Form ECY040-74 "Showing of Compliance With 90.44.100(3)" - Washington

What Is Form ECY040-74?

This is a legal form that was released by the Washington State Department of Ecology - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Washington State Department of Ecology;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ECY040-74 by clicking the link below or browse more documents and templates provided by the Washington State Department of Ecology.

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Download Form ECY040-74 "Showing of Compliance With 90.44.100(3)" - Washington

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WATER RESOURCES PROGRAM
Showing of Compliance with RCW 90.44.100(3)
Water Right Certificate or Permit Number:
Parcel tax identification number:
County:
Landowner(s) name:
Lat.Long. of well:
Original:
New:
To amend the associated water right permit or certificate when drilling an additional or replacement well,
you must submit this form (signed and notarized) to the Department of Ecology to affirm that you have met
the statutory criteria of RCW 90.44.100(3). Please attach the water well report for the new well and any other
information you have to support this affidavit.
Affidavit:
I,
, do certify that the well described in the attached water well report has been drilled
as an additional or replacement well for use under Water Right Number
. This notice and
attached documents describe and support my assertion that the replacement or additional well complies with
RCW 90.44.100(3) (a-g) and RCW 90.44.100(4):
Please check one:
This is an additional well (Attach well report)
This is a replacement well (Attach well report for new Well & Decommissioning report for old well)
Please confirm the following:
a. The new well(s) tap the same body of public groundwater as the original well.
b. If a replacement well is constructed, use of the original well(s) shall stop and the original well(s)
properly decommissioned.
c. The combined withdrawal of water from all wells authorized by the water right certificate does not
enlarge the water right developed (perfected) and maintained by use of water (i.e. no increase in total
instantaneous (Qi) or annual (Qa) withdrawals).
d. The construction and use of the new well(s) does not interfere with or impair water rights with an
earlier priority date.
e. The new well(s) is located no closer than the original well to a well or surface water body with which
it might interfere.
f. The new well was constructed in compliance with chapter 18.104 RCW and chapter 173-160 WAC,
as well as any other conditions specified.
g. The new well(s) is located within the area described as the point of withdrawal in the public notice
published for the original application for water right, or the most current legal description published
for the right.
Therefore the well is in compliance with the requirements for a statutorily granted amendment to the water
right permit or certificate.
ECY 040-74 (Rev 07/2018) To request ADA accommodation including materials in a format for the visually impaired, call Ecology Water Resources Program
at 360-407-6872. People with impaired hearing may call Washington Relay Service at 711. People with speech disability may call TTY at 877-833-6341.
WATER RESOURCES PROGRAM
Showing of Compliance with RCW 90.44.100(3)
Water Right Certificate or Permit Number:
Parcel tax identification number:
County:
Landowner(s) name:
Lat.Long. of well:
Original:
New:
To amend the associated water right permit or certificate when drilling an additional or replacement well,
you must submit this form (signed and notarized) to the Department of Ecology to affirm that you have met
the statutory criteria of RCW 90.44.100(3). Please attach the water well report for the new well and any other
information you have to support this affidavit.
Affidavit:
I,
, do certify that the well described in the attached water well report has been drilled
as an additional or replacement well for use under Water Right Number
. This notice and
attached documents describe and support my assertion that the replacement or additional well complies with
RCW 90.44.100(3) (a-g) and RCW 90.44.100(4):
Please check one:
This is an additional well (Attach well report)
This is a replacement well (Attach well report for new Well & Decommissioning report for old well)
Please confirm the following:
a. The new well(s) tap the same body of public groundwater as the original well.
b. If a replacement well is constructed, use of the original well(s) shall stop and the original well(s)
properly decommissioned.
c. The combined withdrawal of water from all wells authorized by the water right certificate does not
enlarge the water right developed (perfected) and maintained by use of water (i.e. no increase in total
instantaneous (Qi) or annual (Qa) withdrawals).
d. The construction and use of the new well(s) does not interfere with or impair water rights with an
earlier priority date.
e. The new well(s) is located no closer than the original well to a well or surface water body with which
it might interfere.
f. The new well was constructed in compliance with chapter 18.104 RCW and chapter 173-160 WAC,
as well as any other conditions specified.
g. The new well(s) is located within the area described as the point of withdrawal in the public notice
published for the original application for water right, or the most current legal description published
for the right.
Therefore the well is in compliance with the requirements for a statutorily granted amendment to the water
right permit or certificate.
ECY 040-74 (Rev 07/2018) To request ADA accommodation including materials in a format for the visually impaired, call Ecology Water Resources Program
at 360-407-6872. People with impaired hearing may call Washington Relay Service at 711. People with speech disability may call TTY at 877-833-6341.
I understand the acceptance of this affidavit, and any attachments, by the Department of Ecology shall not be
construed as affirming the validity of any water right permit or certificate. The responsibility to comply with
RCW 90.44.100(3) is with the water right permit or certificate holder asserting an amendment pursuant to
RCW 90.44.100(3).
Name or Authorized Agent
Email:
Address
City, State, ZIP
Relationship to Water Right holder
Phone
Signature
Date
Acknowledgement:
State of Washington
County of
I certify that I know or have satisfactory evidence that
is the person who appeared
before me, and said person acknowledged that (he/she) signed this affidavit and acknowledged it to be (his/her)free
and voluntary act for the uses and purposes mentioned in the affidavit.
Dated: ________
(Signature)
(Seal or Stamp)
Residing in
Title
My appointment expires:
If you have any questions please contact the Water Resources Section of the closest regional office. Please submit
copies of new well reports and decommissioned well reports along with this completed and notarized form to the
nearest regional office.
Northwest Regional Office
Southwest Regional Office
3190 - 160th Avenue SE
P.O. Box 47775
Bellevue, WA 98008-5452
Olympia, WA 98504-7775
(425) 649-7000
(360) 407-6300
Central Regional Office
Eastern Regional Office
1250 W. Alder St.
4601 N. Monroe St.
Union Gap, WA 98903-0009
Spokane, WA 99205-1265
(509) 575-2597
(509) 329-3400
ECY 040-74 (Rev 07/2018) To request ADA accommodation including materials in a format for the visually impaired, call Ecology Water Resources Program
at 360-407-6872. People with impaired hearing may call Washington Relay Service at 711. People with speech disability may call TTY at 877-833-6341.
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