Section Env-Wq 1503.07 - AOT Permit Application Form The applicant shall provide the following information on or with an "Alteration of Terrain Permit Application " form, NHDES-W-01-003, dated August 2023, available at: https://onlineforms.nh.gov?formtag=nhdes-w-01-003:
(a) The name and mailing address of the applicant, and if the applicant does not have an agent, the following: (1) For an applicant who is an individual, not an entity, the applicant's daytime telephone number and e-mail address; or(2) For an applicant that is an entity, such as a business or trust, the name of an individual designated by the applicant as the point of contact and that individual's email address and daytime telephone number;(b) If the applicant has authorized an agent, the name, mailing address, daytime telephone number, and email address of the agent, and if the agent is an entity, the name of the individual designated by the agent as the point of contact;(c) The name and mailing address of each owner of the property on which the project will occur, if other than the applicant, and if the property owner does not have an agent, the following: (1) For a property owner who is an individual, not an entity, the property owner's daytime telephone number and e-mail address; and(2) For a property owner that is an entity, such as a business or trust, the name of an individual designated by the property owner as the point of contact and that individual's email address and daytime telephone number;(d) If the property owner has authorized an agent, the name, mailing address, daytime telephone number, and email address of the agent, and if the agent is an entity, the name of the individual designated by the agent as the point of contact;(e) The name, mailing address, and daytime telephone number of the engineering consultant for the project, if any and if other than the applicant's agent, and the name and email address of the individual designated as a point of contact for the consultant;(f) For the proposed project: (1) The type of project, namely excavation only, residential, commercial, golf course, school, municipal, agricultural, land conversion, or other;(2) The project name, street or road address, town or city, and county;(3) The town tax map(s) and lot number(s) and if applicable, the block number and unit number;(4) Whether the project, post-development, will withdraw from or directly discharge to a stream or wetland, a man-made pond formed by impounding a stream or wetland, or an unlined pond formed by digging into the water table, and if so the purpose of the withdrawal or discharge;(5) Whether the project, post-development, will discharge to a surface water impaired for phosphorus and/or nitrogen, a class A surface water or outstanding resource water, or a lake or pond not covered previously;(6) Whether the project is in a high-load area, and if so the type of high load land use or activity;(7) Whether the project is within a water supply intake protection area or a groundwater protection area, and whether the well setbacks identified in Env-Wq 1508.02 will be met;(8) Whether any portion of the property is within the 100-year floodplain, and if so the cut volume in cubic feet within the 100-year floodplain and the fill volume in cubic feet within the 100-year floodplain;(9) Whether the project is located within 1/4 mile of a designated river and if so, the name of the river; and(10) Whether the project is located within a coastal/great bay region community;(g) A brief description of the proposed project, including an outline of the scope of work to be performed, which shall be provided on the application form and not on a separate page;(h) A description of all work commenced prior to receiving a permit, if any;(i) The date the applicant or applicant's agent sent a copy of the application to: (1) The municipality, as required by Env-Wq 1503.05(e); and(2) The local river advisory committee, if required by Env-Wq 1503.05(f);(j) Identification of: (1) The type of plan required by Env-Wq 1503.11(a)-(d); and(2) Any plan(s) required by Env-Wq 1503.11(e)-(g);(k) The area, in square feet, of the following:(1) The total area of disturbance, calculated in accordance with Env-Wq 1503.12;(2) The amount of additional impervious cover resulting from the project and the total final impervious cover; and(3) The total amount of undisturbed cover of the project;(l) For land being subdivided, the total number of lots proposed;(m) The total length of roadway, in linear feet;(n) The name of all receiving waters as shown on a USGS map or, if unnamed, the name of the waterbody to which each receiving water is tributary, as identified on a USGS map;(o) A list of other permits obtainable from the department that are required for the project, and for each, whether an application has been filed, and if so whether the application is pending or, if the approval has been issued, the permit number, registration date, or approval letter date, as applicable; (p) The following information regarding potential impacts to natural resources: (1) A list of each species identified by the department of natural and cultural resources, division of forests and lands, natural heritage bureau as being threatened, endangered, or of concern; and(2) A list of each pollutant for which the receiving water has been identified by the department as being impaired under 40 CFR 130.7 or 40 CFR 130.8, using information obtained from the "Surface Water Impairment" layer of the department's web-based OneStop database; (q) Whether the applicant or applicant's agent had a pre-application meeting with staff of the department's terrain alteration bureau and, if so, the name of the individual staff member; and(r) Whether blasting of bedrock will be required and, if so, the estimated quantity in cubic yards of blast rock.N.H. Admin. Code § Env-Wq 1503.07
(See Revision Note #1 at chapter heading for Env-Wq 1500) #9343, eff 1-1-09
Amended by Volume XXXVII Number 32, Filed August 10, 2017, Proposed by #12342, Effective 8/15/2017, Expires 8/15/2027.Amended by Number 41, Filed October 12, 2023, Proposed by #13758, Effective 9/28/2023, Expires 9/28/2033 (see Revision Note #4 at chapter heading for Env-Wq 1500).