Section Env-Dw 1104.04 - Information and Certification Required for Pre-Application(a) The applicant shall provide the following information to the department on a pre-application form attached or linked to the pre-application solicitation announcement issued by the department: (1) The water system's name and the town or city in which it is located;(2) The water system's PWS identification number;(3) The name, title, email address, and daytime telephone number of the individual who can answer questions on behalf of the applicant regarding the project;(4) A title for the project;(5) A concise description of the proposed project, for example "replace water main on Elm Street" or "upgrade treatment and storage system";(6) A concise description of the need for the proposed project, including how it will address public health protection, whether it includes any energy or water efficiency components, and whether any alternatives have been considered;(7) An estimate of project costs, including construction costs, a construction contingency, and estimated planning and engineering costs, plus the amount and a description of any other costs;(8) The total estimated costs;(9) The amount of loan requested and loan term requested;(10) The current residential water rate per single family home per year, assuming the use of 67,389 gallons per year;(11) If known, the median household income of the population served, which may be based on the results of an income survey done within the prior 3 years or data from the American Community Survey, available at http://www.census.gov/acs or from the department's website;(12) The date the applicant received governing body approval to borrow funds for the project or the date the applicant anticipates receiving such approval; and(13) The anticipated date that the: a. Design will be started;b. Construction contract will be awarded;c. Project will be completed; and(14) If the applicant uses a paper-based pre-application form, the name and title of the individual authorized by the applicant to sign the pre-application form on behalf of the applicant.(b) If the applicant uses the web-based pre-application survey form, submitting the form shall constitute a signature and the certification specified in (d), below.(c) If the applicant uses a paper-based pre-application form, the individual authorized by the applicant to sign the pre-application form shall sign and date the pre-application form and print his or her name and title.(d) The submission of the form electronically or the signature affixed pursuant to (c), above, shall constitute certification by the applicant that: (1) The information provided is true, complete, and not misleading to the knowledge and belief of the applicant; and(2) The applicant understands that any department determination that the applicant and the applicant's project qualifies for funding from the DWSRF that is based on false, incomplete, or misleading information is subject to modification, up to and including reversal, through an adjudicative proceeding conducted in accordance with applicable provisions of Env-C 200.N.H. Admin. Code § Env-Dw 1104.04
(See Revision Note at chapter heading for Env-Dw 1100) #8702, eff 8-24-06
Amended by Volume XXXV Number 06, Filed February 12, 2015 , Proposed by #10772, Effective 1/24/2015, Expires1/24/2025.