Seasonal Dock Notification For Lakes And Ponds Page 2
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24. REQUIRED CERTIFICATIONS: Agree to the following required statements by initialing each box below
______
a. I understand that any impacts completed under a Seasonal Dock Notification based on false, incomplete, or
misleading information on the application or attachments shall be subject to enforcement action.
b. I am aware that an accepted Seasonal Dock Notification will not exempt the work I am proposing from other
______
state, local or federal approvals.
c. I understand that project proposals that do not meet the minimum standards of RSA 482-A and Administrative
______
Rules Chapter Env-Wt 100-900 shall be rejected.
d. I agree to conduct all work under this Permit by Notification in accordance with the conditions specified in
______
Section 3, above and that failure to conduct the work in accordance with the application submitted shall be
considered work without a permit and subject to enforcement action.
e. I understand that no approval or permit will be mailed to me. I will monitor the Wetlands Bureau data base
______
at:
and will determine if my notification
has been accepted or rejected. If the notification has been rejected, I will not proceed with installing the dock.
5. REQUIRED SIGNATURE: The information I have provided is true, complete and not misleading.
OWNER:
DATE:
The following waterbodies are greater than 1,000 acres in size. Ownership of 75 feet of shoreline frontage on these
waterbodies allows for a seasonal dock that measures a maximum of 6 feet in width and 40 feet in length.
Bow Lake
Lake Winnipesaukee
Province Lake
Conway Lake
Mascoma Lake
Squam Lake
Comerford Storage
Massabesic Lake
Sunapee Lake
st
Connecticut Lake (1
)
Merrymeeting Lake
Vernon Dam
nd
Connecticut Lake (2
)
Moore Reservoir
Winnisquam Lake
Great East Lake
Newfound Lake
Ossipee Lake
Lake Umbagog
Lake Wentworth
Paugus Bay
The state has fee-simple ownership or flowage rights on the below waterbodies. This may impact your ability to
place a dock. Before you submit this notification, contact the NHDES Dam Bureau Land Agent at (603) 271-1960 in
for more information.
Deering Lake
Glen Lake (Gregg Falls)
Lake Horace (Weare Reservoir)
Francis Lake (docks not allowed)
Goose Pond (Hanover/Canaan)
Winnisquam Lake (Lochmere Dam)
NOTIFICATION SUBMITTAL
This notification process is free of charge.
Mail the complete notification form to the address on the bottom of this form.
For More Information:
If you have questions regarding this form, see:
seasonal-dock.htm
or contact the Land Resources Management Program at (603) 271-2147.
shoreland@des.nh.gov
or (603) 271-2147
NHDES Wetlands Bureau, 29 Hazen Drive, PO Box 95, Concord, NH 03302-0095
Seasonal Dock Notification Form for Lakes and Ponds – Valid Until 01/2017
Page 2 of 2
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