Certification of Existing Subsurface Sewage Disposal and Water Supply Facilities for a Single Family Residence
Inspection report completed by a licensed architect or engineer certifying the present condition of an existing on-site sewage disposal system and water supply, required when existing components are proposed to be reused.
- Form
- WWM-072
- Jurisdiction
- Suffolk County, New York
- Fields
- 43
- Includes
- Signatures
Create a free account to fill this form, sign it and download it ready to file. No card needed.
- Your answers print onto the health department's own PDF
- Sign on screen: phone, tablet or laptop
- Save it and come back to it
Fill it online
Type into the real county form. No printing, no retyping.
The county's own PDF
Your answers print onto the health department's document, not a lookalike.
Download and file
Get the finished PDF and hand it in exactly as they expect it.
What this form asks for
Have these to hand before you start.
- Address Of Residence Street
- Hamlet
- Zip
- District
- Section
- Block
- Lots
- Owners Name
- Phone
- Clients Name If Different Than Owner
- Proposed Changes In Use
- Public Water
- Private Well Provide Copy Of Water Analysis Dated Within One Calendar Year
- Date Of Sanitary System Pumping
- Total Gallons Removed
- Precast
- Block 2
- Septic Tank Gallons
- Septic Tank Diameter
- Septic Tank Effective Depth
- Leaching Pools Diameter
- Leaching Pools Effective Depth
- Leaching Pools Total Number Of Pools
- Acceptable
…and 19 more.
Where it goes
Submit with a WWM-057 application when proposing to utilize any existing sanitary system or water supply components.
Filed with HealthWWM@suffolkcountyny.gov.
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Free
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- 3 forms a month, filled and signed
- The county's own PDF, not a lookalike
- Site sketch and on-screen signatures
- Saved for 6 months
- Send to the property owner to sign
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