3800-PM-BPNPSM0025e
Module
Rev. 8/2012
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF POINT AND NON-POINT SOURCE MANAGEMENT
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
PERMIT APPLICATION FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES
ANTIDEGRADATION MODULE
PESTICIDE APPLICATION TO HIGH QUALITY OR EXCEPTIONAL VALUE WATERS
APPLICANT NAME
TREATMENT AREA NO.
WATER BODY NAME
PESTICIDE NAME(S)
(HQ or EV)
TARGET ORGANISMS
ACTIVE INGREDIENT(S)
Check here if treatment area is “grandfathered” and proof is attached
ANTIDEGRADATION ANALYSIS
Public Health and Environmental Benefits: Explain the public health and/or environmental benefits of controlling the
organism(s).
Non-Discharge Alternatives: All environmentally sound and cost effective options that do not involve any application
of pesticide (e.g., no action, prevention, source reduction, education, biological control agents, mechanical removal,
stream buffers) must be considered before deciding to apply a pesticide. Describe and compare the non-discharge
alternatives to pesticide application that were considered and why it was decided that they were not environmentally
sound and cost effective, and that pesticides must be used.
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3800-PM-BPNPSM0025e
Module
Rev. 8/2012
Antidegradation Best Available Combination of Technologies (ABACT): Best practices must be employed to assure
that adverse impacts on aquatic life other than the targeted organism are minimized, the minimum effective dose will
be applied, and water quality effects do not persist beyond the timeframe needed for effective treatment. List the
selected pesticide and the dose rate per unit area, flow, time or volume. Describe:
1) How the pesticide was evaluated to assure that it is the best option to minimize impacts on aquatic life other than
the targeted species; if additional water uses will be affected, describe how they will be protected (e.g., public
water supply, recreation, etc.).
2) How the dose rate was determined to be the minimum effective dose rate (e.g., label instructions); and
3) For pesticides that persist in the environment beyond the timeframe needed for effective treatment, the expected
ultimate fate and effects on the aquatic environment.
Check here if you are attaching a separate Social or Economic Justification (SEJ) demonstration in order to allow
for some degree of degradation in High Quality waters (see instructions, 3800-PM-BPNPSM0025d).
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