N.Y. Comp. Codes R. & Regs. tit. 10, § 5-2.11 – Notification of abandonment of a water well.

(a) name and address of the applicant;
(b) legal or other description adequate to locate the property and the well;
(c) name and address of the water well contractor employed to perform the work herein required for abandonment;
(d) type and description of well;
(e) reason for abandonment; and
(f) description of work to be performed to effect abandonment.

Every abandoned well shall be sealed or closed so as to protect the aquifer from pollution and to prevent a hazard to life or property. If such well is to be sealed or closed the owner of the property shall make application of notification to abandon such water well and provide the following information: