Dutchess County, NY · Dutchess County
Application to Construct or Abandon a Water Well
Property owners submit this application to the Dutchess County Department of Health to construct or abandon a water well.
At a glance
- Issued by
- City of Dutchess County · Dutchess County, Dutchess County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- dutchessny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this application to request approval to construct a new water well or notify the Dutchess County Department of Health about an existing well’s abandonment. Complete Sections A through D with project, owner, well, and well-driller information. The form lists a nonrefundable $45 application fee and may require a location sketch showing nearby pollution sources and structures.
Who needs it
Property owners applying to construct or abandon a water well in Dutchess County need to complete and submit this application.
How to submit it
Complete Sections A through D and submit the form to the Dutchess County Department of Health, 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601. Include the nonrefundable $45 fee by cash, check, or money order.
About notarization
This application does not require a notary; it identifies no notarized attachment or sworn step, and the applicant completes Sections A through D.
How to submit this form
- 1
Download the Application
Download the application to construct or abandon a water well.
- 2
Complete Sections A Through D
Provide the requested project, owner, well, and well-driller information.
- 3
Prepare Any Sketch
Attach sketches if needed; the form requires a location sketch and pollution sources when there is no approved plan.
- 4
Submit to the County
Send the completed form and $45 fee to the Dutchess County Department of Health at the address listed on the application.
Frequently asked questions
- Do I need a notary for the water well application?
- No. The application has no notary requirement and identifies no notarized attachment or sworn step. Complete Sections A through D as instructed.
- How do I submit the water well application?
- Complete Sections A through D and submit the form to the Dutchess County Department of Health, 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601. The listed fee is $45, payable by cash, check, or money order.
- What information does the application request?
- It asks for project, owner, well, and well-driller information. Depending on the site, include a sketch of nearby potential groundwater pollution sources and structures.
- What must I submit after constructing a well?
- The instructions say the owner or agent must submit a well log to the Dutchess County Department of Health within 30 days of completion. Water-quality analytical data must also be submitted when available.