What is the Dutchess County septic system repair form for?

It documents notice of intent to repair, replace, or refurbish an existing septic system serving a single-family home with a system under 1,000 gallons per day. It does not establish formal approval.

Who should complete this septic system form?

The form requests information about the property owner and contractor, along with existing and proposed system details. If the owner is completing the work, the instructions say to enter “same as Section A” for the contractor.

Do I need a notary for the septic system repair form?

No. The property owner and contractor sign the form without a notary; no notarized or sworn attachment is specified.

Dutchess County, NY · Dutchess County

No notary required

Septic System Repair/Replacement/Refurbishment Form

Dutchess County property owners and contractors use this form to give notice of intent to repair, replace, or refurbish an existing 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: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This form documents notice of intent to repair, replace, or refurbish an existing septic system for a single-family home with a system under 1,000 gallons per day. It is not an approval and does not apply to new homes, bedroom additions, or work requiring a building permit. It asks for property and contractor details, existing and proposed system information, soil measurements, a sketch, and owner and contractor signatures.

Who needs it

Property owners or contractors planning repair, replacement, or refurbishment of an existing qualifying single-family residential septic system use 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, or email [email protected].

About notarization

This document is signed without a notary; the property owner and contractor sign the form, and no notarized or sworn attachment is specified.

How to submit this form

1
Download the Form
Download the Dutchess County septic system repair, replacement, or refurbishment form.
2
Complete the Form
Fill in the property, owner, contractor, existing system, and proposed work details requested in Sections A through D.
3
Add the Sketch
Sketch the system on the reverse side and attach supplemental sheets as necessary; note any deviations from design standards.
4
Sign and Submit
Have the property owner and contractor sign, then submit the form to the county Environmental Health Services Division.

Frequently asked questions

What is the Dutchess County septic system repair form for?: It documents notice of intent to repair, replace, or refurbish an existing septic system serving a single-family home with a system under 1,000 gallons per day. It does not establish formal approval.
Who should complete this septic system form?: The form requests information about the property owner and contractor, along with existing and proposed system details. If the owner is completing the work, the instructions say to enter “same as Section A” for the contractor.
Do I need a notary for the septic system repair form?: No. The property owner and contractor sign the form without a notary; no notarized or sworn attachment is specified.
How do I submit the septic system repair form?: Submit it to the Dutchess County Department of Behavioral and Community Health, Environmental Health Services Division, at the address or email listed on the form.

Need something notarized?

This Septic System Repair/Replacement/Refurbishment Form doesn’t need a notary, but if you have another Dutchess County form that does, a commissioned online notary can help.