To obtain a PBN, the applicant shall submit to the department:

1. (a) A completed Form NHDES-W-06-27, “Wetlands Permit-By-Notification”, dated January 2026 that has been signed and certified as specified in Env-Wt 311.11;

2. (b) Information on the proposed project location, including:

   1. (1) A copy of the town tax map showing the location of the proposed project in relation to abutters;
   2. (2) A copy of the appropriate US geological survey map with the property and project located;
   3. (3) Original or digital photos, clearly showing the area to be impacted, mounted no more than 2 per sheet, on 8.5 inches by 11 inches paper and annotated to explain impact; and
   4. (4) The DataCheck Tool results containing the identification number from the department as well as documentation of any ecological review requests made to the department pursuant to Env-C 800, communications and information related to the requested ecological review, and the results of the ecological review pursuant to Env-C 800;

3. (c) Information on the proposed project, including:

   1. (1) Identification of the applicable minimum project provision in Env-Wt 500, Env-Wt 600, or Env-Wt 900, as applicable, and any required project-specific information;
   2. (2) An accurate drawing with dimensions clearly shown to document existing site conditions and to show the location of the property;

   3. (3) An accurate drawing to show the impact of the proposed activity on jurisdictional areas, including the following:

      1. a. An overview of the property and proposed impact areas in relation to property lines;
      2. b. The scale, if any, used on the plan;
      3. c. If the drawing is not to scale, the dimensions of all existing and proposed structures and all other relevant features necessary to clearly define the project;
      4. d. A labeled north-pointing arrow to indicate orientation;
      5. e. A legend that clearly indicates all symbols, line types, and shading used on the plan;
      6. f. The location of jurisdictional areas delineated in accordance with Env-Wt 400;
      7. g. Proposed sequence of construction including pre-construction through post-construction activities and the relative timing and progression of all work;
      8. h. The location and type of siltation and turbidity controls indicated graphically and labeled, or annotated as necessary; and
      9. i. For any project using a temporary coffer dam and for any repair of a tier 3 stream crossing, the date, signature, and seal of the licensed professional engineer who prepared or had responsibility for the plan(s);
   4. (4) Any additional information required by the applicable section in Env-Wt 500, Env-Wt 600, or Env-Wt 900; and
   5. (5) The plan date, latest revision date, and preparer’s name;

4. (d) A signed statement by the applicant certifying, in addition to the certifications specified in Env-Wt 311.11, that:

   1. (1) The proposed project will be conducted in a manner that will meet the applicable conditions and limits of Env-Wt 307 and all applicable minimum impact project rules;
   2. (2) If the project is to repair or replace a docking structure, the docking structure is an existing legal structure;
   3. (3) The proposal is the alternative with the least adverse impact to jurisdictional areas, as required by Env-Wt 313.03(a); and
   4. (4) The applicant is aware of the limits of the PBN and understands and will comply with all conditions in the PBN;
5. (e) The application fee for minimum impact projects as required by RSA 482-A:3, I;
6. (f) A statement signed by the town or city clerk of the municipality in which the property is located or, if the property is located in more than one municipality, by the city or town clerk of each such municipality, certifying that the municipality has received 4 copies of the application including all attachments;
7. (g) A signed statement by the county conservation district or certified wetland scientist, if required by the appropriate minimum impact project rule, certifying compliance with all conditions of that rule;

8. (h) In addition to the information required in (a) through (g) above, the applicant may submit a signed statement from the conservation commission or, if there is no conservation commission, the local governing body, certifying that the municipality waives its right to intervene on the project, unless the PBN is for one of the following project types in which case no review or signed statement is necessary to qualify for review under Env-Wt 309.08(a)(1):

   1. (1) Replenishment of an existing legal beach that complies with Env-Wt 511.07(a);
   2. (2) Repair or replacement of an existing legal deck or patio that complies with Env-Wt 511.08;
   3. (3) Repair or replacement of an existing legal docking structure that complies with Env-Wt 513.25;
   4. (4) Repair or replacement of an existing legal retaining wall that complies with Env-Wt 514.07(a)(3);
   5. (5) Maintenance or repair of an existing legal boathouse that complies with Env-Wt 515.07;
   6. (6) Maintenance of an existing legal tidal docking structure that complies with Env-Wt 606.17(b);
   7. (7) Repair of an existing legal tier 1 or tier 2 stream crossing that complies with Env-Wt 903.01(e)(2);
   8. (8) Repair of an existing legal tier 3 stream crossing that complies with Env-Wt 903.01(e)(3); and
   9. (9) Replacement of an existing legal tier 1 stream crossing that complies with Env-Wt 903.01(e)(4); and
9. (i) A signed statement from the LAC, if the project is a routine roadway maintenance activity within LAC jurisdiction, certifying that the LAC waives its right to intervene on the project.

Source. #12803, eff 12-15-19; amd by #12954, eff 12-24-19 (formerly Env-Wt 309.06); amd by #12976, eff 1-22-20; amd by #13124, eff 10-23-20; ss by #13777, eff 10-13-23; ss by #14349, INTERIM, eff 8-26-25; ss by #14471, eff 1-2-26, EXPIRES: 1-2-36