Well Decommissioning Application

What to expect: When your application is submitted, you will be shown a receipt. You will also receive an email from noreply@skipthepaper.com. If you do not receive the email, please check your email program's spam filter and spam settings.

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Applicant's Address
First Name:
Last Name:

Business Name:

Street 1:

Street 2:

City:
State:
Zip/Postal:


Email (will receive email updates):
Phone:
Question Section
QuestionAnswer
Decommissioning Questions
Well site address
Well site Tax Parcel Number
Type of well being decommissioned
Well depth
Well Diamter
Static Water Level
Well casing or liner type
Well casing or liner depth
Is there a source of contamination (salt water, septic tank, drainfield, contaminated site, etc.) within 100 feet of the well?
Name of Licensed Driller who is performing the decomissioning
Contact information for the driller (phone)
Describe the proposed method of decommissioning per 173-160-381.
Information
The Health District must be notified at least 24-hours before any decommissioning related work starts. Please call (360) 337-5221 and leave a message.
Decommissioning which cannot be done in accordance with Chapter 173-160 WAC, will require a written variance from either this office or the State Department of Ecology. Variance requests submitted to this office will be billed at the Health District’s hourly rate of $109 for review time required.
Application Services
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Specific Attachments
NOTE: PDF, JPG and GIF files are allowed. File size limit is 5 Megabytes.
Items marked with * are required. 

Scaled Site Plan
A scaled site plan is required to complete the permanent record.

Billing Address

First Name:
Last Name:

Business Name:

Street 1:

Street 2:

City:
State:
Zip/Postal:


Terms and Conditions

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ORME Application v3.0