Section He-P 817.04 - License Application Requirements(a) Each applicant for a license shall comply with the requirements of RSA 151:4, I-III-a, and submit the following to the department, except that subparagraphs (a) (1) -(3) and (5) -(7) shall not apply to mobile collection station vans: (1) A completed application form entitled "Application for Residential or Health Care License (Laboratories and Collecting Stations) " (10/25/2011), signed by the applicant or 2 of the corporate officers, affirming the following: "I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of a license, or imposition of a fine."
(2) A floor plan of the prospective collection station;(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following: a. "Certificate of Authority," if a corporation;b. "Certificate of Formation," if a limited liability company; orc. "Certificate of Trade Name," where applicable;(4) The applicable fee, in accordance with RSA 151:5, IX, payable in cash or, if paid by check or money order, in the exact amount of the fee, made payable to the "Treasurer of the State of New Hampshire";(5) A resume identifying the qualifications and copies of applicable licenses for the collection station administrator;(6) Written local approvals as follows: a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application from the following local officials, or if there is no such official(s), from the board of selectmen or mayor: 1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and4. The fire chief verifying that the applicant complies with the state fire code, including the business chapter of NFPA 101 as adopted by the department of safety, and local fire ordinances applicable for a collection station; andb. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official's review of the building plans and again upon completion of the construction project;(7) If the collection station uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 313.01 and 314.01, or if a public water supply, a copy of a water bill; and(8) The results of a criminal records check from the NH department of safety for the applicant, including the licensee and administrator, as applicable.(b) The applicant shall mail or hand deliver the documents in (a) above to: Department of Health and Human Services
Health Facilities Administration
129 Pleasant Street
Concord, NH 03301
N.H. Admin. Code § He-P 817.04
#5775, eff 1-24-94, EXPIRED: 1-24-00
New. #8410 eff 8-19-05; ss by #8853, eff 3-24-07
Amended by Volume XXXV Number 49, Filed December 10, 2015, Proposed by #10979, Effective 11/20/2015, Expires11/20/2025.