Do I need a notary for the Individual Water Supply Wells Application?

No. This application is signed without a notary, and the document does not identify any attachment or related step that must be notarized or sworn.

What information does the application ask for?

It asks for property owner and location details, well construction and location information, yield and flow observations, and information about disinfection and water sampling.

What attachment does the application require?

The form says to submit a copy of the NYSDEC Water Well Completion Report with the application. It also asks for a copy of the bacteriological water sample report if a sample was collected.

Wyoming County, NY · Wyoming County

No notary required

Individual Water Supply Wells Application

Property owners use this application to provide information about a new or replacement potable water well to the Wyoming County Health Department.

At a glance

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

What this form is

This application provides the Wyoming County Health Department with details about a new or replacement potable water well. It asks for property and well location information, construction details, well yield and water flow observations, and information about disinfection and water sampling. The form notes that a copy of the NYSDEC Water Well Completion Report must accompany the application.

Who needs it

Property owners applying for installation of a new or replacement potable water well complete this form with information about the property and well.

How to submit it

Submit the application and a copy of the NYSDEC Water Well Completion Report to the Wyoming County Health Department, Environmental Health Division, at 5362 Mungers Mill Road, Silver Springs, NY 14550.

About notarization

This application is signed without a notary, and it does not identify any attachment or related step that must be notarized or sworn; the signer just signs and dates it.

How to submit this form

1
Download the Application
Download the Individual Water Supply Wells Application.
2
Complete the Application
Provide the requested property, well location, construction, yield, and water sampling information.
3
Gather Required Reports
Include a copy of the NYSDEC Water Well Completion Report and, if applicable, the bacteriological water sample report.
4
Submit to the County
Send the application and required report to the Wyoming County Health Department, Environmental Health Division, at the address on the form.

Frequently asked questions

Do I need a notary for the Individual Water Supply Wells Application?: No. This application is signed without a notary, and the document does not identify any attachment or related step that must be notarized or sworn.
How do I submit the Individual Water Supply Wells Application?: Submit the application and a copy of the NYSDEC Water Well Completion Report to the Wyoming County Health Department, Environmental Health Division, at the address shown on the form.
What information does the application ask for?: It asks for property owner and location details, well construction and location information, yield and flow observations, and information about disinfection and water sampling.
What attachment does the application require?: The form says to submit a copy of the NYSDEC Water Well Completion Report with the application. It also asks for a copy of the bacteriological water sample report if a sample was collected.

Need something notarized?

This Individual Water Supply Wells Application doesn’t need a notary, but if you have another Wyoming County form that does, a commissioned online notary can help.