The URL can be used to link to this page

Home My WebLink AboutDaycare Inspection 150 Burnham Street ENVIRONMENTAL INSPECTION REPORT INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT S , V44-4 r Department of Public Health Child Care Licensing Program Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 2 Datg o In pection INSTRUCTIONS _Zt Check=Compliance, Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Date of Expiration Licensed Capacity-1(0 Under 3 Endorsement 90 #Children Present_ #Staff PresentJLI Pro ra me License# Telephone# Address Operator Licensed for: P<`nder 3 Yrs re-School(3-5 Years) School Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a License remises clean/ ood repair o 7 - o b p g P Refrigeration no more than 45 W�Ilo�r.¢f��y Equipment clean,in good repair,safe/non-toxic Food prep area clean/good repair- j�)r-4# o 3 Free from observable hazards Food safely stored C- 14 Food prep hand washings ❑ 15 Adequate dishwashing pQ 4 Wate apply in compliance with all PHC requirements Kitchen separated --ro��#3_tfcj'- 1? M.ar�as appropriate: 4a Customer of a Water Comp,aq�nyy M Snacks served ❑ Cold breakfast pO2 Water Comp y Name: 90c /- ❑ Meals served ❑ Meals transported ey-3'�P Lead Wat Test Date: �S:5 Other Within Limits ❑ Exceeds Limits -or- L�J Bui mg: Pre 1978 Construction(Lead In^sn_ection Required) ❑ 4b ClasOn-sification Well No Lead-Based Paint Identified Classification of Welt-Check One ❑ Lead Hazards Identified and Eliminat1d ❑ Public Well-Well supplies 25 or more adults and Children,daily at least 60 days per year. (Plan of Correction on file with Local Health Deoartment) (If not,then private well) ❑ Intact Lead-Based Paint Identified ❑ Private Well-Serves less than 25 adults&children (Management Plan on file with Local Health Denartment) Review of Water Ouality Test Results Building: Post 1978 Construction ?gyp,' col + 1.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits ,°REMARKS„ il.Bacteriological Analysis Test Date: ❑ Within Limits ❑ Exceeds Limits ❑ iii.Chemical Analysis Test Date: — Awrcval recommended. No code violations identified. ❑ Within Limits ❑ Exceeds Limits LVApproval recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. Well meets construction and separation distance c� requirements of CT Public Health Code Sections y^^z'ri - -Le� 19-13-B51a-m.❑ Yes ❑ No 1� 1t ' 6tit4,`Qt,W14 ❑ 4c Other(Please specify) 1 t' Ll l�o .},, �riru�r# WwCt�n�o�t w'�cn�r 1 V3 %A 1, { 16 t a� d10CI�C0�6Aj41 S� Required toilets/sinks/supplies ( � u ° (CS1 tvvu-e.�an Gei�i ir+caP„�r Adequate ventilation in toilet room c� � -�� Ib7 iZ 1 o �J 7 Sewage disposal adequate cS - '1bk g1a�13 p�� Outdoor Space 19a-79-7a a �� ki I 1 Saves ❑ 8 Swimming pool complies with PHC 19-13-B33b 0 tax ❑ 9 Playground free from observable hazards j 9VO O�C^A �6*4L_fc.e16 ' ❑ 10 Drinking water available,adequate,safe _k14 tA Signe Inspector) Date Corrections Due Sig a erson h NA rg S:/Division/Licensu a roup&Center/Environmental Inspection Report 10/08/08 website) ENVIRONMENTAL INSPECTION REPORT INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT War Department of Public Health-Child Care Licensing Program Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 )a, Dat of spe ion INSTRUCTIONS 2 Check=Compliance, Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Date of&piration Licensed Capacity 1 6- Under 3 Endorsements_ #Children Present #Staff Present_ C)r'A A, Cp�" ! 1 Lr�)Y — cam _t;,q2 _7sa9 Program N License# Telephone# Address Operator Licensed for: UrUnder 3 Yrs Pre-School(3-5 Years) School Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a 1 License premises clean/good repair � Refrigeration no more than 45' c Equipment clean,in good repair,safe/non-toxic Food prep area elean/good repair�Y"" 3X 3 Free from observable hazards Food safely stored T'5*6 9-14 Food prep hand washings 2_ �o Al Adequate dishwashing -^� � _ 33a 4 Water Supply in compliance with all PHC requirements ElKitchen separated _ E2rl7 Ma as appropriate: 4a Customer of a Water Company Snacks served(� Cold breakfast Water Company Name: �� _/ Meals served ❑ Meals transported Lead Wat Test Date: 1�;�—In qb Other � o L'11 ►.,� / Vithin Limits ❑ Exceeds Limits -or- /Bui tng: Pre 1978 Construction(Lead Inspection Reauiredl ❑ 4b On-Site Well No Lead-Based Paint Identified r_s.A Classification of Well—Check One: ❑ Lead Hazards Identified and Eliminatbd ❑ Public Well-Well supplies 25 or more adults and (Plan of Correction on file with Local Health De artmentl Children,daily at least 60 days per year. (If not,then private well) ❑ Intact Lead-Based Paint Identified p ❑ Private Well—Serves less than 25 adults&children _,/ (Management Plan on file with Local Health Department) _Review of Water Ouality Test Results L/Building: Post 1978 Construction �-Or' V�%k I.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits "REMARKS„ ii.Bacteriological Analysis Test Date: ❑ Within Limits ❑ Exceeds Limits iii.Chemical Analysis Test Date: PProval recommended. No code violations identified. ❑ Within Limits ❑ Exceeds Limits ffjApproval recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. Well meets construction and separation distance P y _ � r- S",a --Cow requirements of CT Public Health Code Sections 1M1Zo 0-c � 19-13-B51a-m.El Yes ❑ No ❑ 4c Other(Please specify) �f l�a�dk.a-any"'W -CCB1,1u'I ' - , 98 2- t. I CT o Required toilets/sinks/supplies §, Adequate ventilation in toilet room o 7 Sewage disposal adequate <_ _s ._rC1M.q,r 3— �� 4� *� �7�'J' ��` Outdoor Space 19a-79-7a ❑ 8 Swimming pool complies with PHC 19-13-B33b Playground free from observable hazards '�� P10 Drinking water available,adequate,safe V Signed(I s ector) Date Corrections Due Sig erson in har e w4 .ke ri A S:/Divisio icensure/Gr &Center/Environmental Inspection Repldrt 10/08/08 (website) ENVIRONMENTAL INSPECTION REPORT ❑ INSPECTION ❑ FOLLOW-UP INSPECTION Rf COMPLAINT 5&&n, �hL:• ec►f Department of Public Health-Child Care Licensing Program Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 101al2 Mate f In ection INSTRUCTIONS p Check=Compliance, Circle=Non-Compliance; 3=Not Observed; 4=NotApplicable f Ex1firation Licensed Capacity Under 3 Endorsement qO #Children Present #Staff Present C Al Pr gram N License# r Telephone# Address Operator Licensed for: Under 3 Yrs Pre-School(3-5 Years) School Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a LI 1 License premises clean/good repair ❑ 11 Refrigeration no more than 450 ❑ V Equipment clean,in good repair,safe/non-toxic ❑ 12 Food prep area clean/good repair IQ 3 Free from observable hazards ❑ 13 Food safely stored ❑ 14 Food prep hand washing ❑ 15 Adequate dishwashing 4;4a ,er Supply in compliance with all PHC requirements ❑ 16 Kitchen separated ❑ 17 Mark as appropriate: Customer of a Water Company ❑ Snacks served ❑ Cold breakfast Water Company Name: ❑ Meals served ❑ Meals transported Lead Water Test Date: ❑ Other ❑ Within Limits ❑ Exceeds Limits -or- �Bui ing: Pre 1978 Construction(Lead Inspection Required) El 4b On-Site Well VNo Lead-Based Paint Identified ®(v r-PA INDS Classification of Well-Check One: ❑ Lead Hazards Identified and Eliminate ❑ Public Well-Well supplies 25 or more adults and (Plan of Correction on file with Local Health Department) Children,daily at least 60 days per year.(If not,then private well) ❑ Intact Lead-Based Paint Identified ❑ Private Well-Serves less than 25 adults&children (Management Plan on file with Local Health Denartment) Review of Water Quality Test Results Building: Post 1978 Construction PAJ-A1D f1 Ictu I.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits 4, 5„ ii.Bacteriological Analysis Test Date: ❑ Within Limits El Exceeds Limits iii.Chemical Analysis Test Date: N1 APP roval recommended. No code violations identified. ❑ Within Limits ❑ Exceeds Limits ❑ Approval recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. { Well meets construction and separation distance _-__ _g-,� p�.S p�-�D\\Ow.-,it }O requirements of CT Public Health Code Sections 19-13-B51a-m.❑ Yes ❑ No ❑ 4e Other(Please specify) 0. ^} .Stec v 0+- ❑ 5 Required toilets/sinks/supplies Adequate ventilation in toilet room 7 Sewage disposal adequate Se.A,c&-,\Mtnk-S �T Outdoor Space 19a-79-7a ❑ 8 Swimming pool complies with PHC 19-13-1333b - +° ❑ 9 Playground free from observable hazards OApT-S Or "-&L� O ❑ 10 Drinking water available,adequate,safe k1C+� Op�rv-Lr+� 0 "C-.c � �Sswt, i r\ air. Signe speetor) Date Corrections Due Sig (Persnu i C arge) N i� S:/Divlsion/Licensu oup&Center/Envir nmental Inspection Report l /08/08 (website) �' Q.wv.,11 1-1- +h S- —(Ao ie,aLTDAP* 10111117- #14MYLO27 Commerce Street PHONE DATE 9,F ORDER plumbing Glastonbury,CT 06033 JOB NAME/NUMBER & heating Clean,Courteous,Professional Service (860) 633-5117 JOB LOCATION CT Lic.#P10201269•CT Lic.#S I-301425 Fax: (860)633-3316 JOB PHONE TO .77 i ti p t / i 1 T 2 FUEL SURCHARGE I hereby acknowledge the satisfactory completion of the above described work. TOTAL COST • FINANCE CHARGE on past due account is computed at a Invoices not paid within 30 days will be considered past In case of non-payment,cost of collection including "Periodic Rate"of 11/2%per month which is an ANNUAL due, reasonable attorney's fees will be charged. PERCENTAGE RATE OF 18%. (10/06) Print http://us.mg206.mail.yahoo.com/dc/launch?.partner=sbc&.gK=1&.ran... From: Paul Dinoia(pdinoia@puroct.com) To: RisingStarsCT@att.net; Date: Mon, October 8, 2012 9:12:16 PM Cc: ferbanz@puroct.com; Subject: 150 Burnham St-South Windsor-RisingStars Good Afternoon, Attached is a paid invoice for work done on 1.0/07/1.2 at 150 Burnham Street. At your service... ------------------------------------- PuroClean Mitigation Services 116 Riverside Avenue Bristol,CT 06010 purat, 10WIP" (gel 1 of 1 10/9/2012 9:46 AM @PuroClearftea Invoice Suite 293 123 Farmington Avenue Bristol, CT 06010 Date Invoice# 800-644-1252 10/8/2012 12633 Rising Stars Child Care,LLC 150 Burnham Street South Windsor,CT 06074 Adjuster Claim Number Self Paid Visa/MC Add 3%Processing Fee Due Date Due upon Receipt 10/8/2012 Description Qty Amount Cleaning Services Sewage 1 550.00T Sewage backup from septic tank -After hours labor and service charge -Clean and Treat—221 sf concrete basement floor with Microban BotaniClean Thank You Subtotal $550.00 Sales Tax $34.93 Payments $-584.93 Balance $0.00 It has been our pleasure to serve you. EnvironmentsHQ.com I New BotaniClean from Microban Page 1 of 1 Control your environment. o BotaniClean carries a Category IV rating from the EPA.This means no "warning"or "danger"labels are required, and no Personal Protection Equipment(PPE) is required*. BotaniClean is a broad-spectrum hospital-grade disinfectant, effective at controlling microorganisms such as tuberculosis, MRSA, H1N1, HIV, as well as gram positive and gram negative microorganisms(commonly found in sewage). It's also a germicide, virucide and fungicide. • Ideal for use in hospitals or healthcare environments • BotaniClean's mildly acidic formulation makes it ideal for daily cleaning in facilities, commercial and industrial environments,airports, etc. • Cleans,disinfects and deodorizes in one time-saving step *Please see label for details Specs Documentation Specifications 224002000 Formulation Ready-to-use Sold in cases only 4 one gallon(3.81.)bottles Case reorder no. 224002000 Appearance Opaque dear liquid pH 3.5±0.5 Specific gravity 1.03-1.00(H20=1) EPA registration no. 34810-25-70385 Legend Brands 866-932-3233 North American Sales info@EnvironmentsHQ,com 15180 Josh Wilson Road 360-757-7776 Corporate Offices sales@EnvironmentsHQ.com Burlington WA,98233 360-757-7950 Facsimile hlftp://www.enviromnentshq.com/Content-003.aspx?wpid=l 933&AspxAutoDetectCookie... 10/9/2012 STPAR E cO Ni.ECTICUT REGULATO DEgR7 MNT OF PUBLIC HEALTH RY SERVICES BRANCH cHILDSUSAN �'. ROSEN CO CHI ARE LIC ENS)NG SPECIALIST LAITY BASED REGULATION SECTION TEL:(800)282-6063 + 410 CAPITOL AVE., MS#12DAC P.O. BO TEL (800)439-0437 X 3), TEL:(860 hIARTFORD, CT 06134- )509-8045 0308 FAX NO. (860)509-754 1 Email:susan.rosen@ ------------- CF- �~-533 - 3 � 3 - 0.;rn9e- ENVIRONMENTAL INSPECTION REPORT [INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLA 9. WIN.>boa Department of Public Health-Child Care Licensing Program Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 ZQ i G —.2 D It Date of Inspection INSTRUCTIONS a2-1 a o20 Zc,C Check=Compliance; Circle=Non-Compliance, 3=Not Observed; 4=Not Applicable Date of Expiration Licensed Capacity !q�rD Under 3 Endorsement �CO #Children Present sz #Staff Present /a2 �Ixoy G Sys�{�j c.r) �r-r - L L C l�'�S"/5� RICO --<8'-' 7S-2,? Program Name License# Telephone# Z d 4 46!4'-t .S7- . .Sd rs mt /6)i fb s � G G-�6Y � Cd &C N Address Operator Licensed for: 9_/nder 3 Yrs L'Pre-School(3-5 Years) School Age ❑Night Care Physical Plant(Indoor Space 19a-79-7a Health and Safety 19a-79-6a 3011, License premises dean/good repair —S �iL�94'yf 1�r� Refrigeration no more than 450 [� Equipment clean,in good repair,safe/non-toxic ❑ 12 Free from observable hazards Q;-1T_ Food safely stored [9-"- Food prep hand washing ❑ 15 . Water Supply in compliance with all PHC requirements ❑ 16 / ❑ 17. M,a�'as appropriate: H 4a Customer of a Water Company LT Snacks served ❑ rfaet, Water Company Name: ❑ 44eatsqe� eats transported Lead Wat est Date: ❑ Other Within Limits ❑ Exceeds Limits -or- ❑ Building: Pre 1978 Construction(Lead Inspection Required) ❑ 4b On-Site Well ❑ No Lead-Based Paint Identified Classification of Well-Check One: ❑ Lead Hazards Identified and Eliminated ❑ Public Well-Well supplies 25 or more adults and (Plan of Correction on file with Local Health Department) Children,daily at least 60 days per year. (If not,then private well) ❑ Intact Lead-Based Paint Identified ❑ Private Well-Serves less than 25 adults&children (Manaeement Plan on file with Local Health Department) Review of Water Ouality Test Results Building: Post 1978 Construction i.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits "REMARKS" ii.Bacteriological Analysis Test Date: ❑ Within Limits ❑ Exceeds Limits ( { ,a royal recommended. No code violations identified. iii.Chemical Analysis Test Date: ` ❑ Within Limits ❑ Exceeds Limits 2Approval recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. Well meets construction and separation distance requirements of CT Public Health Code Sections 19-13-B51a-m.❑ Yes ❑ No _ ❑ 4c Other(Please specify) r�r C`47.19� Required toilets/sinks/supplies Adequate ventilation in toilet room C 7 Sewage disposal adequate c c__ /yd T' �l t lr T f�jfntx� Outdoor Space 19a-79-7a ❑ s Swimming pool eem, - Playground free from observable hazards Y0 Drinking water available,adequate,safe Signed(Ins pe r Date Corrections Due Signed(P in Char ) ,,, ), S:/Division/Ltcens Groi Center nviro pection Report i 08 website) ,ALYTICAL LABORATORY 39 Spruce Street*East Longmeadow,MA 01028*FAX 413/525-6405*TEL.4131525-2332 QUALITY CONTROL Metals Analyses(Total)-Quality Control Reporting Spike Source %REC RPD FAnalyte Result Limit Units Level Result %REC Limits RPD Limit Notes Batch B024077-EPA 200.8 Blank(B024077-BLKI) Prepared&Analyzed:12/22/10 Lead - NO 0.50 µg/L Page 6 of 10 Post for 30 Department of Public Health-Child Care Licensing Program Page 1 of 2 Operating 410 Capitol Ave,MS#12 DAC Days PO Box 340308 Hartford,CT 06134-0308 800-282-6063/(fax)860-509-7541 CHILD CARE CENTER/GROUP INSPECTION FORM INITIAL INSPECTION ErINSPECTION ❑ FOLLOW UP . ❑ OTHER Pro ram Name: CC License Number: Date of Time of Arrival:J IS c 1 V-hi PS Mo Inspection"� �® /L ddress: Expiration Date: Licensed / 50 60/n om `F' j - Capacity: C�J ��' phon • p Under Three °n Sd1- 020V- Endorsement:In- / v erator: Licensed For: Instructions: ,s,n Sta(s Carl C�r� GCC. �,� Numbe of Chi ren Number of U3 Number of Staff IJ' Under Three(6wks-36m) ✓ =Compliance Present: Present: Present: PreSC00 - O =Non-Compliance U-11 h ! 35( y y) 3 =Not Observed Hours of Operation: Summer Care L"! School Age(5y&up) 4 =Not Applicable @this time ❑ Night Care(6wks&up) Lic sure Procedures 19a-79-2a Health and Safety 19a-79-6a 1.Local Health Inspection Date: Gf 40.Nutritious Snacks/Meals(Required Food Groups) Administration 19a-79-3a / 41.Proper Refrigeration 45' �2.New Staff/Employee Orientation 42.Kitchen Separated /3.Annual Staff Training �43.Hand Washing Before Eating/Food Handling ;/�6. . inocumentation of Beh M.Tech Discussed w/Parents t 44.First Aid Kit(s):Indoor/Outdoor/Field Trip otification of Change Ph sical Plant 19a-79-7a olicies:Discipline/Supervision/Child Protection/General dF IF;-License Premise Clean/Good Repair/Safe � /Operating Policies/Personnel Policies/Closing Time Policy 46.Peeling Paint Observed: _ mple Taken: �J UV 7.Daily Attendance Records:Children/Staff j7 Lead Management Plan Reviewedj�N Ite osted:Conspicuous/Accessible Q- 48.Sanitary Drinking Founta'ns/Dis osable Cups /8.License Q/ 49.Lead Water Test Date: o G;1'J 9.Current Fire Marshal Certificate Date: `��/ V-So. Within Acceptable LimitsT GY 10.DPH Complaint Procedure On Bottled Water Y/&) � 5- 11.Food Service Certificate Date: Walkways Maintained 40B x2.Menus Designated Staff Toilet/Sink U1 .Emergency Plans P54 2.All Openings for Ventilation Screened 4.No Smoking Signs 3.Windows Protected to Prevent Falls 15.RadonTest Date: l ) esults:�, .Glass Protected to 36" Stafring 19a-79-4a 941'55.Overhead Doors:Locking Devices/Spring Protectors V16, Staff Health Records is-✓56.Exits/Hallways and Stairs Unobstructed K1/17. Professional Development Individual Storage of Clothing/Bedding G?'/�8.Disciplinary Actions l�•Smoking Prohibited ,19.Designated Head Teacher/60% WY 9• atches/I.ighters Inaccessible GY 20.Two Staff Present U.".60.Approved Safety Outlets/Covers �//d22 1.Ratio:1 Staff to 10 Children p�Toileting Needs Met .Group Size:Maximum 20 Children 62.Required Toilets/Sinks/Supplies Cr7' 23.Designated Director �D-,A3.Potty Chairs:Nonporous/Emptied/Disinfected 24.CPR Certified Staff Q� 4.Hand Washing After Toileting:Staff/Children ZS.First Aid Trained Staff Q� .Ventilation in Toilet Room Co ultants 19a-79-4a l� Air Temp 65°,Thermometer Affixed �6.Agreements/Contracts(Signed Annually) 67.Water Temperature 600-1150 0/ 27.Logs/Visits Documented / 68.Portable Space Heaters Y N Early Ch.Education✓ Health�Denta Walls/Ceilings/Floors/Rugs:Clean/Good Repair Social Service�Dietitian� /70.Rugs Secured Swim28.N n-Swimm L9' 1.Hot Water/Steam Pipes Protected 28.Non-Swimmers Identifiedi32,Working Phone on Each Level 3 30.CPR Certi Ratios 191 73.Emergency Numbers Posted 31.CPR Certified Staff(20 years of age) ;�1`')74.Adequate Lighting:50130 Candle Feet 3d Lifeguard Certified/Supervision U 5.Light Fixtures Shielded/Shatter Proof Record Keening 19aInfora 7 .Potentially Hazardous Substances Locked �2.Enrollment Information 1 .Garbage/Rubbish Disposed Daily Q/.33.Emergency Medical Permission Q O 78.Stairs Protected/Good Repair/Handrails LY 4.Authorized Released Permission •M'-, 79.Pets:Maintained/Care Phan U/ 35.Field Trip Permission t�' ,80.Operable CO Detector on Each Level .Transportation Permission p/$ W 37 1.Program Space/Adequate Sq.Ft.Per Child O� 37.Child Health Records/Immunizations/TB W,/§,Ze-Equipment Clean/Good Repair/Safe/Non-toxic ' ❑/118.Individual Care Plan(Signed by Parent/Staff) p 13.Cots Stored/Maintained/Adequate Number E 39.Injury/Illness/Accident Reports p0 84.Develo mentally Appr.Equipment/Materials Signature of Inspector Written Corrective Action Plan Sig re of Person in Charge -✓ D e to DPH by: rV6 1 1 d-L Post for 30 Department of Public Health-Child Care Licensing Program Page 1 of 2 crating 410 Capitol Ave,MS 912 DAC 'ffays PO Box 340308 Hartford,CT 06134-0308 800-282-6063/(fax)860-509-7541 CHILD CARE CENTER/GROUP INSPECTION FORM ❑ INITIAL INSPECTION INSPECTION ❑ FOLLOW UP ❑ OTHER Program Name: License Number: Date of (.Q 110 Time of (` f Inspection: Arrival: Address Expiration Date: Licensed c;p 0 I(_ Capacity:N�, Town: Telephone: Under Three ( Endorsement: Rperator: Licensed For: Instructions: Numbe Children Number of U3 Number of Staff Under Three(6wks-36m) ✓ =Compliance Present: Present: -Present: Preschool(3y-5y) O =Non-Compliance Hours of Operation: Summer Care School Age(Sy&up) 3 =Not Observed 4 =Not Applicable �- 0 Yes/No ❑ Night Care(6wks&up) Administration 19a-79-2a Health and Safety 19a-79-6a 1.Local Health Inspection Date:i;tl 4-101 40.Nutritious Suacks/Meals(Required Food Groups) ` Administration 19a-79 3a 41.Proper Refrigeration 450 2.New Staff/Employee Orientation 1Ll lt 42.Kitchen Separated 3.Annual Staff Training 43.Hand Washing Before Eating/Food Handling Cl 4:Documentation of Bch M.Tech Discussed wlParents Y/N ❑ 44.First Aid Kit(s):Indoor/Outdoor/Field Trip �7 5.Notification of Change ekhvsical Plant 19a-79-7a +E3 6.Policies:Discipline/Supervision/Child Protection/General 45.License Premise Clean/ d Repair/Safe Operating Policies/Personnel Policies/Closing Time Policy 46.Peeling Paint Observedt W,Sample Taken: 7.Daily Attendance Records:Children/Staff 47.Lead Management Plan Reviewed:Y/N Items Posted:Conspicuous/Accessible 48.Sanitary Drinking Fountains ispos ble Cups 8.License '*-IQ 49.Lead Water-Test Date: 9.Current Fire Marshal Certificate Date: `1 Within Acceptable L' its IN 10.DPH Complaint Procedure ` l On Bottled Water 1 ❑ 11.Food Service Certificate Date \V1 50.Walkways Maintained ` •Lit 12.Menus `�pj 51.Designated Staff Toilet/Sink 13.Emergency Plans 52.All Openings for Ventilation Screened 14.No Smoking Signs �il 53.Windows Protected to Prevent Falls 15.Radon Test Date: ResultsQBMA 54.Glass Protected to 36" S affin 19a-7949 1 4@- 555.Overhead Doors:Locking Devices/Spring Protectors 16. Staff Health Records V 56.Exits/Hallways and.Stairs Unobstructed 17. Professional Development �'V 57.Individual Storage of Clothing/Bedding +f C] I&Disciplinary Actions 1`6A 58.Smoking Prohibited V19.Designated Head Teacher/60% �1g 59.Matches/Lighters Inaccessible 20.Two Staff Present ` 60.Approved Safety Outlets/Covers 21.Ratio:1 Staff to 10 Children `V 61.Toileting Needs Met 1 22.Group Size:Maximum 20 Children ``�_ 62.Required Toilets/Sinks/Suppiies 23.Designated Director `Ea 63.Potty Chairs:Nonporous/Emptied/Disinfected 24.CPR Certified Staff' 64.Hand Washing After Toileting:StaWChiidren 25.First Aid Trained Staff 65.Ventilation in Toilet Room Consultants 19a-794a 66.Air Temp 65%Thermometer Affixed ❑ 26.Agreements/Contracts(Signed Annually) ❑ 67.Water Temperature 60°-11 ° 7.Logs/Visits Documented '�"❑ 2 68.Portable Space Heaters Early Ch.Educations Health Dental ❑ 69.Walls/Ceilings/Floors/Rugs:Clean/Good Repair Social Service Dietitian 70.Rugs Secured Swimming 19a-794a 71.Hot Water/Steam Pipes Protected 0 28.Non-Swimmers Identified 72.Working Phone on Each Level ❑ 29.Staff/Child Ratios 73.Emergency Numbers Posted ❑ 30.CPR Certified Staff(20 years of age) 74.Adequate Lighting:50/30 Candle Feet ie-c-31. 31.Lifeguard Certified/Supervision ❑ 75.Light Fixtures Shielded/Shatter Proof rd Keeaine 19a-79-5a 76.Potentially Hazardous Substances Locked Enrollment Information L 77.Garbage/Rubbish Disposed Daily ` 33.Emergency Medical Permission 78.Stairs Protected/Good Repair/Handrails `§tl 34.Authorized Released Permission 3 79.Pets:Maintained/Care Plan ❑ 35.Field Trip Permission 80.Operable CO Detector on Each Level 36.Transportation Permission �W 81.Program Space/Adequate Sq.Ft.Per Child ❑ 37.Child Health Records/Immunizations/TB `ftl 82.Equipment'Clean/Good Repair/Safe/Non-toxic 3&Individual Care Plan(Signed by Parent/Staf) 83.Cots Stored/Maintained/Adequate Number �( 39.Injury/Illness/Accident Reports 84.Developmentally Appr. Equipment/Materials Signature of Inspector Written Corrective Action Plan Sig ture of Person in Charge Due to DPH by: ENVIRONMENTAL INSPECTION REPORT _F"OALkl' CT CO* '71 a f I ❑ INSPECTION 'FOLLOW-UP INSPECTION ❑ COMPLAINT Department of Public Health-Child Care Licensin Pro am Tow 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 Dat f Inspection INSTRUCTIONS I Check=Compliance; irclee�N�on-Comp lance;a3--Not Observed; 4=NotAp licable , Date of Ex iration o,.A for c��}►" 90 Jr, tdre ti Licensed Capacity Un&1 3 Endorsement_E• O. #Children Present #Staff Present Pro ra a License# Telephone# Address Operator Licensed for: Under 3 Yrs re-School 3-5 Years School Age ( ) ' g ❑Night Care Physical Plant/indoor Space 19a-79-7a Health and Safety 19a-79-6a License premises clean/good repair 11 Refrigeration no more than 450 knr•Vcf_ (� Equipment clean,in good repair,safe/non-toxic 12 Food prep area clean/good repair U (3 Free from observable hazards 13 Food safely stored Q 14 Food prep hand washing Ike Iu'k,.5ils 15 Adequate dishwashing I h Co"e rej,6sb.�v'jb 4Z4a r Supply in compliance with all PHC requirements _ 1 Kitchen separated 17 M�as appropriate: Customer of a Water Compan LEI Snacks served�k ❑ Cold breakfast Water Company Name: ❑ Meals served ElMeals transported Lead W r Test Date: Other "'I— JZ Within Limits xc eds LimitsIs -or- i Ana.x��"'C--Yan• Building: Pre 1978 Con r ction(Lead Inspection Reauired) ❑ 4b On-Site Well ❑ No Lead-Based Paint Identified Classification of Well—Check One: ❑ Lead Hazards Identified and Eliminated �� ❑ Public Well-Well supplies 25 or more adults and (Plan of Correction on file with Local Health Department) Children,daily at least 60 days per year. ❑ Intact Lead-Based Paint Identified (If not,then private well) ❑ Private Well—Serves less than 25 adults&children (Management Plan on file with Local Health De artment Review of Water Quality Test Results Building: Post 1978 Construction •q�� I.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits « 5„ ii.Bacteriological Analysis Test Date: ❑ Within Limits El Exceeds Limits '❑ pproval recommended. No code violations identified. iii.Chemical Analysis Test Date: ❑ Within Limits ❑ Exceeds Limits Approval recommended with conditions(see below)r'wa;'V Approval not recommended due to existing serious code 1 Inspection of Well violations. Well meets construction and separation distance requirements of CT Public Health Code Sections 19-13-B51a-m.❑ Yes ❑ No t:tid` ❑ 4e Other(Please specify) V7Required toilets/sinks/supplies ilia 6 Adequate ventilation in toilet room 1�I� �1u.) 1C1�1 1ae_jr.8�ou�t e Sewage disposal adequate Outdoor Space 19a-79-7a �\\ 3 '� � 3� 8 Swimming pool complies with PHC 19-13-B33b v 9 Playground free from observable hazards `y��a 10 Drinking water available,adequate,safe Signed(Inspee Date Corrections Due I Si d(PgrSawz_in arge) J A A-2 LLPL I S:/Division/Licensure/Group&Cen er nvironmental Inspection Report 10/08/08 (website) -' VA4�o '�r eJc 1SJT4 - ¢ho��t.ct �Jai�iI �o erD�ff � ENVIRONMENTAL INSPECTION REPORT 7/�H �i ❑ INSPECTION ,, d FOLL tOW-UP INSPEC ION ❑ COMPLAINT Department of Public Health-Cy hvild Ca>'�Licensin�Rro am- S. �` �� g-\� Town 410 Capitol Ave.,MS#12 DAC,P.O.Box 340308,Hartford,Connecticut 06134-0308 j4yem-�-Q Date of spection INSTRUCTIONS Check=Copt liane Circle=Non-Co pl'ance, 3=Not Observed; 4=Not ApplicableCAWM Da of xpiration p .- v — ono.) chi Licensed Capacity (o Under 3 Endorsement 90 #Children Present #Staff Present Pro ram N m License# Telephone# 1'�G �'x..sy.�a.��---Y��Sll f^ � ,hu l�•�e�1r, Address Operator Licensed for: Under 3 Yrs Pre-School(3-5 Years) School Age ❑Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a ❑ 1 License premises clean/good repair ❑ 11 Refrigeration no more than 45° ❑ 2 Equipment clean,in good repair,safe/non-toxic ❑ 12 Food prep area clean/good repair ❑ 3 Free from observable hazards ❑ 13 Food safely stored ❑ 14 Food prep hand washing ❑ 15 Adequate dishwashing ❑ 4 Water Supply in compliance with all PHC requirements ❑ 16 Kitchen separated ❑ 17 Mark as appropriate: ❑ 4a Customer of a Water Company ❑ Snacks served ❑ Cold breakfast Water Company Name: ❑ Meals served ❑ Meals transported Lead Water Test Date: ❑ Other ❑ Within Limits ❑ Exceeds Limits ® B,,,_u,}i�ing: Pre 1 Construction(Lead Inspection Required) El4b On-Site Well Lid No Lead-Based Paint Identified Classification of Well-Check One: ❑ Lead Hazards Identified and Eliminated ❑ Public Well-Well supplies 25 or more adults and (Plan of Correction on file with Local Health Department) Children,daily at least 60 days per year.(If not,then private well) ❑ Intact Lead-Based Paint Identified ❑ Private Well-Serves less than 25 adults&children (Management Plan on file with Local Health Department) _Review of Water Ouality Test Results W Building: Post 1978 Constructionp� 1.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits « 5„ ii.Bacteriological Analysis Test Date: ❑ Within Limits El Exceeds Limits iii.Chemical Analysis Test Date: M/ApP roval recommended. No code violations identified. ❑ Within Limits ❑ Exceeds Limits ❑ Approval recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. Well meets construction and separation distance requirements of CT Public Health Code Sections �`` __*3 19-13-B51a-m.El Yes Yes No v L�c'� ❑ 4c Other(Please specify) \ - ❑ 5 Required toilets/sinks/supplies ❑ 6 Adequate ventilation in toilet room v ❑ 7 Sewage disposal adequateS Outdoor Space 19a-79-7a � ❑ 8 Swimming pool complies with PHC 19-13-B33b A :�— El Playground free from observable hazards I W �.4��-'C, ,_ ( n�C- as 1 ❑ 10 Drinking water available,adequate,safe L►t1 ; � _Sj 'k4__SN1r-JA t—+h X wJ VJ-Lrf- kmjwr Sign nspector) Date Corrections Due Sign d(Person in Charge) S:/Division/Licensur, Group& a nvironmental Inspection Report 10/08/08 (website) 7jl i/tr L40,4 rYDnr- -GC tee (%CSkA S on ns an Connecticut Lead Paint Solutions, LLC 1245 Hebron Avenue Lead Paint Inspections&Testing Glastonbury,CT 06033 Consulting&Cost Analysis 860-633-3330 Abatement/Management Plans CT License#2124 Abatement&Clean-up andrew@ctleadpaint.com Directed Lead Paint Inspection This report is prepared for; Rising Stars Childcare 150 Burnham St South Windsor,CT 06074 The property inspected; 150 Burnham St(Room#3,2°d Fl only) South Windsor,CT 06074 The testing instrument used is a Niton XLp 300A Lead Paint,Spectrum Analyzer,serial#16387.A reading of 1.0 milligrams lead per square centimeter of surface(1.0mg/cm)or greater is defined as a toxic level of lead,by the State of Connecticut,Dept.of Public Health,Regulations for Lead Poisoning Prevention and Control, 19a-111-1 a. This inspection is a directed inspection. The owner only requested that Room#3 on the 2nd floor,also known as Dramatic Play Area,be tested.The other rooms or areas on the 2"a'floor that will be used for child care are in the part of the building that was built after 1978 or later. The 1st floor of this building had been previously inspected. All interior surfaces tested were negative for lead-based paint. Lead in Dust Assessment Two dust wipe samples were collected for analysis of lead concentrations by an accredited laboratory. Both of the dust wipe samples collected were well under the limits set for risk assessment testing.The limits used are 40µg/f z(micrograms lead per square foot of surface area)for floors and 250µg/ip for window sills.The test results should not exceed these limits If you have any questions on this report,please do not hesitate to call. Andrew Miller Lead Inspector,#001127 July 20,2011 How to read the data sheets Starting frovn:the left side column. Index The instnunent assigns a number to:every reading. Fl. Floor Room Indicated which room or am was tested.The room or area is also detailed on floor plan. Side The side;of the room that faces the street is the A Side,the B side is clockwise to the A wall,the C wall is opposite the A wall and so on.For the exterior the A side is the front facing the street,the B side is clockwise,the C side is the rear ect.See attached floor plan for more details.' Component Indicates which building component was tested,window,door,wall ect. Many components have sub-components such as a window ming or window xash.If these is more than 1 similar building component on a wall in a room or area,than the component>may be further'described as being the Lfl for left,Ctr for center or Rht for right.This would be as you;face the wall. Substrate Indicates what building material the component was constructed of. Color Indicates the color of the test surface.Ile color selected is influenced'by many factors including lighting,contrasting colors,smoke films among otbes, Condition Indicates the condition of the paint film or the substrate.`The ratings are as follows;Intact,a paint film with no cracked or peeling paint;Fair,the paint film is cracked or chipped but paint chips can not be picked ofl,Poor,the paint film is cracked.or chipped and paint chips can be picked off;Peeling;the point film is very loose and can fall off with little or no external effort;Defective-Sub, Defective substrate. Substrate conditions are only'listed if it effects the condition of the paint film.The worse visible condition is noted. Result Indicates the results of that test.Either Positive,equal to or reder than 1.O milligrams lead_per square centimeter of surface(LOmg/an),Negative meaning below the action level of l.OnWcm2 or Null ifthe reading was interrupted and not completed.The Mull reading is almost always followed by a complete reading from the same surface.All positive reading lines are in red print. PbC This is the range of the lead concentration in the dry paint:The testing instrument narrows the reading down to plus or minus from the main(0)number. Calibration Readings At the beginning and end of the inspection,calibration tests are done on known control standards and the readings recorded to note the accuracy of the testing device.The calibration line on the data sheets provides the measured lead concentration of the control standards(in the Condition column)and whether the lead is at the surface of the control standard.The actual test reading is recorded in the Pbc column. On the data sheets any lead reading 1.0mg/cm2 or greater is positive for lead-based paint and the line for that reading is in red print. The calibration readings are from the known control standards and not from any painted;surfaces on the property tested.A property that has been certified as being"free of lead-based paint"will still have positive calibration readings listed on the report. Connecticut Lead Paint Solutions July 19 2011 1245 Hebron Ave Glastonbury,CT 06033 860-633-3330 Since 1994 150 Burnham St,Room#3,2nd Fl,South Windsor,CT 06074 l Calibration-Surface 1.53mglem' Positive 150 * al0 2 Calibration-Surface 1.04rulvetn, Positive 1100 t 0.10 3 t::alibrafion-Surface I.114mg/cm° Positive 1100 t 0.10 4 Calibration-Surface 1.04tug/cm, Positive 1.00 3: OM 5 Calibration,surface 0.01mgfee Negative 0.00 + 0.02 6 2nd Room 3 A Door Wood White intact Negative 0.00 t 0.02 7 2od Roam 3 A DoorJamb Wood Brown Intact Negative 0.05 t 0.06 8 2nd Room 3 B Closet Casing Wood Brown Intact Negative 0.07 t 0.06 9 2nd Room 3 B Closet Casing Wood Brawn Intact Negative 0.14 t 0.10 10 2nd Roam 3 D Closet Door Wend Brown Intact Negative 0.06 t 0.08 If god Room 3 D Closet lamb Wood Brawn Fact Negative 0.07 t 0.07 32 2nd Room 3 C Opening Casing Wood Brown Intact Negative 0.00 t 0.02 13 2od Room 3 C OpeningJamb Wood Brown Intact Negative 0.00 t 0.02 14 2nd Roam 3' A Baseboard: Wood Brown Intact Negative 0.06 t 0.06 15 lid Room 3 A Wag Plaster Green Intact Negative 0.40 t 0.10 16 2nd Room 3 A Wall Plaster Green Intact Negative 0.50 f 0.10 17 2ud :Room 3 B Wall Plaster Green intact Negative 0.80 t 0.10 18 2nd Room 3 B Wall Plaster Green Intact Negative 0.30 f 0.16 19 2nd Room 3 C Wall Drywall Green Intact Negative 0.00 f 0.02 20 2nd Room 3 D Walt Metal Green Intact Negative 0.40 t 0.10 21 2ad Room 3 A Ceft Plaster White Intact Negative 0.02 t 0.03 22 2ad Roam 3 C Radiator Metal White Intact Negative 0.01'- 0.03 23 2od Room 3 Closet N B Window Casing Wood Brawn Intact Negative 0.14 t 0.11 24 tad Room 3 Closet N B Window Casing Wood Brawn Intact Negative 0.06 t 0.06 25 2nd Roam 3 Closet N B Wiodowpowl Drywall Off-White Intact Negative 0.00 t 0.02 26 2nd Room 3 Closet N D Closet Dow Wood Brown Intact Negative 011 f 0.18 27 2od Roan 3 Closet N D Closet Jamb Wood Brown Intact Negative 0.04 f 0.06 28 2nd Roam 3 Closet N A Closet Wall Drywall Off-White intact Negative 0.00 t 0.02 29 2od Room 3 Closet N B Closet Wall Plaster Off-White Intact Negative 0.00 t 0.02 30 2od Roam 3 Closet N C Closet Wall Drywall Off-White Peeling Negative 0.00 t 0.02 31 2nd Roam 3ClosetN D Closet Wall Drywall Off-WLite Intact Negative 0.00 t 0.02 32 2od Room 3 Cloiset N C Closet Ceiling: Drywall White Intact Negative 0.00 t 0.02 33 2od Room 3 Closet S D Window Sill Wood Brown Intact Negative 0.06 t 0.09 34 god Roam 3 Closet S D Window casing Wool Brown Intact Negative 0.04 t 0.06 35 2od Room 3 Closet S D WitdowPanel Drywall Off-White Intact Negative O.00 t 0.02 36 2od Roam 3 Closet S B Closet Door Wood Brown Intact Negative 0.03 t 0.05 37 2od Roam 3 Closet S B Closet Casing Wood Broom Intact Negative 0.02 f Q04 38 2nd Room 3 Closet S B Closet Baseboard Wood Brown Intact Negative 0,02<# 0.05 39 2nd Roan 3 Closet S A Closet Shelf Wool Brawn intact Negative 0.02 t Q04 40 2nd Room 3 Closet 3 A Closet Cleat Waal Broom Intact Negative 0.05 t 0.08 42 2nd Raw 3 Closet S A Closet Wall Plaster Off--White Intact Negative 023 t 0.07 43 2nd Room 3 Closet:S B Closet Wall Plaster Off-White Intact Negative 0.18 t 0.06 44 2nd Roan 3 Closet S C Closet Wan Plaster Off-white Poer Negative 0.27 t 0.07 46 2nd Room 3 Closet S D Closet Wall Plaster Off-White Intact Negative 0.24 t 0.06 47 2nd Room 3 Closet S C Closet Ceiling Plaster Wrote Intact Negative 0.02 t 0.03 48 Calibration-Surface 1.S3;ugfcml Positive 1.60 -1, 0.40 49 C:alabrafion-Buried 1.04mg/cm, Positive 1.10 t k10 so Calibrotion-Buried 1.04mglcrtt= Positive 1,00 t 0.10 M Cali bration-Buried M04MWcm' Position 1.00 r alo 52 Calibration-Buried: OOlmg/cm' Negative 0.00 t 0.02 Page I oft 07/20/1122:47:33 FflsiD L�,�a i r*W' Lead Dust Wipe Environmental Hazards Services,L.L.C. Analysis Report 7469 Whitepine Rd Richmond,VA 23237 Telephone:800.347.4010 Report Number. 11-07-02652 Client: CT Lead Paint Solutions Inc. Received Date: 07/20/2011 1245 Hebron Avenue Analyzed Date: 07/20/2011 Glastonbury, CT 06033 Reported Date: 07/20/2011 Project/Test Address: 150 Burnham Street;South Windsor,CT 06074; 11-0289 Collection Date: 07/19/2011 Client Number: Fax Number 07-1566 Laboratory Results 860-633-3330 Lab Sample Client Sample Collection Location Surface Total Pb Wipe Area Concentration Narrative Number Number (ug) (ft2) (ug/ft$) ID 11-07-02552- DW 1 RM#3 2ND`FL FL <10.0 1.00 <10 001 11-07-02552- DWW 2 RM#3 CLOSET SL 42.9 0.458 94 002 Method: EPA SW846 7000B Accreditation#: CT PH-0234 Reviewed By Authorized Signatory: Deborah Britt QA✓QC Clerk The Federal lead guidelines for dust clearance levels by wipe sampling: Floors(FL)-40 ug/ft2, Interior Window Sills(SL)-250 ug/ftz,Window Wells(WW)-400 ug/42, The Reporting Limit(RI-)is 10.0 ug Total Pb. Reported results are not corrected for field blanks. Dust wipe area and results are;calculated based on area measurements determined by the client. All internal quality control requirements associated with this batch were met, unless otherwise noted. The condition of the samples analyzed was acceptable upon receipt per laboratory protocol unless otherwise noted on this report.Results represent the analysis of samples submitted by the client.Sample location,description,area,etc.,was provided by the client. Results reported above in ug/ft2 are calculated based on area supplied by the client. If the report does not contain the result for a field blank,it is to the fact that the client did not include a field blank with their samples. EHS sample results do not reflect blank correction. This report shall not be reproduced except in full,without the written consent of the Environmental Hazards Service,L.L.C.California Certification#2319 NY ELAP#11714. Legend ug=microgram ugfft2=micrograms per square foot Pb=lead mL=milliliter ftz=square foot Page 1 of 1 v Environmental.Hazards Services,;LLC 7469 Whitepine Road Richmond, Virginia 23237 804-275-4788 CE" OF CUSTODY FORK Date: July 19, 2011 Company Name: CT Lead Paint Solutions Address 1245 Hebron>Ave. City, State, Zip Glastonbury, CT 06033 E-mail to; Phone: 860-633-3330 andrev*tleadpaint.com Project Name Rising Stars Childcare Dates of Collections: Assessment Tests July 19,2011 Project Address: 150 Burnham St South Windsor, CT 06074 Project Number 11-0289 Matrix fthod a T Lead in Dust EPA SW 846 7420 Fk=Atomic Absorption 3.0 ug/wipe 24 hours Ghost Wipes Used Lead in Dust Sample # Area size/ Location Sample and Room or Area . inch substrate DW-I 144.00 Floor Aside t Room#3 2nd fl DW-2 66.00 Wind. Sill D side wood Room#3 closet'sou t ' Collected Andrew MWeT S. tune Date: J 19 2011 Mailed by S' a re Date:J 19 2011 Andrea'Miller Received Date: a ( - 11-07-02552 1 Due gate: 07/2=011 Msdneadap) AE SOWN Sf4 co C ' 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 r�Osox•Co TELEPHONE (860) 644-2511 June 2, 2011 Renee C.Welch Director 150 Burnham Street South Windsor, CT 06074 Dear Ms.Welch: RE: RISING STAR CHILDCARE,LLC We have reviewed your request to increase the number of children currently approved for the above mentioned facility from 70 to 76 children. Based on the information submitted, and'the number of parking spaces currently on the site, we are approving this request to allow up to 76 children. This approval is contingent on your ability to meet all necessary fire and building codes and obtaining any other approvals/licenses as required. If you have further questions, please do not hesitate to contact me at 644-2511, ext. 252, or by e-mail at Michele.lipe@southwindsor.org. Sincerely, Michele R. Lipe,AICP Town Planner ML Cc: Chief Building Official Fire Marshal Environmental Health Officer ENVIRONMENTAL INSPECTION REPORT INSPECTION ❑ FOLLOW-UP INSPECTION ❑ COMPLAINT Department of Public Health-Child Care Licensing Program Town 410 Capitol Ave., MS#12 DAC, P.O. Box 340308, Hartford,Connecticut 06134-0308 .../12 -y G --9 D� Date of Inspection INSTRUCTIONS �Z 1 D o20 Check=Compliance; Circle=Non-Compliance; 3=Not Observed; 4=Not Applicable Date of Expiration Licensed Capacity -r—Co Under 3/Endorsement Children Present sZ #Staff Present t.5-Ly G SAS L C Program Name License# ' Telephone# Address Operator Licensed for: 2Tinder 3 Yrs +-Pre-School(3-5 Years) School Age ❑ Night Care Physical Plant/Indoor Space 19a-79-7a Health and Safety 19a-79-6a Ca"I License premises clean/good repair - S t k- 0er'o"N94yyf 21t Refrigeration no more than 45' Equipment clean,in good repair,safe/non-toxic ❑ 12 9 3 Free from observable hazards Food safely stored [9-t14- Food prep hand washing ❑ 15 --4 Water Supply in compliance with all PHC requirements ❑ 16 El17 Mar as appropriate: 2X4. Customer of a Water Company Snacks served ❑ Water Company Name: /11 c� (' ❑ A4"6-A*yed cals transported Lead Wat est Date, �A ��.-/i3 [I Other Within Limits ❑ Exceeds Limits -or- El Building: Pre 1978 Construction(Lead Inspection Required) ❑ 4b On-Site Well ❑ No Lead-Based Paint Identified Classification of Well-Check One: ❑ Lead Hazards Identified and Eliminated ❑ Public Well-Well supplies 25 or more adults and (Plan of Correction on file with Local Health Department) Children,daily at least 60 days per year. (if not,then private well) ❑ Intact Lead-Based Paint Identified ❑ Private Well-Serves less than 25 adults&children (Management Plan on file with Local Health Department) Review of Water Oualitv Test Results LV.,/Building: Post 1978 Construction i.Lead Water Test Date: ❑ Within Limits ❑ Exceeds Limits "REMARKS" ii.Bacteriological Analysis Test Date: ❑ Within Limits ❑ Exceeds Limits iii.Chemical Analysis Test Date: El proval recommended. No code violations identified. ❑ Within Limits ❑ Exceeds Limits R Approval recommended with conditions(see below). ❑ Approval not recommended due to existing serious code Inspection of Well violations. Well meets construction and separation distance requirements of CT Public Health Code Sections 19-13-B51a-m.❑ Yes ❑ No 'I _ ❑ 4c Other(Please specify) SUS S 7— Required toilets/sinks/supplies LJ 6 -Adequate ventilation in toilet room ( 7 Sewage disposal adequate n C C /Yd 7-0 o T 0� Outdoor Space 19a-79-7a F-�jcic tT- ❑ s Smimm_ing pool VPlayground free from observable hazards 0 Drinking water available,adequate,safe Signed(Inspec r Date Corrections Due Signed(P in Char ) S:/Division/Licens /Grou Center/Environm t nspection Report 10/08 8 (wcbsite)