HomeMy WebLinkAboutSP-24-08 - Supplemental - 0870 Williston Road (12)FOR INTERNAL USE ONLY WWA Permit# ____ _
CITY OF SOUTH BURLINGTON APPLICATION for WASTEWATER ALLOCATION
*Items marked with an asterisk must be filled in by ALL applicants
*APPLICANT INFORMATION
Applicant: AAM Burlington Hotel, LLC
Contact Person: Anthony Librot------''-----------------------
Mailing Address: 78 Blanchard Road, Suite 100
Burlington, MA 01803
Telephone & Fax for Contact Person: ...,_(7_8_1...:.)_2_2_2_-4_1_5_0_x_1_0_2 _________ _
Property Owner Name (if not applicant): _S_a_m_e_a_s_A_,_p,_pl_ic_a_n_t ________ _Property Owner Mailing Address: 78 Blanchard Road, Suite 100
Burlington, MA 01803
*Physical Location of Project: 870 Williston Rd, South Burl_ington// d# .£_,,.-,/:-.,.-✓ -/ � � �&7 ,,�--4 *Signalure of Applicant *Signatqfe of Property Owner(Both applicant and property owner MUST sign the application!)
*Project Information
If the project is a single-family home, please check one: ON"ew OE:xisting
If not a single-family home, project name: Double Tree Hotel Addition & Parking
* Application or Permit Numbers: (from Planning & Zoning office)
# __ -__ -__
# __ -__ -__# __ -__ -__
Engineer's Information for flows over 1,000 gpd Name of Engineer: _,,D'--'e'--'-r":ic:'--'k---'-R_,_,e""a"'d:1---'--P-':.E:'-'.'--:--- -,------------Firm: Krebs & Lansing Consulting Engineers,
Inc.
Mailing Address: 164 Ma in Street, Colchester, VT 05446 Phone & Fax: (802) 878-0375 PE License#: 018.0008105
*Flow Calculations
(You may substitute an engineer’s calculation or letter for the information requested
below)
For residential projects, list number of bedrooms and units requested:
Number of
Bedrooms
Number of Units
X
Gallons per day
per unit =
Total Flows
1 140
2 or more 210
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
*Total development wastewater flow requested: ________gallons 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)
______________________ _____________
Director of Water Pollution Control Date
Preliminary allocation issued: (payment of fee is not required)
_______________________ _____________
Director of Planning and Zoning Date
Final allocation issued: (payment of fee is required, either in full or pro-rated for
projects with 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 of Final Allocation Only
EXTENSION GRANTED ____________to______________
(Date) (Date of Expiration)
50% EXTENSION FEE PAID _________ $___________
(Date) (Amount)