Well Application (Individual Water Supply Permit Application)
Application for a private well permit that must accompany or precede a septic permit application when a new water supply is also proposed on the same parcel.
- Jurisdiction
- Madison County, New York
- Fields
- 38
- 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.
- Well
- Untitled field (Check Box1)
- Untitled field (Check Box2)
- Re Visit Fee
- Untitled field (Text9)
- Applicant Name Property Identification Number Map
- Current Mailing Address Well Contractor
- Untitled field (Text8)
- Home Phone Work Phone Cell Phone Property Owners Phone
- Untitled field (Text5)
- Untitled field (Text6)
- Untitled field (Text7)
- Untitled field (Text4)
- Property Owners Name Mailing Address
- Property Address Subdivision Section Lot Number
- Untitled field (Text3)
- Property Location Directions To Site 2
- Single Or Multifamily
- Residential
- Commercial
- Irrigation
- New Construction
- Existing Dwelling
- Property Acreage
…and 14 more.
Where it goes
Submit with site plan to Madison County Public Health Environmental Health Division; call 315-366-2526 to confirm current submission address.
SepticSync runs the rest of the job too
Filling this permit is free and stays free. What you pay for is everything that happens around it: the filing, the chasing, the paperwork that piles up behind every install.
Free
no cardEnough to get a permit out the door today.
- 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
A paid plan
from $99/moFor anyone doing this more than occasionally.
- Unlimited forms, filed to the county for you
- Permits, inspections and parcels in one place
- Scheduling, jobs, customers and invoicing
- AI diagnostics and failure prediction
- Your whole crew, with roles and permissions
14 days of everything, free and without a card.
What a plan actually does
Filed for you
We send the finished form to the health department at the address you set per form, and keep the receipt.
Permits tracked
Every application followed from submission to approval, so nothing sits waiting on someone without you knowing.
Scheduling and dispatch
A drag-and-drop calendar, crews assigned, and a service record written the moment a job is finished.
Invoicing and QuickBooks
Invoice straight from a completed job with labour and materials pulled in, take payment online, sync to QuickBooks.
AI diagnostics
Photograph a tank or field and get cracks, corrosion and root intrusion flagged, with failure risk at 6, 12 and 24 months.
Parcels and compliance
Every property with a permanent record of pumping, inspections, and the paperwork that goes with them, on a map coloured by compliance status.
Built for the truck
Timestamped photos, GPS pins and signatures captured in the field, on a phone, without a signal babysitter.
Any form, not just ours
Upload a PDF, a Word file or a photo of a paper form and it comes back fillable, checked and ready to use.