HomeMy WebLinkAboutPermit Wastewater Allocation WWA-12-01FOR INTERNAL USE ONLY
WWAPermit #~-o[
CITY OF SOUTH BURLINGTON
APPLICATION for WASTEWATER ALLOCATION
*Items marked with an asterisk must be filled in by ALL applicants
*APPLICANT INFORMATION
Applicant: David Shenk
Contact Person: David Shenk -=~~~~~-----------------------------------------------------------------------------
Mailing Address: --=-p..:....;.o::....;.:......:B:::....::o=x::....;;4;;&;.:l::..o..<3r=2'--------------------------------_________________________________________
Burlington, VT 05406
Telephone & Fax for Contact Person: (802) 658-8142, Ext. 132
Property Owner Name (ifnot applicant): Chase Properties & Development, LTD
(c/o Tom Chase)
PropertyOwn~M~li~~dre~:~P~.0~.~B~o=x~2=2=8~3~_________________________________________________
Burlington, VT 05407
*Physi al Lr~at~on ofProject: 42 Airport Road. South ~VT ,. JhL ~ ~Z
* 19nature ofApplicant *Signature ofProperty Owner
(Both applicant and property owner MUST sign the application!)
*Project Information
If the project is a single-family home, please check one: __New __Existing
If not a single-family home, project name: Shenk Planned Residential Development
*Application or Permit Numbers: (from Planning & Zoning office)
#_----
#_----
Engineer's Information for flows over 1,000 gpd
N arne of Engineer: ~P=-au=l~O::::....'_=L:..:::.e=ary~,~P..:..:::.E=._____________________________________________________________
Firm: 0'Leary-Burke Civil Associates, PLC
Mailing Address: 1 Corporate Drive, Suite #1, Essex J ct., VT 05452
Phone & Fax: (802) 878-9990 Fax: (802) 878-9989
---------------------------------
PE License #: --'I,.i~-I------------______________
*Flow Calculations
(You may substitute an engineer's calculation or letter for the information requested
below)
For reSl en la proJects, r1st number 0 fbedrooms and unIts reques e t d:
Number of
Bedrooms
Number of Units
X
Gallons per day
per unit =
Total Flows
1 140
2 or more 6 210 1,260
TOTAL
Notes:
For commercial and industrial projects, list existing and proposed tenants, uses and
flows:
Tenant/ Type of use Number of Flows per Other Total
Business seats, SF, etc X unit Adjustments Flow
*Total development wastewater flow requested: 1,260 gaiions per day
Flow characteristics (for commercial and industrial projects)
Volume:
Flow rate:
Strength:
Please do not write below this line
Application & Recording Fee received: ________
Name Date
Receiving Plant: __------'Airport Pkwy ___Bartlett Bay
City Center District: Yes ---No
Approved by Water Pollution Control Department (Commercial and Industrial
Projects)
p~reliminar~?on issued: (payment offee is not required)
~. I/'o~o/~-D-rr-e-ct-o:........,r-o-f-P~lalC--<n<--n~in-g-an-d-Z-on-l-·n-g- Da~f
Final allocation issued: (payment offee is required, either inJull or pro-ratedfor
Z ith multiple zoning permits involved)
Director of Planning and Zoning Date
Final allocation expires _________with permit #______
(Date)
Zoning permit issued__________with permit#______
(Date)
Associated WW connection permit (if applicable) # __-____
For extensions ofFinal Allocation Only
EXTENSION GRANTED , _______to_________
(Date) (Date of Expiration)
50% EXTENSION FEE PAID ----_$_----(Date) (Amount)