The forms below are not printable and are only available directly at the Health Department:
- CP-97 Construction Permit for Sewage Treatment System
- CC-97 Certificate of Construction Compliance for Sewage Treatment System
- PC-RP Proposal for Sewage Treatment System Repair
- WP-97 Application to Construction a Water Well
- WA-97 Application to Abandon a Water Well
- WC-97 Well Completion Report
Tanning Facilities
- Tanning Facility Regulations (Subpart 72-1)
- Tanning Hazards Information Sheet
- Tanning Facility Statement of Acknowledgement Form
- Tanning Facility Parental Consent Form
- Warning Poster
- Injury and Illness Report Form
- Permit Application
- Letter to New Operator
- Renewal Letter to Operator
- Tanning Fee Schedule
- Workers Compensation and Disability Requirements
- Tanning Facilities Fee Determination
- Application Checklist for Tanning Facility Operators
Additions to Existing Residences, Individual Separate Sewage Treatment Systems, Commercial Sewage and Realty Subdivisions.
- CS-31 Procedures & Policies for Commercial & Multi-Family Sewage Treatment & Water Supply
- ST-19 Procedures & Policies for Subsurface Sewage Treatment & Water Supply for Single Family Residences
- RP-1 Procedures & Policies for Sewage System Repair Permits
- RS-21 Procedures & Policies for Realty Subdivision Program
- HA-1 Procedures & Policies for House Additions (Revised 10.16.17)
- DD-97 Design Data Sheet (2 page form)
- PC-97, Application for Approval of Plans for a Wastewater Treatment System (2 page form)
- LA-97 Letter of Authorization
- CA-97 Affidavit Corporate Owner
- WAR-97 Well Abandonment Report
- GS-97 Guarantee of Subsurface Treatment System
- FIR-99 Request for Final Inspection
- Fieldtest Request for Field Testing
- E911 Address Verification Form
- Appendix E Format Construction Permit Neighbor Notification Letter
- SEQR Short Environmental Assessment Form (4 page form)
- HD Gen 157 Application for Approval of Sanitary Facilities for Realty Subdivision (2 page form)
- Proposal For Exploration of Septic System Failure
- Accessory Apartment Application
- Certificate of Occupancy Certification for Bedroom Count
- NYS Design Standards for Intermediate Sized Wastewater Treatment Systems
| If you have any questions, please call (845) 808-1390 or email PutnamHealth@putnamcountyny.gov. |