Section Env-Wq 403.06 - Large Groundwater Withdrawal Permit Preliminary Application(a) Subject to (b), below, the large groundwater withdrawal permit preliminary application required by Env-Wq 403.05(a)(1) shall include: (1) On a document to facilitate submission of information for a large groundwater withdrwawal permit application obtained from the department, the following information: a. The name, mailing address, daytime telephone number, and, if available, e-mail address of the applicant;b. If the applicant is other than an individual, the name, affiliation with the applicant, daytime telephone number and, if available, e-mail address of the individual who will serve as the contact person for purposes of the application;c. The name of, mailing address, daytime telephone number, and, if available, e-mail address of the company preparing the application, and the name of the primary contact person;d. The name and title of the authorized signer, and if the authorized signer is not an official of the applicant, a copy of the written authorization;e. The name of the licensed professional who prepared the application, together with the individual's license type and number; andf. Project information, including: 1. The name of the owner of the project site;2. The street address of the project and the tax map lot and block number;3. The name of each municipality within the potential impact area of the project;4. The name of each community water system within the potential impact area of the project;6. Type of proposed water source;7. Number of proposed water sources;8. Proposed cumulative withdrawal volume in gallons per day; and9. A narrative summary of the project;(2) The maximum 24-hour withdrawal volume for which the new withdrawal permit is being requested;(3) A water conservation plan prepared in accordance with Env-Wq 2101;(4) A description of use prepared in accordance with Env-Wq 403.08;(5) A conceptual hydrologic model of the withdrawal prepared in accordance with Env-Wq 403.09;(6) A delineation of the estimated potential impact area and a description of how it was delineated using the conceptual hydrologic model, prepared in accordance with Env-Wq 403.09;(7) A preliminary inventory of contamination sources completed in accordance with Env-Wq 403.10;(8) A preliminary inventory of water resources and uses in the potential impact area completed in accordance with Env-Wq 403.11;(9) A description of withdrawal effects estimated in accordance with Env-Wq 403.12;(10) A description of the withdrawal testing program design prepared in accordance with Env-Wq 403.13;(11) For a new groundwater source of bottled water where a pre-testing conference is being requested, the information required by Env-Dw 303.13; and(12) A list of the names and mailing addresses of the municipalities and public water suppliers being notified as required by RSA 485-C:21, II and, once available, copies of the return receipts.(b) As provided in RSA 485-C:21, II, for a public water system, a preliminary report prepared in accordance with Env-Dw 302.05 shall be submitted as the application.(c) The preliminary large groundwater withdrawal permit application shall be stamped and signed by an individual possessing either a professional geologist's license issued in accordance with RSA 310-A:118-139 or a professional engineer's license issued in accordance with RSA 310-A:2-27.N.H. Admin. Code § Env-Wq 403.06
(See Revision Note at part heading for Env-Wq 403) #9569, eff 10-17-09
Amended by Volume XXXVIII Number 15, Filed April 12, 2018, Proposed by #12493, Effective 3/21/2018, Expires 3/21/2028.