HomeMy WebLinkAboutdrain layer permit 540 Sullivan Avenue O SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
.+ DATE OF 'REQUEST: /a -o�j- 9S� TIME: e�
BY: FOR LOCATION: -
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. DAY INSPEC. " NEEDED ®j�/� ����-7� TIME:
TYPE GF INSPECTION:
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(OC ) SANITARY/ng7�9�' ('PERMIT NO. FOOTING: DRAIN..-
EXCAVATION . (PERMIT NO. ) ( } OTHER
INSPECTION.RrEP"ORT
DATE.:, TIME: IAO-1 p/W INSP:
CONTRACTOR . / !� ��Zi WEATHER:
WORK IN- PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
MV 6364
TOWN OF SOUTH WINDSOR
DEPART OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: 9t;
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to
perform work at $46 =;L'.4it// 1 = , Lot# as indicated below, at
premises owned by -rlJl" je6P_ _75*rA22'Fk/ whose address is and
to Lay House Drain , Repair House Drain Lay Main , Other for
occupancy or use, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE O, INDUSTRIAL WAS TES(J,
OR-0 J Connection will be made with 16� r� All
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
indicated on the back of this permit.
Proposed start date 7- Estimated time for completion /h'4i✓'ff
Permit is to be issued to J � AM, the holder of Drain Layer's License No.
207 Only holders of P1, P7 & VV9 licenses wi b issued permit. Permit will expire thirty (301
Bays after date-of issuance. The undersigned Drain Layer her y agrees to all the terms and conditions set
ibrth,4*17 the permit and the reverse side thereof. pplica t has received Town Street ca Permit No.
-� and/or ConnDOT Permit No.
Signed
Licensed Drain ayer
FOR TOWN USE ONLY /
Permit Fee Paid$ ✓� OU#, (Check No.) (�
Y N Connection Charge S tJ.Z& (Receipt No.) ---- Dated
Insurance on File
Bond on File This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement
Record of Sewer
Assessment ( J ( J Issued by Date 6 S
INSPECTION
i
Date Work Started ���� ✓� Date Completed
Comments
APPROVED:
zz-
Inspector Date
TOWN Of SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
# DRAIN LAYER'S PERMIT w� 6094
• /ti►"97R C// 19 f•Y
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
Ar AA-e at premises owned by 7-Ajj /?�
whose address is # ye —77- n" mf--� and to f
Lay House Drain, Repair House Drain, Lay Main, Other ,
for co?, J, occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with /, �� /0ye-
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
Cori<r .PkS�,/X-� w,� d ti�;od,-b err.•.-,.7�
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date J-2_2 - 9 y Estimated Time for Completion eC
Permit to be issued to 14/n•. r- J;,. -, , -7.*-•C
the holder of Drain Layer's License No. '.2a ,,ip Permit will expire thirty
(30) days after date of issuance. The undersigned Drain Layer hereby agrees
to all the terms and conditions set . forth in the permit and the reverse side
thereof . Applicant has received Town Permit No. and/or
CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
X�P 3 - 0-3
r Engineering Dept . Date
Permit Fee Paid ,$ 'j ✓ Check Number u?
Connection Charge Receipt No. q/-Jjg Dated
Issued by MaQl3r-
INSPECTION
Date work started 3 3 Date completed - 3/-}4
Sufficient notification eceive : _� es No
Specia Conditions
Y
APPROVED•
Inspector Date
yr
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 3 o Z 3 i 9 Q- TIME: /6 0 n A r
BY: FOR LOCATION:
DAY INSPEC. NEEDED o Z 9 TIME:
Q Q Q A.44 r
. TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTION REPORT
DATE: - IME: /Q;po DO INSP:
CONTRACTOR: F EATHER: S G
WORK IN PROGRESS:
. '444
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
TOWN OF SOUTH WINDSOR INSPECTION REPORT
. PROJECT: 'Yo. 'OeA L04 DEVELOPER•�icvf^,�� � �'` '" ���?
STREE �iJi .�i� Gtif.� • CONTRACT R.
DATE: -- TIME: 9 '0
WEATHER: 0. O INSP: i�-..� �
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WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
TOWN OF SOUTH WINDSOR INSPECTION REPORT
. PROJECT: DEVELOPER://iwImA
STREET: 5'¢O -CONTRACTOR:
DATE:_ �Sr TIME:
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WEATHER:, _
WORK IN PROGRESS: •
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AREA OF CON ERN:
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SPECIAL INSTRUCTIONS:
TOWN OF SOUTH WINDSOR INSPECTION REPORT
.PROJECT: DEVELOPER:
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STREET: ic CONTRACTO
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' DATE: 3 Z �1- - 7' 4- TIME: 9,
WEATHER: ��[ ✓�.�c INSP: ���`
WORK IN PROGRESS:
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AREA OF CONCERN:
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SPECIAL INSTRUCTIONS:
TOWN OF SOUTH WINDSOR INSPECTION REPORT
,PROJECT: DEVELOPER:
STREET: �6- ® j CONTRACTOR:
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- TIME:
' DATE:-- eu Z v v
WEATHER: INSP:
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WORK IN PROGRESS: D : ?6 AAAM 23 s 9
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SPECIAL INSTRUCTIONS:
APPROVAL FOR CONNECTION TO MUNICIPAL SANITARY SEWER
(Type or Print Clearly)
1) APPLICANT COMPLETES THIS SECTION
TNT RED STAR EXPRESS
Applicant: 7?OBERT J Mn_r_nEFu
6650 TRANSIT RD
Address:
WILLIAMSVILLE NY 14221
Facility: TNT RED STAR EXPRESS
Address: 540 SULLUVAN AVE
SOUTH WINDSOR CT 06074
2) MUNICIPALITY COMPLETES THIS SECTION
City/Town/Borough of South Windsor
Department/Office of Public Works
Address 1540 Sullivan Ave. .
South Windsor, CT 06074
THE APPLICANT 1S HEREBY TENTATIVELY APPROVED FOR CONNECTION TO THE
MUNICIPAL SANITARY SEWERAGE SYSTEM, AT THE FACILITY LOCATION REFERENCED
ABOVE, FOR THE DISCHARGE OF UP TO 1,000 GALLONS PER DAY OF VEHICLE SERVICE
FLOOR DRAIN WASTEWATER.
FINAL APPROVAL MAY BE CONTINGENT UPON RECEIVING AN APPROVAUPERMIT FROM
THE DEPARTMENT OF ENVIRONMENTAL PROTECTION AND/OR OTHER APPROVALS OR
PERMITS REQUIRED BY THE MUNICIPALITY.
f-1�4 ,IV� *
Signature of Duly Authorized Municipal Official Date
C. F. Straw
Name of Duly Authorized Municipal Official
Title of Duly Authorized Municipal Official
Application - Page 5
DEPARTMENT OF ENVIRONMENTAL PROTECTION
WATER MANAGEMENT BUREAU
AGENCY USE ONLY COMPLETE APPLICATION AND SUBMIT WITH:
A. CERTIFICATION OF COMPLIANCE FORM VS1
B. OIL SEPARATOR SPECIFICATION SHEET
Application No. C. MUNICIPAL APPROVAL FORM
0. APPLICATION FEE PAYMENT OF $50.00.
Facility ID. No.
TO: CT DEPIWATER MANAGEMENT BUREAU
Permit ID. No. GVS PERMITTING, ENFORCEMENT.& REMEDIATION DIVISION
19 ELM STREET
HARTFORD, CT 06106.5127
GENERAL PERMIT APPLICATION FOR
VEHICLE SERVICE FLOOR DRAIN WASTEWATER
(TYPE OR PRINT CLEARLY)
1. PURPOSE OF FORM:
APPLICATION FOR GENERAL PERMIT[X ] ADDITIONAL FACILITY[ I
2. APPLICANT:
NAME TNT RFD STAR X RESTS TELEPHONE 201-344-7700
MAILING ADDRESS 400 DELANCY STREET
TOWN NEWARK STATE NJ ZIP 07105
LOCATION ADDRESS 400 DELANCY REFT
TOWN _ NEWARK STATE NJ DP 07105
3. FACILITY INFORMATION:
NAME TNT PRn STAB TELEPHONE 203-2R2-7474
MAILING ADDRESS 540 SULLIVAN AVENUE
TOWN SOUTH WINDSOR STATE CT ZIP 06074
LOCATION ADDRESS 540 SULLIVAN AVENUE
TOWN SOUTH WINDSOR STATE CT ZIP 06074
4. FACILITY OWNER INFORMATION:
NAME TNT RED STAR EXPRESS TELEPHONE 201-344-7700
MAILING ADDRESS 400 DELANCY STREET
TOWN NEWARK STATE NJ ZIP 07105
LOCATION ADDRESS 400 DELANCEY STREET
TOWN NEWARK STATE
NJ ZIP 071 nS
Application - Page 1
5. FACILITY OPERATOR INFORMATION:
NAME TNT RED STAR EXPRESS TELEPHONE 203-282-7474
MAILING ADDRESS _540 SULLIVAN AVENUE
TOWN SOUTH WINDSOR STATE CT
ZIP 06074
LOCATION ADDRESS 540 SULLIVAN AVENUE
TOWN SOUTH WINDSOR STATE CT ZIP 06074
6. OPERATOR'S STATUS: Federal[ I State[ J Public[ I Private[IQ Other [ J
7. DISCHARGE INFORMATION:
AVERAGE DAILY FLOW 150 (IN GALLONS PER DAY)
TOTAL HOURS DISCHARGE WILL OCCUR PER DAY: 24
DATE DISCHARGE BEGAN OR WILL BEGIN (MoJDay/Yr.): OLO / 3C / d7s
8. NAME AND ADDRESS OF PERSON CONTRACTED TO REMOVE WASTE OIL & OTHER CHEMICALS:
NAME ADVANCE LIQUID RECYCLING TELEPHONE ' 203-238-6772
MAILING ADDREss 357 W. MAIN STREET
TOWN MERIDEN STATE CT ZIP 06451
9. NAME AND ADDRESS OF PROFESSIONAL ENGINEER LICENSED IN CONNECTICUT.
NAME TELEPHONE
MAILING ADDRESS
TOWN STATE ziP
10. COASTAL BOUNDARY/ INDIAN LANDS: Is the facility located
Within the coastal boundary as defined by section 22a-94 of the Connecticut General Statutes as amended? No[xI Yes( I
On Indian lands as defined by section 47-63 of the Connecticut General Statutes as amended? No 00 Yes[ J
11. THE APPLICANT SHALL MAKE THE FOLLOWING CERTIFICATION:
"1 CERTIFY UNDER PENALTY OF LAW THAT THIS DOCUMENT AND ALL ATTACHMENTS WERE PREPARED UNDER MY DIRECTION OR SUPERVISION
IN ACCORDANCE WITH A SYSTEM DESIGNED TO ASSURE THAT QUALIFIED PERSONNEL PROPERLY GATHER AND EVALUATE THE INFORMATION
SUBMITTED. BASED ON MY INQUIRY OF THE PERSON OR PERSONS WHO MANAGE THE SYSTEM,OR THOSE PERSONS DIRECTLY RESPONSIBLE
FOR GATHERING THE INFORMATION,THE INFORMATION IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,ACCURATE AND COMPLETE.
I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE POSSIBILITY OF FINE AND
IMPRISONMENT."
PLhSIGNATURE OF APPLICANT v• DATE
The Application shall be signed by one of the followi For a corporation-a responsible corporate officer;b.For a partnership-a general partner;c.
For a sole proprietorship-the proprietor;or d. Fora n u icipality, State, federal, or other public agency-either a principal executive officer or a ranking
elected official.
Application - Page 2
• CERTIFICATION FORM VS 1:
COMPLIANCE WITH WATER DISCHARGE REGULATIONS
FACILITY NAME: TNT RED STAR EXPRESS "
LOCATION: _540 SUI,T.IVAN AVENUE
SOUTH WINDSOR CT 06074
APPLICANT: ROBERT J MACPEER FIELD MAINTENANCE MANAGER
"Applicant" is defined on page 2 of the Application Form
THE UNDERSIGNED CERTIFIES AS FOLLOWS:
1) THE ONLY DISCHARGE FROM THIS FACILITY (EXCEPT DOMESTIC SEWAGE) WILL BE VEHICLE SERVICE FLOOR DRAIN
WASTEWATER, UNLESS THIS DEPARTMENT HAS ISSUED A PERMIT FOR OTHER DISCHARGE(S)AT THIS FACILITY.
2) THE DISCHARGE OF VEHICLE SERVICE FLOOR DRAIN WASTEWATER SHALL NOT EXCEED 1,000 GALLONS PER DAY.
3) EXCEPT FOR HAND WASHING OF VEHICLES AS PART OF NORMAL SERVICING OPERATIONS,NO VEHICLE WASHING WILL
OCCUR UNLESS A SEPARATE VEHICLE WASHING PERMIT IS OBTAINED FROM THE COMMISSIONER.
4) THE VEHICLE SERVICE FLOOR DRAIN WASTEWATER WILL DISCHARGE TO AN OIL SEPARATOR WHICH CONFORMS TO THE
REQUIREMENTS OF THIS APPLICATION PACKAGE,AND WHICH DISCHARGES TO THE SANITARY SEWER.
5) TOTAL OIL AND GREASE, HYDROCARBON FRACTION IN THE OIL SEPARATOR DISCHARGE SHALL AT ALL TIMES BE LESS
THAN 100 mg/I AS DETERMINED PER 40 CFR 136.
6) THE OIL SEPARATOR TANK SHALL BE COMPLETELY CLEANED AT LEAST ONCE PER CALENDAR YEAR BY A CERTIFIED WASTE
HAULER LICENSED FOR THAT PURPOSE UNDER THE CONNECTICUT GENERAL STATUTES.
7) LUBRICATING OILS,GASOLINE,ANTI-FREEZE,DEGREASING AGENTS,PAINTS,SOLVENTS,RUSTPROOFING COMPOUNDS AND
OTHER WASTE MOTOR VEHICLE FLUIDS WILL BE STORED IN CONTAINERS,AND REMOVED BY A CERTIFIED WASTE HAULER
LICENSED FOR THAT PURPOSE UNDER THE CONNECTICUT GENERAL STATUTES.
8) THE WASTE OIL STORAGE TANK SHALL HAVE A CAPACITY OF AT LEAST 250 GALLONS.
9) IF THE WASTE OIL TANK IS UNDERGROUND IT MEETS ALL APPLICABLE REQUIREMENTS OF THE UNDERGROUND STORAGE
TANK SECTION OF THE DEP(566-4630).
70) ALL SPILLS OF THE FLUIDS LISTED IN PARAGRAPH(7)SHALL BE IMMEDIATELY CLEANED UP AND DISPOSED OF PROPERLY.
SUCH SPILLS MAY NOT BE DISPOSED OF TO THE FLOOR DRAINS, TOILETS, SINKS, SANITARY SEWER, STORM DRAINS,
SURFACE WATER BODIES OR TO THE GROUND.
11) ALL AREAS USED FOR STORAGE OF WASTE OIL,WASTE ANTI-FREEZE AND FOR ANY FRESH OR WASTE SOLVENTS SHALL BE
PROVIDED WITH SECONDARY CONTAINMENT CAPABLE OF HOLDING THE ENTIRE VOLUME OF THE LARGEST TANK
CONTAINED THEREIN PLUS TEN PERCENT.
ANY MISREPRESENTATION OR DEVIATION FROM THE ABOVE STATEMENTS MAY SUBJECT THE UNDERSIGNED TO ENFORCEMENT
ACTION,INCLUDING BUT NOT LIMITED TO PENALTIES,FINES AND ARREST,UNDER THE AUTHORITY OF SECTIONS 22ar427,22a-i30,
AND 22a-438 OF THE CONNECTICUT GENERAL STATUTES.
1 HEREBY CERTIFY UNDER PENALTY OF THE LAW THAT THE ABOVE CONDITIONS SHALL BE COMPLIED WITH.
Signature of Appl ca t(as defined on pg. 2 of the Application Form) Date
Application - Page 3
OIL SEPARATOR TANK SPECIFICATION CERTIFICATION FORM
FACILITY: TrrrP RFn WPAR FXPRFCC
ADDRESS: 540 SULLIVAN AVENUE
SOUTH WINDSOR eT 06074
1. Each oil/water separator tank shall be constructed of
a. precast concrete or precast polymer concrete;
b. other materials and designed, constructed, installed and maintained in conformance with the Regulations of Connecticut State Agencies,
Section 22a-449(d)-1(e);
c. other materials resistant to corrosion and degradation for the concentrations of chemicals involved,and approved by the Department.
2. Tank shall have a minimum capacity sufficient to pretreat the maximum daily flow proposed and no less than 1000 gallons.
3. The inlet extension to grade shall be provided with a vent line which extends eight(8) feet above finished grade and properly secured to the
building. The size of the vent shall be at least half the size of the outlet discharge line from the tank.
4. The inlet piping shall not include any sources of domestic sewage wastewater or stormwater.
S. The outlet pipe shall be at least the size of the inlet pipe or greater and at a minimum shall be 4.0 inches in diameter.
6. The outlet pipe shall be connected to the sanitary sewer.
7. If heavy piping, such as cast iron, is used, all piping must be structurally secured.
FOR CONCRETE TANKS ONLY
8. Interior of the tank shall be coated with an epoxy petroleum resistant sealant(ensure that the epoxy vendor states that the prcdua will be resisartt
to gasoline, oil, and solvents). Exterior of the tank shall be coated with a waterproof foundation sealant, including the exterior top and bottom.
Interior and exterior of the extensions to grade shall also be waterproofed.
FOR CONCRETE AND CONCRETE POLYMER TANKS ONLY
9. The tank shall have manholes with extensions to grade above the inlet and outlet piping.The extensions shall have steel frames and manhole
covers. The manholes, extensions, and accesses to the tank shall be at least 18 inches in diameter.
10. The outlet piping shall utilize a tee-pipe on the interior of the tank. The tee-pipe shallbe equipped with a stand pipe riser extending up the
extension to grade but no closer than eight(8) inches from the manhole cover. the tee-pipe shall extend six (6)to fifteen 05)inches freom the
bottom of the tank.
11. If there is a structural seam, it must be located above the static liquid level of the tank, filled in with non-shrinking cement or water plug and
coated with a waterproof sealant.
12. Voids between inlet and outlet piping of the tank and the tank itself shall be grouted with non-shrinking cement and coated with a waterproof
sealant.
13. The concrete covers provided by the oil separator manufacturers must be permanently removed.
1 HEREBY CERTIFY THAT THE OIL SEPARATOR TANK WILL BE INSTALLED IN ACCORDANCE WITH THE ABOVE
CONDITIONS.
Signatu a of App rc nt (as defined on the Application Form) Date
RnRFRT J MACPFFR FIELD MAINTENANCE MANAGER
Print Name of Applicant
App=ication - Page 4