Orange County, NY · Orange County
Application for Approval of a Chlorinator Installation
This application requests Orange County Department of Health approval for a chlorinator installation serving a non-community water supply using a single groundwater source.
At a glance
- Issued by
- City of Orange County · Orange County, Orange County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- orangecountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The Orange County Department of Health uses this application to review chlorinator installations for non-community water supplies using a single groundwater source. The owner provides facility, contact, water-system, fixture, pump, and tank details, draws the proposed storage and pressure tank configuration, and calculates chlorine contact time. The form also describes installation requirements and lists conditions of approval.
Who needs it
Owners seeking approval for a chlorinator installation serving a non-community water supply with a single groundwater source should complete this application.
How to submit it
The form names the Orange County Department of Health at 124 Main Street, Goshen, NY 10924. It does not give further submission instructions.
About notarization
This document is signed and dated without a notary; the form asks for the owner's signature and includes an approval signature and date, but no notarized attachment.
How to submit this form
- 1
Download the Application
Download the chlorinator installation approval application PDF.
- 2
Complete the Application
Enter the facility, owner, water-system, fixture, pump, and tank information requested on the form.
- 3
Add the Required Drawing
Draw the storage and pressure tank configuration in the space provided; attach a sketch if proposing a different configuration.
- 4
Submit to the County
The form names the Orange County Department of Health at 124 Main Street, Goshen, NY 10924.
Frequently asked questions
- Do I need a notary for the Chlorinator Installation Approval Application?
- No. The form asks for the owner's signature and date but has no notary block or notarized attachment.
- Who uses this chlorinator installation application?
- Owners seeking approval for a chlorinator installation serving a non-community water supply that uses a single groundwater source.
- What information does the application request?
- It asks for facility and owner contact details, water-system and fixture information, pump and tank details, and a drawing of the tank configuration.
- How do I submit the chlorinator installation application?
- The form names the Orange County Department of Health at 124 Main Street, Goshen, NY 10924, but gives no further submission instructions.