Dutchess County, NY · Dutchess County
Septic System Repair/Replacement/Refurbishment Contractor Supplement
Contractors and property owners use this form to document completed repairs, replacements, or refurbishments to an existing single-family residential septic system.
At a glance
- Issued by
- City of Dutchess County · Dutchess County, Dutchess County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- dutchessny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This Step 2 form documents completed septic system repair, replacement, or refurbishment work for an existing single-family home with a system under 1,000 gallons per day. It may be used only after the Department has reviewed and accepted the Step 1 form, before work begins. The form requests property and contractor details, a description of the work, an as-built sketch, and signatures certifying the work.
Who needs it
Property owners and contractors completing repair, replacement, or refurbishment work on an eligible existing single-family residential septic system need this form.
How to submit it
Submit it to the Dutchess County Department of Behavioral and Community Health, Environmental Health Services Division, at 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601.
About notarization
This document is signed without a notary; the property owner and contractor sign the certification, and the signer just signs and dates it.
How to submit this form
- 1
Download the Form
Download the contractor supplement for septic system repair, replacement, or refurbishment.
- 2
Complete the Sections
Enter the property and contractor details, describe the work performed, and record the date the work was placed into operation.
- 3
Add the As-Built Sketch
Draw the installed components and tie-in dimensions on the reverse; attach supplemental sketch sheets if needed.
- 4
Gather Required Approvals
Attach any supplemental permits or approvals from other agencies required for the work.
- 5
Sign and Submit
Have the property owner and contractor sign the certification, then submit the form to the Environmental Health Services Division at the listed address.
Frequently asked questions
- Who should complete the septic contractor supplement?
- The contractor who performed the work and the property owner provide information and sign the certification. If the owner completes the work, the form says to enter “same as Section A” for contractor details.
- Do I need a notary for the Septic System Repair/Replacement/Refurbishment Contractor Supplement?
- No. This document is signed without a notary; the property owner and contractor sign the certification, and the signer just signs and dates it.
- How do I submit the contractor supplement?
- Submit it to the Dutchess County Department of Behavioral and Community Health, Environmental Health Services Division, at 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601.
- What should I attach to the form?
- Provide an as-built sketch on the reverse, including tie-in dimensions to constructed components. Attach supplemental sheets as needed and any supplemental permits or approvals required from other agencies.