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Well Construction & Licensing

Step 1 of 3: Enter Information

Notice of Intent Form to Construct and Decommission an Environmental Investigation Well - Water Sampling or Measuring

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

Notice of Intent

Please enter the notice of intent number preprinted on the paper form in the field below.

Notice of Intent Number

Payment Information

CJ Received Date

CJ Number

CJ Amount

NOI Received Date

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

Fee Exemption Type

Number of Wells to Construct and Decommission

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