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Well Construction & Licensing

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Step 1 of 3: Enter Information

Notice of Intent Form to Construct a Water Well

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

NOI number is required

Payment Information

CJ Received Date

CJ received date is required

CJ Number

CJ Number is required

CJ Amount

CJ amount is required

NOI Received Date

Received date is required

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

Email Address

Invalid Email Format Email 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

Tax Parcel Number

County

County is required

Latitude (Decimal Degrees)

Longitude (Decimal Degrees)

Well / Boring Project Information

Project Name

Type of Well

Well type is required

Well Size

Well size is required

Fee Exemption Type

Well Use

Well use is required

Description of Other

Description of well use is required

Number of Homes Served

Please enter a postive whole number Number of homes is required

Type of Work

Work type is required

Description of Other

Description of work type is required

For information on Ground Water withdrawal permits and exemptions, please Contact Us.

Does well require a Water Right?

Water right selection is required

Water Right Permit Number

Permit number is required

The licensed driller must have a copy of the water right permit on site at all times. See WAC 173-160-121 for more information.

Number of Wells to Construct

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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