1. (a) A rebate application shall include the following information:

   1. (1) The applicant’s contact information:

      1. a. Full name;
      2. b. Mailing address, including street name and number or post office box number, city or town, state, and zip code; and
      3. c. Email address and daytime telephone number including area code;
   2. (2) The physical address where the remedy was completed including street name and number, city or town, and zip code, if different from the mailing address provided in (1)b. above, including all unit numbers or additional addresses that benefit from the remedy;
   3. (3) The physical address of the impacted well including street name and number, city or town, and zip code, if different from the address provided in (1) or (2) above;
   4. (4) A state vendor code number obtained pursuant to the vendor code requirements established by the New Hampshire department of administrative services, currently Adm 603, for the intended recipient(s);

   5. (5) If the intended recipient is different from the applicant, the applicant shall provide:

      1. a. The relationship between the intended recipient and the applicant; and
      2. b. The requested rebate amount associated with each recipient, if applicable;
   6. (6) The entity that collected the water sample as specified in (b)(1) below; and

   7. (7) Remedy information including:

      1. a. Filter media name and manufacturer for a POE installation;
      2. b. System manufacturer(s) and model(s) for POU installation(s); or
      3. c. Water provider for a service connection.

2. (b) The applicant shall provide to the department the following documentation to support the demonstration of eligibility:

   1. (1) Analytical laboratory results pursuant to Env-Dw 1503.02(a)(2), with the exception of the department having been the entity to collect the water sample;
   2. (2) Copies of itemized sales receipt(s), invoice(s), or both for eligible costs;
   3. (3) Manufacturer specification sheet(s) for the remedy as specified in (a)(6) above, if applicable;
   4. (4) Post-treatment analytical laboratory results pursuant to Env-Dw 1503.02(a)(3)a., with the exception of the department having been the entity to collect the water sample;
   5. (5) Photo documentation of the remedy for which a rebate is sought; and
   6. (6) In the instance where eligible pre-treatment was installed, source water quality results demonstrating concentrations that exceed the respective criteria pursuant to Env-Dw 1503.02 (a)(3)b.

3. (c) The applicant shall affirm the following:

   1. (1) The drinking water supply at the residential property is from a private well in which PFAS are present in the source water at concentrations that exceed applicable standards;
   2. (2) The work for which a rebate is sought has been completed on the residential property of record or within the residence at the property of record;
   3. (3) No offer of alternate water from a third party, as specified by Env-Or 603.04, has been or is being made available for the residential property;
   4. (4) The remedy complies with applicable state and local plumbing regulations and local permitting requirements;
   5. (5) The state funding will be used for treatment installation, a service connection only, or both. The department and state do not warranty or otherwise guarantee treatment performance, contractor performance, product quality, water quality, or any other aspect of the installation or connection. In the case of treatment, it is the responsibility of the owner to appropriately operate and maintain the installed equipment in accordance with the manufacturer or vendor recommendations once installed. For a service connection, it is the responsibility of the owner to remit payment for associated water costs; and
   6. (6) All conditions set forth in this Chapter have been read and understood.

Source. #14201, eff 2-26-25