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Home My WebLink About2800 Tamarack Avenue (2) K oKr� Town of South Windsor — Health Department � ��■ its` �,. 1540 Sullivan Ave., South Windsor, CT 06074- Mailing Address 1530 Sullivan Ave., South Windsor, CT 06074- Office Address Phone Number: (860) 337-6173, Fax Number: (860) 644-1930 PUBLIC SWIMMING POOL REGISTRATION FORM FACILITY NAME: L- N ►L 117a ) I o ��1 ee5 >� InJ ADDRESS: �)_Ub ab1�1C1i-ac_k hVe. I,Ae., IC' &6,r, C-T PHONE c} tpC' S L{(v / EMAIL: L}Ce 46c @ -C 1'1 • (j r V I OWNER/ASSOCIATION / L , / REPRESENTATIVE: �1LU5(,7k G f►' &4,LCARA '1&-,� (��tJ �C rI 1�J ADDRESS � A19)01(e 1 , PHONE: •l/ EMAIL MANAGER(if different from owner): r— II n ADDRESS h (3,4 PHONE NUMBER EMAIL: POOL /1_C 70 OPERATOR: I ADDRESS '' NkkI-4-g-rr!4 RCr1 �� f�d��. CT- Q ? S�' J ' PHONE NUMBER �"I U- �23- S 374 EMAIL Cav►�Pa��j Tes��n I �� k �fI '�-e0 �"- al RECEIVED FACILITY INFORMATION: Check all that apply: APR 3 0 2018 Indoor Pool Outdoor Pool Wading Pool Whirlpool/Sha SOUTH VONDSOR HEALTH DEPT. Dates Pool is Open: Flom � CAr i'' Lt-I ) , { to l0 �- Pool Capacity: \� Pool Make-up Water Source: Public Private Disinfectant Used: Cif/a11-Ih16-1 The undersigned agrees to comply with Section 19-13-11333b of the Connecticut Public Health Code: 'ti1u U L'l9i / 2Le % h u-� -� l7Ilk Signatur f Applicant Title U Date 'Please return completed registration form to the South Windsor Health Department. Pool inspection requests must be scheduled 2 weeks prior to anticipated pool opening date 1 c� C M 1�Sm Eastern Connecticut health Network,Inc. CHECK REQUEST FORM Date: r Jii Employee #� Amount: 1 D0 DO Payable To: (For Reimbursement) Remittance Address: Due Date: l)lip tittitiI v'&v6 �� ►"I 11 � '�' C�c't-( IS �� S 6Sy t-� �1� home address required;address required if check is to be mailed Note:If employee reimbursement-employee's General Ledger Account Number(s): YA Reason for Payment: ®re �� PhoneExt: `; Wv��i f C Signature:Requester: r mbursement,employee'nusor 8 signature is required. Note:it employee Title: y Cc J L �SJ �LL�` l #1: �J Ct Approval (PLEASE PRINT) Date: Signature: / /� Title: Approval#2: (PLEASE PRINT) Date: Signature: completed b This portion comp Y Accounts Payable Vendor Number: Processed By: Comments: 7/16/2013 ECHN Check Request Policy npW'wy�°'e� 04ft�outine Inspection door Pool Town of South Windsor—Health Department 0 Re-inspection 0 Outdoor Pool 1540 Sullivan Avenue,S.Windsor,CT 06074 0 Complaint A Wading Pool Phone: 860-337-6182 Fax: 860-644-1930 0 Other: _ 0 Whirlpool/Spa Public Swimming Pool Inspection Report Name of Facility can,V 0A Inspection Date: slyA y Address: I6t11Mr",/ tk- Phone:& — �S-33' Li(,- CJ Items marked with an X indicate non-compliance with CT Public Health Code(Section 19-13-1333b). Violations must be corrected by the listed compliance date. a-4 Life Saving Equipment b-12 Vacuuming Ring buoy <15" inner diameter, attached to 50ft length of%" line I z Pool vacuumed to maintain cleanliness Life pole/shepard's crook with blunted ends, a b-13 Accessibility to Pool Area minimum of 12ft in length Outdoor pools surrounded by barrier(>4ft) b-1 Pool Construction / Outdoor pool entry gates self-closing and self- Pool in good repair " latching b-2 Supervisory Personnel (/ Pool access restricted when pool is closed Knowledgeable pool supervisor onsite b-14 Lifeguards List of personnel provided to Health Dept. Warning signs if no lifeguard on duty (letters b-4 Pool Water Clarity >4" high) 6" secchi disk at pool bottom visible Warning signs visible from all entry points in b-5 Pool Water Disinfection pool area Automatic Feeder Used b-15 First Aid Kit v Kit filled, ready for use, materials current Test mg/liter Free Chlorine Amer. Red Cross 24-unit first aid kit or equiv. b-5, b-6 Test Kits r/ DPD Test Kit onsite (for disinfectant and pH) b-16 Emergency Telephone b-6 Pool Water pH Telephone readily available in pool area Value between 7.2 and 7.8 b-17 Signs b-7 Records and Testing ✓ "All persons shall bathe with water and soap before entering pool" / Residual disinfectant & pH tested prior to daily "Anyone having a communicable disease shall I/ opening !� not use the pool" _ '" Daily pool testing records kept "Spitting, or blowing the nose in the pool is b-8 Decks, Dressing,Toilet&Shower Rooms L,**' prohibited" Clean, good repair, well ventilated "Running, boisterous or rough play is v 0.5%chlorine cleaning solution for floors prohibited" Shower water 90—105 degrees F b-18 Emergency Communications Adequate toilet facilities Directions to nearest telephone and first-aid kit b-9 Equipment rooms/areas&Equipment '/ posted at entrance Maintained in good repair, clean/sanitary Telephone numbers (print>.25 ) of police, fire, Skimmers, gutters, strainer baskets clean and in hospital and EMS / good repair b-19 Registration Drain grates compliant Name of owner or owner's agent, address and b-10 Deck Equipment _ location on file ✓ Handrails provided on steps, step holes, and c-1 Depth Markers ladders Markers on rim at min and max depth and Equipment properly secured points of slope change b-11 Pool Chemical Storage Markers visible from pool deck and from within Stored in a cool, dry, clean, well-ventilated area ✓ pool Containers stored tightly closed 53 Ncwberry Road GLast Windsor, CT 06088 8 60-6z3-8 374 �. Www.aLlua� com i; f-IIC#0558149-SPt License#0280519 SERVICE CORPORATION March 17, 2017 ECHN 2800 Tamarack Ave Suite 101 South Windsor, CT 06074 To whom it may concern: On March 10t', 2017 the swimming pool located at the address above was Acid Wash and cleaned up the plaster. On that date new suction outlet covers were installed that are Virginia Graeme Baker approved (VGB). The Act states that the suction outlet covers should be replaced every five years in order to stay compliant with commercial pool safety codes for suction entrapment. The date of which the covers should be replaced by is 3/10/2022. The suction outlet covers that were installed are Paramount SDX suction outlet covers. Along with this letter, I have attached the certificate of listing and certificate of conformity from the manufacturer Paramount Pool and Spa Systems. Please let us know if you have any questions. Thank You, Debbie Callender Aqua Pool Service 1 1 / RETRO HIGH FLOW SAFETY DRAIN HIGH FLOW SAFETY DRAIN CERTIFICATE OF CONFORMITY SDX HIGH FLOW SAFETY DRAIN Submerged Suction Outlet For Single or Multiple Drain Use For Use on Wall and Floor No Sump Required The SDX High Flow Safety Drain is a 10" diameter frame and grate or bulkhead style drain fitting. It includes a back plate and cover that is affixed to a frame, a bulkhead or an existing drain sump. SDX Retro replaces most existing drain covers up to 1 0" in diameter. FLOW RATING FLOOR WALL COMPLIANT WITH: One SDX or SDX Retro 200 GPM 192 GPM • Virginia Graeme Baker Pool and Spa Square Inches of opening = 43.201 sq. inches Safety Act Velocity @ 200 GPM = 1 .485 fps ASME Al 1 2.1 9.8-2007 PLACE OF MANUFACTURE: ANSI/APSP - 7 Paramount Pool & Spa Systems IAPMO Listed 295 E. Corporate Place SDX Model Numbers: Chandler, AZ 85225 USA Concrete XXX-1 62-2212-XX (480) 893-7607 Vinyl XXX-1 72-221 2-XX NAME OF THIRD PtARTY LABORATORY: IAPMO Fiberglass XXX-182-2212-XX R&T LAB Retro XXX-192-221 2-XX TEST RECORD DOCUMENTATION: IAPMO R&T Retro Vinyl XXX-159-2212-XX 5001 E. Philadelphia Street Retro Equalizer XXX-1 57-221 2-XX Ontario, CA 91 761 (909) 472-4104 Test Report—March 17. 201 1 LIFE SPAN: 5 YEARS FROM DATE OF INSTALLATION ` "I Install Date 10 1 ID NSHANSI 50 . U s P G =+ . Replacement 5 years from installed date • I1Hit9A% �' •»r was NOTE: Suction Safety Standards require that drain grates used to cover sumps must have the suction pipe cut at least 1.5 times the pipe diameter behind the drain cover. There is NO SUMP requirement for SDX because the patent- ed design provides uniform suction regardless of pipe location. If the pipe is too close to the back of the cover, it may restrict water flow to the pump, potentially reducing hydraulic efficiency, but this does not pose a suction safety hazard. This is confirmed by the IAPMO Test Report. `..� This Product must be installed in accordance with all applicable Federal, State and Local Codes. REV063011