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Home My WebLink AboutBALFOUR SENIOR LIVING - PDP220001 - SUBMITTAL DOCUMENTS - ROUND 2 - OTHER WATER AND OR SANITATION DISTRICTS (2)January 18, 2021 1 South Fort Collins Sanitation District Industrial Pretreatment Business Questionnaire 5150 Snead Drive Fort Collins, Colorado 80525 (Office) 970-226-3104 (Fax) 970-226-0186 The South Fort Collins Sanitation District (the District) requires all commercial and industrial businesses to fill out the following Industrial Pretreatment Business Questionnaire. The information provided will be used to update the District’s Wastewater Pretreatment User Database and assist us in monitoring what types of waste are being discharged into the sanitary sewer system. IMPORTANT: Before submitting this questionnaire, please complete as thorough and as accurate as possible . All of the sections are important and should be completed to the best of your knowledge. Take extra care to ensure that all sections have been filled out properly and section IV. Certification of the form is carefully understood and signed. If you do not understand any of the sections contained in this questionnaire, please contact Derik Caudill for assistance at 970-657-3505. I. GENERAL INFORMATION Business Name: ____________________________________________________________________ Individual Responsible for Operation: Individual Providing Information: Name: ___________________________________ Name: __________________________________ Title: ___________________________________ Title: ___________________________________ Phone: ___________________________________ Phone: __________________________________ Location Address: __________________________________________________________________ Contact Address (if different from above): _______________________________________________ Phone: ____________________________________________________________________________ Email Address: _____________________________________________________________________ Days of Operation: __________________________________________________________________ Hours of Operation: _________________________________________________________________ Number of Employees: _______________________________________________________ Balfour Senior Living Chris Smith Vice President, Construction 303.895.7376 183 South Taylor Road, Suite 155 Louisville, CO 80027 csmith@balfourcare.com 3733 East Harmony Road Fort Collins, CO 80528 Monday thru Sunday 9 am till 5 pm 70 Thomas Pannell, PE Principal, Bowman Consulting 303.801.2917 303.895.7376 January 18, 2021 2 Is this Business in a multi-use building (are there other Businesses in the same building)?  Yes  No If Yes, which unit(s) do you occupy? _____________________________________________________________________ Are you the owner of the property?  Yes  No If No, please provide the name and address of the owner. _____________________________________________________________________ If you lease the building to several different clients, please list the name of each client, suite and description of the activity or operation of each client. Client’s Name Address Activity / Operation __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Business official to be contacted about this survey: _____________________________ __________________ ________________ Name Title Phone # II. PRODUCT INFORMATION Give a brief description of the operations at this facility including primary products and services. X X Senior Living Community providing licensed care to Assisted Living and Memory Care residents, similar to a Group Home. Kathryn Anderson, Bill Winchester II, Sheri Lucas, and BN Harmony, LLC PO Box 2632Monument, CO 80132 Chris Smith Vice President, Construction 303.895.7376 January 18, 2021 3 Check all activities that occur at your facility.  Assembly  Machining – Sheet Metal Shop  Auto body, Shop, Vehicle Repair  Painting / Finishing / Stripping  Auto / Truck Wash  Photography  Battery Manufacturing  Plant Wash Down  Biotechnology  Plastics/ Manufacturing/Molding/Forming  Cement Manufacturing  Pharmaceutical Manufacturing  Chemical Manufacturing  Photo Processing  Copper / Aluminum Forming  Plastics manufacturing / molding  Dairy Products  Porcelain Enameling  Dry Cleaning / Laundries  Printed Circuit Board Manufacturing  Education/Vocation  Printing/Publishing  Electrical Component Assembly  Pulp, Paper, Paperboard Manufacturing  Electroplating  Research  Engraving/Coating  Restaurant  Feedlot  Retail Trade  Flammables/Explosives  Rubber Manufacturing / Processing  Food Processing  Smelting  Funeral Services  Soap / Detergent Manufacturing  Gas Station  Steam/Power Generation  Glass Manufacturer  Sugar Manufacturing  Government  Textile Manufacturing  Grain Mill  Timber Products  Laboratory  Vehicle Repair  Leather / Tanning/Finishing  Warehouse  Office Unit  Wholesale Trade  Manufacturing  Wood Preserving / Finishing  Medical Care  Woodworking Shop  Metal finishing (plating, anodizing, coating, etching  X-ray  Metal Modeling and Casting  Other (Specify)___________________ III. WASTE GENERATION AND DISPOSAL INFORMATION Are There Any Floor Drains in the storage or use area(s)?  Yes  No Note: Floor drains are drainage fittings that sit flush with the floor. They are used in basements, bathrooms, laundry and furnace rooms, garages, etc. Since floor drains are connected to the SFCSD sewer system, the District needs to know what potentially goes down the drain and where it is located. Saline Swimming Pool January 18, 2021 4 Where are the floor drains located? (You may include a separate drawing.) __________________________________________________________________________________ Identify which of the following discharge to the sanitary sewer: ⁭ Pool ⁭ Fountain ⁭ Loading dock drain ⁭ Sump pump(s) ⁭ Roof drain ⁭ Storm water ⁭ Outside drains What is the maximum water use at this facility? _________ gallons per ⁭ day ⁭ month ⁭ estimated ⁭ unknown Is there a grease trap or sand & oil interceptor?  Yes  No If yes, please list the capacity (gallons): ______________ Method of Wastewater Disposal (check one):  Municipal Sewer  Septic Tank Type of Wastewater Discharge into Municipal Sewer (check one or both): ___ Domestic ___ Industrial List types and amounts of chemicals, fluids, and/or liquid waste used in gallons per day. Indicate the method of disposal for each by listing the letter that corresponds to the appropriate method. Attach additional sheets if necessary. If none are used, write NA in the space. Methods of waste disposal: a. Discharge to SFCSD sewer system.c. Placement with trash for collection. b. Discharge to SFCSD sewer system after pretreatment. d. On-site storage, treatment or disposal. e.Shipment off-site by outside hazardous waste hauler to waste management facility. Chemical, Fluid, Liquid Waste Amount (gal/day) Method of Disposal In the commercial kitchen area. Location to be determined. To be determined 13,500 Saline Pool 500 Surge tank connection to sanitary Sanitary Waste Direct Sanitary Connections13,500