1. (a) To be processed as provided in Env-Dw 1104.06(a), the applicant shall provide the following information to the department on a “DWSRF Pre-Application Form”, NHDES-W-03-217, found at https://onlineforms.nh.gov/?FormTag=NHDES-W-03-217:

   1. (1) The water system’s name and PWS identifier;
   2. (2) Whether the water system’s ownership is public or private;
   3. (3) The water system’s address, including city or town, state, and zip code;
   4. (4) The name, title, email address, and daytime telephone number of the applicant’s point of contact (POC) for the pre-application;
   5. (5) A short title for the project and whether the project is design and preliminary engineering only, design and construction, or construction only;
   6. (6) A concise description of the proposed project, for example “replace water main on Elm Street” or “upgrade treatment and storage system”;
   7. (7) Whether the proposed project implements recommendations from an asset management plan;
   8. (8) The amount of loan requested;
   9. (9) The loan term requested; and
   10. (10) If the applicant uses a paper-based pre-application, the name and title of the individual authorized by the applicant to sign the pre-application on behalf of the applicant.

2. (b) The applicant also shall provide to the department as much of the following information as practicable:

   1. (1) 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;
   2. (2) An estimate of total project costs, including construction costs, a construction contingency, and estimated planning and engineering costs, plus the amount and a description of any other costs;
   3. (3) Whether there are other funding sources contributing to the project and if so, the source, the amount, and whether the funding has been secured;
   4. (4) The current residential water rate per single family home per year;

   5. (5) The median household income of the population served, which may be based on:

      1. a. The results of an income survey done within the prior 3 years;
      2. b. Data from the American Community Survey, available at http://www.census.gov/acs; or
      3. c. Data available on the department’s website;
   6. (6) The date the applicant received governing body approval to borrow funds for the project or the date the applicant anticipates receiving such approval; and

   7. (7) The anticipated date that the:

      1. a. Design will be started;
      2. b. Construction contract will be awarded; and
      3. c. Project will be completed.

Source. (See Revision Note #1 and Revision Note #2 at chapter heading for Env-Dw 1100) #13160, eff 1-20-21