Current through Register No. 40, October 3, 2024
(a)
Each applicant for a license shall comply with the requirements of RSA
151:4II-a, I-I, and submit the following to the department, except that
subparagraphs (a)(1)-(3) and (5)-(7) shall not apply to mobile laboratory vans:
(1) A completed application form entitled
"Application for Residential and or Health Care License (Laboratories and
Collecting Stations)," (July 2023 edition) signed by the owner if a private
facility, 2 officers if a corporation, 2 authorized individuals if an
association or partnership, or the head of the government department if a
government unit, affirming to the following:
"I affirm that I am familiar with the requirements of RSA
151 and the rules adopted thereunder and that the premises are in full
compliance. I understand that providing false information shall be grounds for
denial, suspension, or revocation of a license, or imposition of a
fine.";
(2) A floor plan of
the prospective laboratory;
(3) If
applicable, proof of authorization from the New Hampshire secretary of state to
do business in the state of New Hampshire in the form of one of the following:
a. "Certificate of Authority," if a
corporation;
b. "Certificate of
Formation," if a limited liability company; or
c. "Certificate of Trade Name," if a sole
proprietorship;
(4) The
applicable fee in accordance with
RSA
151:5, XXIII, payable in
cash, or if paid by check or money order, in the exact amount of the fee and
made payable to the "Treasurer, State of New Hampshire";
(5) A resume identifying the qualifications,
and copies of applicable licenses, for the administrator and laboratory
director;
(6) Written local
approvals as follows:
a. For an existing
building, the following written local approvals shall be obtained no more than
90 days prior to submission of the application, from the following local
officials, or if there is no such official(s), from the board of selectmen or
mayor:
1. The health officer verifying that
the applicant complies with all applicable local health requirements and
drinking water and wastewater requirements;
2. The building official verifying that the
applicant complies with all state building codes and local building
ordinances;
3. The zoning officer
verifying that the applicant complies with all applicable local zoning
ordinances; and
4. The fire chief
verifying that the applicant complies with the state fire code and any local
ordinances; and
b. For a
building under construction, the written approvals required by a. above shall
be submitted at the time of the application based on the local official's
review of the building plans and again upon completion of the construction
project;
(7) If the
laboratory uses a private water supply, documentation that the water supply has
been tested in accordance with RSA 485 and
Env-Dw
702.02,
Env-Dw
704.02, or, if a public water supply is used, a copy
of a water bill;
(8) The results of
a criminal records check for the applicant, the licensee, if different than the
applicant, the laboratory director, and the administrator, as applicable. The
results must include criminal history from the state of New Hampshire;
and
(9) List of all tests performed
and a copy of the CLIA certificate.
(b) The applicant shall mail or hand deliver
the documents to:
Department of Health and Human Services
Health Facilities Administration
129 Pleasant Street
Concord, NH 03301
#2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by
#5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
