N.H. Code Admin. R. Env-Dw 303.06

Current through Register No. 25, June 20, 2024

Section Env-Dw 303.06 - Application: Cover Page

(a) The cover page required by Env-Dw 303.05(a)(1) shall contain the following:

(1) The applicant's name, mailing address, daytime telephone number including area code, and website URL, if any;

(2) The name, daytime telephone number including area code, and email address, if any, of an individual authorized by the applicant to represent the applicant for purposes of the department's review of the application;

(3) The location of the proposed source, by tax map and lot number; and

(4) The volume of the proposed withdrawal.

(b) If the applicant is an individual, the applicant shall sign and date the application.

(c) If the applicant is other than an individual, the applicant shall authorize an official of the applicant to sign the application, and the authorized individual shall sign and date the application and print or type his or her name and title.

(d) A signature provided under (b) or (c), above, shall constitute certification that:

(1) The information contained in or otherwise submitted with the application is true, complete, and not misleading to the best of the applicant's knowledge and belief;

(2) The applicant understands that:

a. The submission of false, incomplete, or misleading information is grounds for:

1. Not approving the application;

2. Revoking any approval or request that is granted based on the information;

3. Referring the matter to the joint board for potential action against the professional license held by the signer; and

4. If the signer is acting as or on behalf of a listed engineer as defined in Env-C 502.10, debarring the listed engineer from the roster; and

b. He or she is subject to the penalties specified in New Hampshire law, currently RSA 641:3, for making unsworn false statements; and

(3) The applicant agrees to comply with all applicable rules and conditions of the approval, if issued.

N.H. Code Admin. R. Env-Dw 303.06

(See Revision Note at part heading for Env-Dw 303) #8998, eff 9-29-07

Amended by, Volume XXXVI Number 14, Filed April 7, 2016, Proposed by #11059, Effective 4/1/2016, Expires 4/1/2026.