Form Center

2. Well Start Notification

4. Please use this form to notify us of well construction starts, cancellations, or to reschedule. Only licensed well drillers or their representatives should complete this form.

   Submit this form, call our Drinking Water Program Coordinator at 509-249-6525, or email YHD.Help.Desk@co.yakima.wa.us at least 3 business days before you start well construction or decommissioning.

   This is not an appointment; confirmation from YHD is not required prior to starting the well project. Notification of the delegated authority (Yakima Health District) is required under WAC 173-160-040 (2) and YHD policy.

6. Notification*
   -- Select One --Start NotificationRescheduled Start DateCancelled Start
8. DOE Start Number (NOI)*
10. Start Date*
    Start Date
12. Well Type*

    1. Group A
    2. Group B
    3. Shared
    4. Individual
14. Information needed to access site (gate code, specific gate for access, etc.)
16. To receive a copy of your submission, enter your email address in the field below.
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field