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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

First Name

Mailing Address

City

State

Zip Code

Phone Number

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

Consulting Firm Contact Information

Firm Name

Mailing Address

City

State

Zip Code

Phone Number

Well / Boring Project Information

Project Name

Type of Well

What type of well is being decommissioned

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

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

Estimated Start Date

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

Where should we send confirmation to?

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

Email Address

Anything else we should know?

Comments