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Well Construction & Licensing

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Notice of Intent Form to Decommission a Well

A red asterisk () next to a field designates it as required.

International applicants cannot submit online. PleaseContact usfor assistance.

Please enter the original notice of intent number and well tag number, if available, for the well to be decommissioned in the fields below.

Original Installation NOI Number

Well Tag Number to be Decommissioned

Property Owner Contact Information

In the space provided below, enter either the property owner's:

business/organization name or
first and last names.

Organization Name

Last Name

Last name may not exceed 50 characters

First Name

First name may not exceed 50 characters

Mailing Address

Mailing address is required

City

City name may not exceed 30 characters City name is required

State

State is required

Zip Code

Zip Code is required

Phone Number

Phone number is required

Are you using a consulting firm? If so, check this box.

Consulting Firm Contact Information

Firm Name

Firm name may not exceed 50 characters Firm Name is required

Mailing Address

Address may not exceed 50 characters Mailing address is required

City

City name may not exceed 30 characters City is required

State

State is required

Zip Code

Zip Code is required

Phone Number

Phone number is required

Well Location Information

Township

Township is required

Range

Range is required

Section

Section is required

Quarter-Quarter Section

Quarter-Quarter section is required

Well Street Address

City

City name may not exceed 30 characters

Zip Code

Does your project require drilling or decommissioning wells on mulitple, adjacent tax parcels within the same county? If so, enter the tax parcel numbers, seperated by a comma in the space provided below.

Tax Parcel Number(s)

County

County is required

Latitude (Decimal Degrees)

Longitude (Decimal Degrees)

Well / Boring Project Information

Project Name

Type of Well

Well type is required

What type of well is being decommissioned

Decommissioning well type is required

The fees for decommissioning wells are based on the type of well being decommissioned. Resource Protection and Ground Source Heat Pump wells are $20 each. Water wells are $50 each. There are no fees for Environmental Investigation well or Geotechnical Soil Boring.

Fee Exemption Type

Number of Wells Being Decommissioned

Please enter a postive whole number Number of Wells is required

Washington State RCW 18.104.048 requires a minumum of 72 hours (3 days) prior notice before commencing work.

Estimated Start Date

Start date is required

Drilling Company and Driller Information

Please select the drilling company and driller who will be performing the construction and/or decommissioning of the wells/borings in this notice.

If you are not using a drilling company, check this box.

Drilling Company Name

Don't have a driller selected or aren't using one? Check this box.

Driller Name (License Number)

Please select the type of driller which best describes the person who will be constructing and/or decomissioning the wells/borings.
If the person constructing or decommissioning is not a Washington State licensed Well Operator, they must meet the exemption requirements enumerated in RCW 18.104.180.

Driller Type

Driller type is required

WA License Number

Last Name

Last name may not exceed 50 characters Last name is required

First Name

Last name may not exceed 50 characters First name is required

Phone Number

Phone number is required

Where should we send confirmation to?

Enter the email address where you would like your validation email sent.

Email Address

Invalid Email Format Email address is required

Anything else we should know?

Comments

Comments may not exceed 250 characters

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