Environmental Protection311

EOH Septic System Rehabilitation Reimbursement Determination of Eligibility

Submit this form to determine if your property is eligible for septic system rehabilitation reimbursement. If you have any questions, please call 914-749-5677. Visit EOH Septic System Repair Rehabilitation Reimbursement Program for more information.

* Indicates required fields

Owner Name*

Email*

Phone*

Property Address*

Property City*

Property State*

Property ZIP Code*

Is this your primary residence?*

Yes No

Was the home built before May 1, 1997?*

Yes No

Property Type*

1 Family

2 Family

Other

Number of Bedrooms*

Has the County Health Department issued a Notice of Non-Compliance?*

Yes No

Has the system been pumped out within the last two years?*

Yes No

Has a licensed septic contractor evaluated the system?*

Yes No

I hereby certify that the information I have provided is true and correct to the best of my knowledge*

I certify

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EOH Septic System Rehabilitation Reimbursement Determination of Eligibility

EOH Septic System Repair Reimbursement Program Intake Form