TOWN OF BLOOMING GROVE

BUILDING DEPT. PERMIT APPLICATION

Phone 496-7011         Fax 496-1945

WELLS  &    SEWAGE DISPOSAL FACILITIES

DATE:                    PERMIT #

WELLS SEPTIC

NEW         $150.00                MAJOR REPAIR         $300.00

REDRILL     50.00                REPLACE TANK          150.00

REPAIR        50.00                REPLACE FIELDS       150.00

SECTION BLOCK  LOT

OWNER NAME: PHONE #

MAIL ADDRESS:

PROPERTY LOCATION:

ENGINEER: PHONE #

CONTRACTOR/DRILLER:

ADDRESS: PHONE #

DRILLER REG # NYS DEC CERT:       YES            NO

WELLS -     New well applications must include two sets of stamped engineer plans.  To close out new or re-drill permits, the DEC well log and final water test results must be submitted. 

SEPTICS – Major repair and field replacement applications must include two sets of stamped engineer plans.  An inspection by the Town engineer must be scheduled before backfill is done.  To close out these permits, a final as-built and certified engineer letter must be submitted.  To close out a tank replacement permit, a sketch of the property showing the measurements off the house to the septic tank must be submitted.

A copy of the contractor’s or driller’s Workmen’s compensation and liability insurance must be submitted with application.  The liability must name the Town of Blooming Grove as Certificate Holder AND Additional Insured.

APPLICANT’S SIGNATURE

PLEASE BE ADVISED:  It is the owner/applicant’s responsibility to submit proper paperwork, schedule inspections and re-inspections (if necessary) and to properly close out the permit.  A building permit expires one year from the issue date.  There will be a $75.00 fee to close out and issue a CO or CC for an expired permit.