Mitigation Intake Form

Washington State Department of Ecology (Ecology) application processing time: 6-9 months.
Ecology mitigation suitability varies between: 1) Likely Suitable, 2) May Be Suitable, and 3) Not Suitable (depending on parcel geographic location).
Seller makes no warranties about suitability or the outcome of Ecology's decision.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parcel Number(s)

Email Address

Phone

(###)

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Location of Well

Please list any additional information about your property.