1. (a) The capacity assurance self-assessment required by Env-Dw 1106.01(d) shall consist of the following, provided using “Form 4: Capacity Assurance Self-Assessment”, NDES-W-03-125, January 2020, available at https://onlineforms.nh.gov/?FormTag=NHDES-W-03-125:

   1. (1) The name and PWS identifier of the applicant;
   2. (2) The name, title, email address, and daytime telephone number including area code of the individual who completed the self-assessment; and
   3. (3) Answers to the questions listed in (c)-(e), below, or such other questions as may be required for the department to assess capacity as listed in the applicable IUP.

2. (b) The applicant shall:

   1. (1) Answer yes, no, not applicable, or don’t know to each question; and
   2. (2) Provide any supplemental information requested.

3. (c) The questions relating to technical capacity shall be whether the applicant:

   1. (1) Has record drawings or plans of its distribution system;
   2. (2) Has a list of assets such as pumps, wells, tanks, and water mains, and if so whether the list is complete or only partial;
   3. (3) Has a sufficient quantity of water to meet peak water demands;
   4. (4) If the area in which the water system is located has experienced drought conditions, whether the system experienced insufficient water quality during the drought;
   5. (5) Has a means to record daily water volume and to obtain discrete water samples from each source;
   6. (6) Conducts water audits to determine the volume of unaccounted-for water;
   7. (7) Has had, in the past year, any monitoring or reporting violations at its drinking water system;
   8. (8) And its operators, equipment, and infrastructure are safe from electrical, chemical, falling, or other physical hazards;
   9. (9) Has an operations and maintenance manual for its drinking water system; and
   10. (10) Flushes the distribution system piping at least annually;

4. (d) The questions relating to managerial capacity shall be whether the applicant:

   1. (1) Has a current organizational chart identifying system management and operations staff;
   2. (2) Has a written master plan or asset management plan for long range planning;
   3. (3) Logs or otherwise tracks and addresses customer questions or complaints;
   4. (4) Engages in general public education beyond consumer confidence reports;
   5. (5) Has explicit rules and standards for customer-driven system modifications;
   6. (6) Updates and practices its emergency response plan;
   7. (7) Has a system for scheduling routine preventive maintenance; and
   8. (8) Obtains any regular or occasional technical assistance from outside sources such as a consulting engineer, other regulated utilities, or organizations specifically dedicated to providing technical assistance.

5. (e) The questions relating to financial capacity shall be whether the applicant:

   1. (1) Reviews its water rates annually;
   2. (2) Has a water rate that is greater than one percent of the community’s median household income;
   3. (3) Prepares a written annual budget with water system expenses and revenues;
   4. (4) Has a capital improvement plan (CIP);
   5. (5) Funds a capital reserve account based on life-cycle cost; and
   6. (6) Currently operates on a break-even basis or better.

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