREAT AN AREA NOT MORE THAN 50 FEET ALONG THE SHORELINE OR ONE-HALF THE LENGTH OF YOUR SHORELINE, WHICHEVER IS LESS. THE PERMITTED TREATMENT AREA MAY NOT EXCEED 2,500 SQUARE FEET.
 

3. WHO WILL BE DOING THE TREATMENT?
If applicant, provide your application license number:   
  License Number 
If a commercial applicator, provide their name, address, and applicator license number:  
 

4. DATE OF PROPOSED TREATMENT:
 

5. METHOD OF TREATMENT APPLICATION
 

CHEMICAL INFORMATION
The following chemical(s) will be used (list trade/brand name and EPA Registration #):
Chemical Name
and EPA Number
Rate of ApplicationTotal Amount UsedTarget Species
 

Attach a copy of the most recent product label and Material Safety Data Sheets for each chemical used.





 

Are there any water-use restrictions associated with the chemical(s)? If yes, list them below.
 

How does the Applicant intend to ensure compliance by users of the waterbody with the water-use restriction on the product label?
 

ADDITIONAL REQUIRED INFORMATION

1. Attach a topographical map or aerial photo to show the exact location of the treatment area. This information will be used to compare the proximity of the treatment area to receiving streams, other permitted treatment areas and other water users such as public water supplies Applications without map location information will be returned as incomplete.
 

2. Describe the proposed project, include the following items:
a) the reason(s) the Applicant desires to control the aquatic species 
 

b) the history of the growth of the nuisance species in the water (for example, the time of year the aquatic plants begin to lessen the enjoyment of the area)
 
 

c) other methods that have been used to control the aquatic species
 
 

d) an explanation as to why the use of non-pesticide control methods is not reasonable
 
 

NOTIFICATION AND APPLICANT CERTIFICATION

1. Notification of potential users of treated water:
 

Potential users of treated water must be notified at least one week in advance of treatment. Are you aware of any objections to the treatment from potential users of treated water?
  

If yes, describe:
 
 

2. Signatures of Adjoining Property Owners indicating that they are aware that a chemical will be applied in the water to control aquatic vegetation. Please provide a name, address, phone number. NOTE: by entering their information, you are confirming that they are aware of your treatment.
NameAddressPhoneSignature
 

3. The applicant:
(a) accepts responsibility for any damage to the properties not covered by this application that may result from the performance of the permitted activity;

(b) guarantees to hold the State harmless from all suits, claims or causes of action that arise from the permitted activity;

(c) recognizes that by signing this application, I am giving consent to employees of the State to enter this subject property for the purpose of processing this application and for ensuring permit compliance; and

(d) certifies that the statements presented on this application are true and accurate
 


NOTE: If you are submitting this online, you may electronically sign the form by typing the name of the applicant in the signature box below.
    
Applicant SignatureDate 
Signature Date  

  
 

Completed hard copy applications may be sent to:
South Dakota Game, Fish and Parks
Attn: Rhet Russell - Wildlife Biologist
400 West Kemp Avenue
Watertown, SD 57201 (605) 882-5200