Fillable Sanitary and Stormwater Sewer Permit Application (City of Winooski)

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Sanitary and Stormwater Sewer Permit Application (City of Winooski)

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The Sanitary and Stormwater Sewer Permit Application (City of Winooski) form is 4 pages long and contains:

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  • 16 check-boxes
  • 27 other fields

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1
Sanitary and Stormwater
Sewer Permit Application
New service connections
Repair or replacement of existing service connection
disconnection of existing service
(Please Note – for any excavation work within the City Right-of-Way, a separate ROW permit is required.)
Fees (Chapter 28 – City of Winooski Ordinance, Last Updated 7/15/19
Tap into City Sewer Main: $300
Tap into City Storm Sewer: $300
1. Property Information
Property Owner ___________________________________ Date __________________
Applicant Name (if different than property owner) ______________________________
Property Address ___________________________________ Phone _______________
Type of Property:
Single-Family Home
Multi-family dwelling
Commercial
Other _______________
2. Brief Description of Work
Permit#
S
2
3. Attach Drawing(s) of proposed work (if applicable)
Please include dimensions, existing utility locations, depths, material types, etc...
Please note- if field modifications are required as approved by the City, an updated as-built drawing is
required.
4. Construction Information:
Start of Work (Approx
. Date) _____________ Completion of Work (Approx. Date) ___________
Contractor _____________________________ Phone _________________
Contractor Address ____________________ Phone _________________
On-site Contact ________________________ Phone __________________
5. Work Type:
New sanitary sewer co
nnection: gravity pressure
New storm sewer connection: gravity pressure
Sewer service repair: sanitary storm
Sewer service disconnection: sanitary storm
6. Estimated Flows:
Sanitary Sewer
Domestic strength flow: ______ GPD
Industrial strength flow
1
: ______ GPD
Total Flow: ______ GPD
1. A separate Industrial wastewater application and permit may be required. This is reviewed on a case by case
basis for the proposed development in accordance with Chapter 21 of the City of Winooski ordinance.
Storm Sewer
(if applicable)
For new non-residential development, please
include calculated stormwater flows to the City
storm sewer for the following 24-hour rain events;
Water Quality Storm (1.0”), 1-year, 10-year, 25-
year, 50-year and 100-year
3
General Conditions and Requirements
In consideration of granting this permit, the undersigned agrees:
1. To accept and abide by all provisions of the most recent City of Winooski Ordinances,
standards, and specifications for construction and all other pertinent ordinances or
regulations that may be adopted in the future.
2. The City of Winooski is not a member of Dig Safe. For Dig Safe certification, please contact
the City of Winooski Water Resources Manager (John Choate - 802.373.5760).
3. Until the applicant has received written permit approval from DPW, and except as authorized
in the approved permit, no work shall occur in the right-of-way, and no obstacles shall be
placed within the limits of the right of way in any manner that interferes unnecessarily with
the traveling public.
4. All the work herein contemplated shall be done to the satisfaction of the City of Winooski.
5. To notify the Department of Public Works when the work is ready for inspection please
contact City Hall-Public Works at 802.655.6410 or the Utility Manager. Inspections will occur
Monday – Friday during normal business hours (7am-2pm).
6. This permit is valid for thirty (30) days. If the permitted work does not commence within
thirty (30) days a new permit shall be required. In the event that fees increase between the
initial permit and any renewed permit issued subsequently, the applicant is responsible for
paying the difference at the time of reapplication.
All permits must have a final inspection. Failure to contact the City for inspection prior
to backfill of work may require the applicant to uncover or otherwise expose work so
that an inspection can occur.
Applicant Signature ___________________________________ Date ___________________
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signature
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4
This section completed by City:
Application Approval:
Additional Permit Conditions (if any)
Approved by ______________________________ Date __________________
Fee Amount (per ordinance schedule) $ ____________
Application Rejection:
Rejected by _______________________________ Date ___________________
Rejection Description:
Last Updated: 6/23/20
s:\public works\public works - water resouces\permits-forms\sewer application.docx
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Sanitary and Stormwater Sewer Permit Application (City of Winooski)

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Completed 25 January 2021

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