Chemung County, NY · Chemung County
Renewal or Transfer Application for On-Site Wastewater Treatment System Permit
Property owners use this application to extend an on-site wastewater treatment system permit or request its transfer after an ownership or contractor change.
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 lets property owners request a one-to-four-year permit extension, transfer a permit after a change in property ownership, or transfer it to a new contractor. It asks for the property address, owner or contractor details, contact information, and the applicant’s signature and date. A contractor must be registered with the Chemung County Health Department before a permit transfer if not already registered.
Who needs it
Property owners seeking a permit extension or permit transfer after a change in property ownership or contractor need this application.
How to submit it
The form lists Chemung County Health Department, Environmental Health Services, at 103 Washington St., P.O. Box 588, Elmira, NY 14902-0588, and [email protected].
About notarization
This application is signed and dated without a notary; it contains no notarized or sworn attachment requirement.
How to submit this form
- 1
Download the Application
Download the Renewal or Transfer Application for an On-Site Wastewater Treatment System Permit.
- 2
Complete the Application
Enter the property address and the requested owner or contractor information, then check the applicable extension or transfer option.
- 3
Check Contractor Registration
For a transfer to a new contractor, confirm whether the contractor is registered with the Chemung County Health Department.
- 4
Sign and Date
Sign and date the application.
- 5
Submit to the County
Use the Chemung County Health Department contact details provided on the form.
Frequently asked questions
- Do I need a notary for this application?
- No. The application calls for the applicant’s signature and date, with no notarized or sworn attachment requirement.
- How do I submit the wastewater permit application?
- The form lists Chemung County Health Department, Environmental Health Services, at 103 Washington St., P.O. Box 588, Elmira, NY 14902-0588, and provides an email address.
- What can I request with this application?
- You can request a permit extension for one to four years, transfer it after a change in property ownership, or transfer it to a new contractor.
- Does a new contractor need to be registered?
- The form states that a contractor who is not currently registered with the Chemung County Health Department must be registered before the permit can be transferred.