Do I need a notary for the Septic System Variance Request Form?

No. The form requires signatures from the relevant buyer, owner, or seller, but does not require a notary or mention a notarized attachment.

What can I request with this form?

You can request a waiver or extension for a property transfer inspection, routine inspection, or septic tank pump-out.

What information does the form ask for?

It asks for property details, the reason for the request, and contact information and signatures from the relevant buyer, owner, or seller.

Cayuga County, NY · Cayuga County

No notary required

Septic System Variance Request Form

Property owners and buyers use this form to ask Cayuga County’s Health Department to waive or extend a septic system inspection or pump-out.

At a glance

Issued by: City of Cayuga County · Cayuga County, Cayuga County, New York
Notarization: Not required: file this form without a notary.
Official source: cayugacounty.gov
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This form requests a variance for a property transfer inspection, routine inspection, or septic tank pump-out because winter weather makes inspection impossible until April 15, 2022. It asks for the property tax map number, town, 911 address, lake or bay proximity, requested waiver or extension, and reason. The form also requests contact details and signatures from the relevant buyer, owner, or seller.

Who needs it

A buyer, property owner, or seller seeking a septic inspection or pump-out waiver or extension because winter weather prevents inspection should complete this form.

How to submit it

Submit the completed and signed request to the Cayuga County Health & Human Services Environmental Division at 8 Dill Street, Auburn, New York 13021. The form says incomplete requests will be returned.

About notarization

This document is signed without a notary; the form requires the relevant buyer, owner, or seller to sign, but does not mention a notarized attachment.

How to submit this form

1
Download the Form
Download the Septic System Variance Request Form.
2
Complete the Request
Provide the property details, select the requested waiver or extension, and explain the reason.
3
Gather Signatures
Add the applicable buyer, owner, or seller contact information and signatures.
4
Submit to the County
Submit the completed form to the Environmental Division at 8 Dill Street, Auburn, New York 13021.

Frequently asked questions

Do I need a notary for the Septic System Variance Request Form?: No. The form requires signatures from the relevant buyer, owner, or seller, but does not require a notary or mention a notarized attachment.
How do I submit the septic system variance request?: Submit the completed and signed form to the Cayuga County Health & Human Services Environmental Division at 8 Dill Street, Auburn, New York 13021.
What can I request with this form?: You can request a waiver or extension for a property transfer inspection, routine inspection, or septic tank pump-out.
What information does the form ask for?: It asks for property details, the reason for the request, and contact information and signatures from the relevant buyer, owner, or seller.

Need something notarized?

This Septic System Variance Request Form doesn’t need a notary, but if you have another Cayuga County form that does, a commissioned online notary can help.