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Application for Sewage and/or Water System Inspection

  1. County Seal (color)
  2. Wyoming County Health Department
    Environmental Division
    5362 Mungers Mill Road, Silver Springs, NY 14550
    Telephone 585-786-8894
    Sewage and/or Water System Inspection
  3. Reason for Inspection*
  4. Has the home been lived in for the past 30 days?*
  5. Is the home lived in seasonally?
  6. Send Results Via*
  7. Note
    Please be aware the final report is valid for 90 days. Schedule your appointment accordingly to avoid a re-inspection.
  8. The following inspections are requested:*
  9. Note

    Additional tests may be required, Please check with your financial institution. Additional tests are $30 each (when performed with above service).

  10. Please check the desired tests:
  11. Payments
    Make check payable to the Wyoming County Health Department:
    5362 Mungers Mill Road
    Silver Springs, NY 14550
    **Appointments may not be made until payment is recieved by this office.
  12. Note * Payment may be made online by clicking the link or form must be printed and mailed to our office with appropriate fee
  13. Authorized Signature of one of the following - owner, owner's attorney, or executor of estate
  14. Leave This Blank:

  15. This field is not part of the form submission.