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Suffolk County Department of Health Services Public Forms
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Electronic Documents
Applications, Forms, Procedures, Codes, Fact Sheets, Reports and more
All of the documents below are in the PDF format.
Please type or print legibly after downloading and printing forms and follow the instructions on each form.
For a quick overview of some of the services the Health Department performs,
click here for the Directory of Resources Brochure
The following Divisions / Offices / Bureaus of the Department of Health Services have documents available online:
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Office of the Commissioner / Administration
John J Foley Skilled Nursing Facility
Biostatistics
Division of Community Mental Hygiene
Contracts Unit
DEQ (Entire Division)
DEQ: Bureau of Drinking Water
DEQ: Office of Pollution Control
DEQ: Office of Wastewater Management
Current Regulations and Appendices
- Approval Of Plans And Construction - Sewage Disposal Systems For Single-Family Residences Regulation
- Standards For Approval Of Plans And Construction For Sewage Disposal Systems For Other Than Single-Family Residences Regulation (Commercial Standards including Appendix A,B and C)
- Transfer Of Development Rights Standards
- Suffolk County Sanitary Code - Article 6 Realty Subdivisions, Developments And Other Construction Projects
General Guidance Memorandums
- Memorandum #1 - The Use Of Temporary On-Site Subsurface Sewage Disposal Systems Prior To Construction Of A Sewage Treatment Plant
- Memorandum #2 - Department Requirements Regarding Expirations, Renewals, Modifications And Transfers Of Permits To Construct
- Memorandum #3 - Guidelines Regarding Population Density Equivalent Requirements For Existing Food Establishments
- Memorandum #4 (Undergoing revisions) - Department Requirements Regarding Submissions Of Applications To Construct For Two Family Residences
- Memorandum #6 - Procedures Of Office Of Wastewater Management For Processing Payment Of Application Fees And Refunds
- Memorandum #7 - Recommended Procedure For Resolving Construction Problems Involving Existing Neighboring Wells
- Memorandum #8 - Guidelines For Permit Referral For Approval Of Sewage Disposal Systems And Water Supplies For Existing, Renovated, Or Relocated Single-Family Residences
- Memorandum #9 - Guidelines For The Approval Of Sewage Disposal Systems Located Under Driveways For Residential Facilities
- Memorandum #10 - Change Of Use - When Plans Are Required
- Memorandum #11 - Guidelines for the Approval of Sewage Disposal Systems Damaged or Destroyed Due to Coastal Storms
- Memorandum #12 - Guidelines for Issuing Approval of Sewage Disposal Systems and Water Supplies for Existing Residences
- Memorandum #14 - Guidelines For Technical Reports - When Requesting Variances
- Memorandum #15 - Requirements for Grease Traps
- Memorandum #16 - Recommended Procedure For Reviewing Applications Involving Bed And Breakfast Type Of Uses
- Memorandum #17 - Agricultural and Golf Course Density
- Memorandum #18 - Procedures Of Office Of Wastewater Management For Accessory Apartments In Single Family Dwellings
- Memorandum #19 - Procedures Of Office Of Wastewater Management For Classifying Bedrooms Within Dwellings
- Memorandum #20 - Procedure For Grandfathering Sewage Flows For Other Than Single Family Residences
- Memorandum #21 - Requirements For Certifying And/Or Upgrading Existing Sewage Disposal And Water Supply Systems For Existing Buildings On Proposed Realty Subdivisions And Developments
- Memorandum #22 - Procedures Of Office Of Wastewater Management For Calculating Flow From Mezzanines
- Memorandum #23 - Procedures Of Office Of Wastewater Management For Calculating Sewage Flows From Basements And Attics For Other Than Single Family Residences
Fee Schedule
- Schedule of Current Application Fees for Construction Applications
Forms For Construction of Single Family Dwellings
- WWM-041 Submission Requirements for Approval of Sewage Disposal and Water Supply Facilities for Single Family Dwellings
- WWM-057 Application for Sewage Disposal and Water Supply Facilities for Additions, Remodeling or conversion of Single Family Dwellings
- WWM-059 Application for Sewage Disposal Facilities and Water Supplies for New Single Family Dwellings
- WWM-072 Certification of Existing Sewage Disposal and Water Supply Facilities for a Single Family Residence
- WWM-073 Certification of Completed Works by Design Professional
- WWM-078 Certification of Sewage Disposal System By Installer
- WWM-080 Certification of Sewage Disposal System Abandonment
- WWM-083 Certificate of Party Claiming Exemption From New York State Education Law, Section 7210
- WWM-104 Application for Extension, Renewal or Transfer of Existing Permit to Construct Sewage Disposal and Water Supply Facilities for Single Family Dwellings.
- WWM-105 Application for Sewage Disposal and Water Supply Facilities for an Accessory Apartment
Forms For Construction of Other Than Single Family Residences
- WWM-003 Application Requirements for Sewage Disposal Facilities and Water Supplies for Other Than Single Family Residences.
- WWM-004 Application for Construction of Sewage Disposal Facilities and Water Supplies for Other Than Single Family Residences
- WWM-019 Instructions for Obtaining Final Health Department Approval of Constructed Projects for Other Than Single Family Residences
- WWM-073 Certification of Completed Works by Design Professional
- WWM-075 Carbon Monoxide Certification
- WWM-078 Certification of Sewage Disposal System By Installer
- WWM-080 Certification of Sewage Disposal System Abandonment
- WWM-081 Application for Extension, Renewal or Transfer of Existing Permit to Construct Sewage Disposal and Water Supply Facilities for Other than Single Family Dwellings
- WWM-084 Certification of Existing Sewage Disposal and Water Supply Facilities for a Other Than Single Family Residences
- New York State Environmental Quality Review - Short Environmental Assessment Form
Forms For Filing Realty Subdivision or Development Maps
- WWM-022 Application Requirements for Filing Realty Subdivision or Development Maps
- WWM-023 Application for Approval of Realty Subdivisions and Developments
- WWM-070 Test Well Procedures
- WWM-083 Certificate of Party Claiming Exemption From New York State Education Law, Section 7210
Health Department Board of Review Application
- WWM-061 Application for Hearing Before Board of Review
- WWM-121 Transfer of Development Rights Data Sheet
New York State Forms
- SPDES Form D New York State Department of Environmental Conservation Application Form D for a SPDES Permit
- New York State Department of Environmental Conservation Continuation Form for SPDES form D
- New York State Department of Environmental Conservation SPDES Permit General Conditions
Forms For Garbage Companies - New Companies Only
- Application for Permit to Remove, Collect, Transport or Dispose of Offensive Materials (Article III, Section 1e, Suffolk County Sanitary Code)
DEQ - Office of Ecology
Division of Services for Children with Special Needs
Public Health
Public Health Protection: Children's Camps
Saftey Plans
- Children's Camps Safety Plan Adobe Acrobat, 8+ is required
- Appendix E General Activity Worksheet Adobe Acrobat, 8+ is required
- Appendix F Sports Adobe Acrobat, 8+ is required
- Camp Appendix G Swimming Adobe Acrobat, 8+ is required
- Appendix H Camp Trip Swimming Adobe Acrobat, 8+ is required
- Appendix I Boating Adobe Acrobat, 8+ is required
- Appendix J Archery Adobe Acrobat, 8+ is required
- Appendix K Riflery Adobe Acrobat, 8+ is required
- Appendix L Horseback Riding Adobe Acrobat, 8+ is required
- Appendix M Rope or Challenge Courses Adobe Acrobat, 8+ is required
- Appendix N Camp Trips Adobe Acrobat, 8+ is required
- Appendix O Spray Ground Facility Operation and Maintenance Adobe Acrobat, 8+ is required
Application for Permit to Operate DOH-3915
Children's Camp Additional Staff Qualification DOH-367a
Children's Camp Facility & Staff Description DOH-367
Children's Camp Written Plan Checklist DOH-2040
Children's Camps in NYS Brochure
Corporation Officers & Partners DOH-2135
Facility DataSheet
How to Obtain a Permit to Operate a Children's Camp Brochure
NYS Sex Offender Registry Search Procedures
Prospective Children's Camp Director Certified Statement DOH-2271
Required Reporting for Injury and Illness Poster
Statewide Central DataBase Check
Trip Leader Form
Public Health Protection: Food Control
Health Education
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