1. (a) The owner or authorized agent of the seasonal system shall provide the certification required by Env-Dw 506.04(a)(2) by providing the information specified in (b), below, on a form obtained from the department that the owner or authorized agent has signed as specified in (c) below.

2. (b) The information required by (a), above shall be as follows:

   1. (1) The complete legal name of the seasonal system, its PWS identifier, and the municipality in which the seasonal system is located;
   2. (2) The months in which the owner anticipates opening and closing the seasonal system;
   3. (3) For the owner of the seasonal system, the owner’s name, regular mailing address and seasonal mailing address, if different, regular and seasonal daytime telephone numbers, including area codes, and e-mail address;
   4. (4) For the start-up procedures, the date the procedures were completed and the name and title(s) of the individual who completed the procedures; and
   5. (5) The calendar year of the certification and the date the seasonal system opened and started serving water to the public.
3. (c) The owner or authorized agent shall sign and date the certification and print or type their name and title on the certification prior to submitting it to the department. If signed by the authorized agent, the authorized agent shall provide their daytime telephone number including area code and e-mail address.

4. (d) The signature required by (c), above, shall constitute certification that:

   1. (1) The signer is the owner of the seasonal system or has been authorized by the owner to sign the certification;
   2. (2) The start-up procedures required by Env-Dw 506.04(a)(1) have been completed;
   3. (3) The information provided is true, complete, and not misleading to the knowledge and belief of the signer; and
   4. (4) The signer understands that they are subject to the penalties for false swearing specified in RSA 641:3 or any successor statute if the information is false, incomplete, or misleading.

Source. #10771, eff 2-1-15; ss by #14342, eff 8-22-25, EXPIRES: 8-22-35