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Application for Sanitary Sewer Certificate

2. Please submit at least 21 days prior to closing.

4. Instructions
   Applicant is to hire an registered licensed Allegheny County plumber to complete a dye test and video camera inspection of the property's sanitary sewer. Applicant must also complete the following sanitary sewer certificate application, make sure the report of test and inspection in returned by the plumber to the Borough, and pay a $25 fee. Payment is accepted by mail by check or money order, or in person at the Borough Building by cash, check, debit, or credit card. Sanitary sewer certificates are valid for five (5) years. If you are unsure if your property has a valid certificate on file, please contact Stephanie Matus at 412-882-9600 ext 257.

   Applicant is to hire an registered licensed Allegheny County plumber to complete a dye test and video camera inspection of the property's sanitary sewer. Applicant must also complete the following sanitary sewer certificate application, make sure the report of test and inspection in returned by the plumber to the Borough, and pay a $25 fee. Payment is accepted by mail by check or money order, or in person at the Borough Building by cash, check, debit, or credit card. Sanitary sewer certificates are valid for five (5) years. If you are unsure if your property has a valid certificate on file, please contact Stephanie Matus at 412-882-9600 ext 257.

6. Report of Test and Inspection
   Report of Test and Inspection

   Provide this report to a registered licensed Allegheny County plumber to complete after they do the dye test and sanitary sewer video camera inspection. Return completed report by: mail to the Borough Building, fax (412-882-9743), or email (smatus@baldwinborough.org).

10. Date of Application
    Date of Application

12. Applicant's Name*

14. Applicant's Address*

16. City*

17. State*

18. Zip Code*

20. Forwarding Address

22. City

23. State

24. Zip Code

28. Address of Property to be Certified:*

30. City

31. State

32. Zip Code

34. Lot and Block Number (Parcel ID)

38. Purchaser's Name*

40. Purchaser's Current Address*

42. City*

43. State*

44. Zip Code*

46. Phone Number

50. If violations are indicated on the test and inspection report form, they must be corrected prior to a sanitary sewer certificate being issued.

52. Date
    Date

53. Signature*

    I agree that the information I provided on this application is correct to the best of my knowledge.

    1. I agree
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit Submit and Print

* indicates a required field