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State of Washington, Department of Ecology <br />IAA No. C2600194 <br />Entity Name: Kittitas County Public Health Department <br />APPENDIX A <br />STATEMENT OF WORK <br />KCPHD shall implement the provisions of the well tagging, sealing, and decommissioning components of <br />Chapter 173-160 WAC. Authority for this action of delegation and funding is provided through the <br />provisions of RCW 18.104.043 and 18.104.150. Delegation of authority to inspect wells applies only to water <br />supply wells. <br />A. KCPHD shall inspect: <br />• A minimum of thirty percent (30%) of water wells being drilled annually in Kittitas <br />County for proposer sealing and tagging; and <br />• A minimum of ninety percent (90%) of wells being decommissioned annually in Kittitas <br />County. <br />B. KCPHD shall at a minimum, conduct twenty-five percent (25%) of all their inspections while <br />the driller is on -site. This percentage may be adjusted by ECOLOGY's contract manager for <br />driller "no shows". <br />C. KCPHD shall administer and enforce the provisions of Chapter 173-160 WAC, Sections: 173- <br />160-101, 173-160-181, 173-160-221, 173-160-231, 173-160-241, 173-160-251, 173-160-261, <br />173-160-271, 173-160-311, 173-160-381, and any subsequent revisions. <br />D. This Agreement does not preclude ECOLOGY from enforcing these aforementioned <br />regulations in Kittitas County. <br />E. This Agreement does not preclude KCPHD from adopting their own well construction rules or <br />charging additional fees for well inspections. <br />Deliverables: KCPHD shall submit a quarterly report to ECOLOGY which summarizes the well drilling <br />activities for that reporting period. See Appendix a Special Terms and Conditions and Appendix C Well <br />Construction and Decommissioning Quarterly Report Form for additional deliverables. <br />The quarterly report shall be submitted on the form provided by ECOLOGY and shall include the number <br />of well construction and decommissioning notes received by KCPHD as well as the number of <br />inspections made. The report shall indicate if the driller was present during the inspection and if the <br />driller was a "no show" at the scheduled time of inspection. <br />Upon request, an additional detailed report shall itemize (at a minimum) the dates of inspection, notice <br />of intent number, well tag number, well owner, drilling company, and driller. The report will also identify <br />any enforcement activities, and any variances issued. <br />Due Date: Quarterly reports are due on January 201h, April 20th, July 201h, and October 201h for <br />inspections done in the prior three-month period <br />9 <br />Version 1/5/2026 <br />