Wisconsin Administrative Code › Department of Natural Resources › NR 100-199 - Environmental Protection - General › Chapter NR 123 - Well Compensation Program › Section NR 123.22 - Claim application

Current through June 24, 2024
(1) In order to be considered for an award or
				proceed notice, a claimant shall submit a completed claim in accordance with s.
				NR 123.05, to
				the department. The department shall assist claimants in completing claims and
				revising claims in order to fulfill the purpose of s.
				281.75,
				Stats.
(2) The claim shall contain:
(a) A claim form available from the
				department.
(b)
1. Two water sample analyses results,
				analyzed by the state laboratory of hygiene or by a laboratory certified under
				s.
				299.11,
				Stats., which show that the private water supply is contaminated as defined in
				s.
				NR
				123.03(5); or
2. An advisory issued by the
				department.
(c) A
				description of the proposed replacement water supply.
1. The description shall include an analysis
				of each of the following options:
a.
				Reconstruction of the contaminated private water supply;
b. Construction of a new private water
				supply;
c. Providing for a public
				water supply to replace the contaminated private water supply; or,
d. Providing a connection to an existing
				private water supply.
2.
				The analysis shall include a detailed description of each replacement water
				supply alternative or an explanation of why any of the replacement water supply
				alternatives are considered not feasible. The claimant shall propose the
				replacement water supply. If it is not feasible to remedy the problem of the
				contaminated private water supply with a replacement water supply, then a
				detailed description of the equipment to be used for treating the contaminated
				private water supply shall be supplied. The department shall approve the least
				costly feasible replacement water supply which will remedy the
				contamination.
(d) A
				copy of a plat map indicating the location of the well and the legal
				description of the property.
(e) A
				copy of an inspection report of the contaminated private water supply completed
				by the department.
(f) An affidavit
				by the claimant verifying that the information in the claim is true to the best
				of his or her knowledge.
(g)
				Evidence of annual family income of the landowner or lessee of property on
				which the contaminated private water supply is located. Evidence of annual
				family income shall consist of one of the following:
1. A copy of the landowner's or lessee's
				joint Wisconsin income tax return for the year prior to the year in which the
				claim is made; or, if filing separately, the landowner's or lessee's separate
				Wisconsin income tax return and the separate Wisconsin income tax return of his
				or her spouse, if any, for the year prior to the year in which the claim is
				made.
2. For low income residents
				of Wisconsin, an affidavit by the landowner or lessee stating that he or she
				did not have sufficient taxable income in the prior year to be required to file
				a Wisconsin income tax return. The affidavit shall include the landowner's or
				lessee's estimate of projected gross income in the current year.
3. For part-year residents or non-residents
				of Wisconsin, a copy of the landowner's or lessee's federal income tax return
				for the taxable year prior to the year in which the claim is made, the separate
				federal income tax return for the prior year of his or her spouse, if any, and
				an affidavit by the landowner or lessee including the landowner's or lessee's
				estimate of projected gross income in the current year.
4. For landowners or lessees with a reduction
				of income in the current year, an affidavit by the landowner or lessee stating
				the reason that a reduction in adjusted gross income is expected in the current
				year, the estimated amount of the reduction in adjusted gross income, and a
				complete listing of income subject to taxation received since January 1 of the
				current year. In addition to this affidavit, the landowner or lessee shall
				provide copy of the documentation required under subd. 1. or 3.