Chemung County, NY · Chemung County
Application for On-Site Wastewater Treatment System Permit
Property owners or contractors use this application to request a Chemung County permit for a new or replacement on-site wastewater treatment system.
At a glance
- Issued by
- City of Chemung County · Chemung County, Chemung County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- chemungcountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This application requests a permit for a new or replacement on-site wastewater treatment system, or a replacement tank only. It asks for property, water supply, occupancy, owner, and applicant or contractor details, and includes a signed agreement about system design and liability. The Health Department may require test hole excavations or percolation tests; sand filter installations require a sand sieve analysis report before permit issuance.
Who needs it
Property owners or contractors applying for a permit for a new or replacement on-site wastewater treatment system should complete this application.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This application is signed and dated without a notary; the form does not identify any attached or related document requiring notarization.
How to submit this form
- 1
Download the Application
Download the on-site wastewater treatment system permit application.
- 2
Complete the Application
Provide the property, owner, water supply, occupancy, and applicant or contractor information, then sign and date the form.
- 3
Gather Required Attachments
For a sand filter installation, include a sand sieve analysis report from an independent lab before permit issuance.
- 4
Submit to the County
Submit the application to the county department named on the form; check the county website for current contact details.
Frequently asked questions
- Do I need a notary for the wastewater system permit application?
- No. The application has a signature and date line but no notary block, and it does not identify any attachment or related step requiring notarization.
- Who uses this wastewater system permit application?
- Property owners or contractors use it to apply for a permit for a new system, replacement system, or replacement tank only.
- What information does the application ask for?
- It asks for property and owner details, water supply, bedrooms, occupants, lot size, and applicant or contractor contact information. It also includes a design and liability agreement.
- How do I submit the wastewater system permit application?
- Submit it to the county department named on the form; check the county website for current contact details.