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Home My WebLink AboutTwin Oaks - 12/31/2019N h Town of Mansfield - Board of Health 4 �9�rEai5 hdt9lP` Swimming Pool Application Town of Mansfield 6 Park Row Mansfield, MA 02048 PERMIT NUMBER FEE: $150 Re -inspection fee: $100 O Public NAME OF OWNER: 100 r U 3G'n Su a Gk iO , C611)hOOL OPERATION: G'�'Seml-Public G�Je(t Cyr w;n 0a�'-s h -socia eS Q Special Purpose Pool ADDRESS: G,,ve 54- S,,,.ii-e 31'5 CITY: 'v'e t [ S STATE: f�� ^r ZIP: o 2_E-10 Z TELEPHONE: I -� -I "o l Lt FAX: i9 i _i C� (fi q C L-( D EMAIL: -T. N F C) PCC t2,1j LA Co -n FED IDISS NO: OLq Certification Expires Every 5 Years Permit Expires December 31 st Yearly. PERSON CERTIFIED: Pool/SPA Certification Date: 2� 1 Pool/SPA Certification Expires: PERSON CERTIFIED: ,f} Pool/SPA Certification Date: tp i ct y z t Pool/SPA Certification Expires: certification remarks(If necessary): POOLLOCATION: jqc� (Dak.lar"6 S'- TYPE/POOL: t C1 " l.9 r ovn C? (".,) LENGTH: L- " WIDTH: 2 - VOLUME: VOLUME: 2. "1, 060 MIN/MAX DEPTH: i_p F { ?,F r SWIM AREA: 2 2: X 2 'Z ' DIVE AREA: 2 -Li \/ 2_2' WATER SOURCE: E0 ,ry W/W DISPOSAL: TYPE OF FINISH:SCUM GUTTER: GUTTER: DECK TYPE: C On C.{-- SKMMR WEIR LENGTH: TREATMENT SYSTEM: (�,�„�. 1., DISINFECT METHOD: C,,, 1Cr-,mac CHEMICAL TREATMENT: C n \ U r ; c} NUMBER OF BATHERS: REMARKS: SIGNATUR DATE: Sign, date an a ose check payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mans Id, MA 02048. March 5, 2019 Dear Pool Operator, r►'� -e- Town of Mansfield 6 Pm;k Row, Afansfield, A4assachusetts 02048 J a Health Department Arra o ooan-Pabveg AIPH, RS of f f Health Agent lJ� Attached is the public and semi-public pool application for this year. Please submit the attached documents and payment to the Health Department no later than May 1, 2019. Please note that ALL of these documents must be submitted each year for the filing to be complete. Incomplete filings will be returned and no permit will be issued. A'. Swinmring Pool Application f1. / Certified Pool Operator documentation 8/ ax Certification Form Workers' Compensation Insurance Affidavit; General Business with a copy of the policy / declaration page 3. Written policy on how the facility deals with fecal, vomit and blood incidents in swirmning pools Moving forward, the Health Department will communicate with permit holders through email, rather than regular mail. New permit fees, adopted by the Board of Health in September 2018, will apply to these renewals. The new fee per pool is $150. A re -inspection fee of $100 will be issued if violations are found during routine inspections. T - Please do not hesitate to contact me if I can be of any other assistance. Sincerely, Amy Donovan -Palmer, MPH, RS Health Agent Phone (508)261-7366 Fax (508)261-7425 Elvail ad alrner c�i rrransf eldnra. com TAX CERTIFICATION FORM I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under law. rP36VVLA01$4-cUc+10n001r6, c��j�n1 rrar Twirl �� S Signature of Indivi ual or Corporate Name By: Corporate Officer (Mandatory, if Applicable) u ss�tzi�� I_LC DL_`_ ?___11A "Social Security No. (Volmdanj) or Federal Identification Number *This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non -filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law Chapter 62C, section 49A. l'41T>m n\TAX CP1?TIFV'AT1nN FnPM dor The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www. mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print LeEibly Business/Organization Name: Address: qc) Grove a ak( �2 s�,s City/State/Zip:l2 S\ J+ b 1_ Q Are you an employer? Check the appropriate box: 1. [VI am a employer with employees (full and/ or part -tithe). * 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp, insurance required] 3. ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required]* 4. ❑ We are a non-profit organization, staffed by volunteers' with no employees. [No workers' comp. insurance req.] Phone #: (12 l .-� S%-7 (-(:nLis Business Type (required): 5. ❑ Retail 6. ❑ Restaurant/Bar/Eating Establishment 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) 8. ❑ Non-profit 9. ❑ Entertainment 10.❑ Manufacturing 11. E] Health Care 12.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. **If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box #1, 1 aur an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Insurer's Address: 1 0 h City/State/Zip: ICCS LL -C Policy or Self -ins. Lic. # to502-c)r)--61420-�n bI Expiration Date: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance coveraee verification. I do herebygertijyAoider the pains mad penalties ofperjuiy that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Cleric 4. Licensing Board 5. Selectmen's Office � nrt,o,• 0 Fro m:Nati on al SwImmm l Pool Fntln 7196402787 11/07/2017 14:48 NSPF@ authorized fax copy Ii For verification, call 719.540.9119 ill or email service@nspf.org a .r c t 5 O 0 C N N . 5 ` � ®w t Z 0 UIP'0o65'66@1—a_awas_ I—le®w_o j O 11eo'uo;e -o pazuoy;neaddS_N _d �Joa xe; _d — —_ Q2 O YI i N a, �~ y d O U = N LL a a o A, LL fts80 P.001/OO) L U d CQ `{}G : Afo, ;* 00 O �- �/f 0 N AM � U .r c t 5 0 C N N . 5 ` � ®w t Z 0 UIP'0o65'66@1—a_awas_ I—le®w_o j 11eo'uo;e -o pazuoy;neaddS_N _d �Joa xe; _d — —_ O A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DOYYYYI o4/os/zD1s THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Insurance 950 Highland Ave Needham MA 02494 CONTACT Arlene Marsh, CIC, CISR NAMEAronson gHCNEExt: (781)444-3050 FAX,/No: 1781%444-3051 pooaLss: AMarsh@aronsoninsurance.com INSURER(S) AFFORDING COVERAGE NAICIf INSURERA: AEIC INSURED Poorvu Construction Company Inc 40 Grove Street, Suite 315 Wellesley MA 02482 INSURER B: INSURER C: _ INSURERD: _ INSURER E: _ INSURER F: CERTIFICATE NUMBER: 2018-2019 REVISION NUMBER: COVERAGLJ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILmrCOMMERGIAL RANCE INSD NUIRT Me POLICY NUMBER POLICYEFF MM/DD/YYYY POLICYEXP MMIDDNYYY LIMITS AL LIABILITY AUTHORIZED REPRESENTATIVE ,c�0......— Mansfield MA 02048 EACH OCCURRENCE SDA G TORE[ PREMISES Ea occurrence $ OCCUR MED EXP (Any one person) $ ' PERSONAL B ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ PRODUCTS-COMP/OP AGG $ POLICY ❑ PRO - POLICY LOG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eeaaidem $ BODILY INJURY (Per person) $ ANYAUTO BODILY INJURY(Peraccidanl) $ OWNED SCHEDULED AUTOS ONLY AUTO. HIRED NON�OWNED AUTO$ONLY ALIT OS EY PROPERTY DAMAGE Per acutlenl $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ WORNERSCOMPENSATION S PER OTH- X STATUTE ER L00D,000 E. L. EACH ACCIDENT $ A AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED'! IMandatoryln NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A WCC50050189$e 0$/30/2018 05/30/2019 E.L. DISEASE -EA EMPLOYEE S 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mora space is required) CERTIFICAI la HULUtn --------- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Mansfield 6 Park Row AUTHORIZED REPRESENTATIVE ,c�0......— Mansfield MA 02048 v'l966-<v 15 ACURV JJRr..,.,., '.g— ACORD .a..... ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD � A�® CERTIFICATE OF LIABILITY INSURANCE DATE /ODYYVY) 04//0505/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CtRTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMCONTACT E: Arlene Marsh, CIC, CISR Aronson Insurance /HCO3%Eat: (781)444-3050 AIC No: (781)444-3051 EUMAILDRESS: AMarsh@aronsoninsurance.com 950 Highland Ave INSURER(S) AFFORDING COVERAGE NAIC p INSURERA: AEIC Needham MA 02494 INSURED INSURERS: INSURER C: Poorvu Construction Company Inc INSURER D: 40 Grove Street, Suite 315 INSURER E: _ INSURER F: Wellesley MA 02482 COVERAGES CERTIFICATE NUMBER' 2019-2020 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPOLICY LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER EFF MWDDNYYY POLICY EXP MMIDDIYYYY LIMITS COMMERCIALGENERALLIABILITY EACH OCCURRENCE $_15 CLAIMS MADE F—] OCCUR AM G O TED PREMISES Eeoccurtence $.. MED EXP JAdy one persont $ PERSONAL B ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ PRODUCTS - COMP/OP AGO $ RO- PRO ❑ POLICY ❑ LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea amidenll $ BODILY INJURY (Per person) $ ANYAUTO BODILY INJURY(PerecciddoQ $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per acgtlanl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO I I RETENTION $ $ WORKERS COMPENSATION X1 STATUTE ERR A AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatary in NH) If yes, describe under1,000,000 DESCRIPTION OF OPERATIONS below NIA WC05005015958 05/30/2019 05/30/2020.. E. L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE =- EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aaached it mora space Is required) V T Baa-LUl o Nwrtu V V RrvrtM l wrv. ru nynw , nan, veu. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD _.- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Mansfield ACCORDANCE WITH THE POLICY PROVISIONS. 6 Park flow AUTHORIZED REPRESENTATIVE Mansfield MA 02048 V T Baa-LUl o Nwrtu V V RrvrtM l wrv. ru nynw , nan, veu. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD diarrhea in the water when chlorine stabilizer' is NOT in the water? A dial incident is a high-risk event for contamination caused by Cryptosporidium (or ''Crypto''), an extremely chlorine -tolerant parasite. Therefore, it is important that aquatic staff educate patrons not to swim when ill with diarrhea.To disinfect the water following a dial incident, aquatic staff should hyperchlorinate, or raise the fi-ee chlorine concentration to a high concentration for a long period of time. If necessary, before attempting to hyperchlorinate, consult an aquatic professional to determine the feasibility, the most optimal and practical methods, and needed safety considerations. Step 1: Close the aquatic venue to swimmers. If you have multiple venues that use the same filtration system—all of the venues will have to be closed to swimmers. Do not allow anyone to enter the venue(s) until the hyperchlorination process is completed. Step 2: Remove as much of the fecal matter as possible (for example, using a net or bucket) and dispose of the fecal matter in a sanitary manner. Clean and disinfect the item used to remove the fecal matter (for example, after cleaning, leave the net or bucket immersed in the water during hyperchlorination). VACUUMING FECAL MATTER FROM THE WATER IS NOT RECOMMENDED. Step 3: Using unstabilized chlorine (for example, sodium hypochlorite), raise the water's free chlorine concentration (see Table below) and maintain water at pH 7.5 or less.' Step 4: Achieve a concentration x time (CT) inactivation value of 15,3003 to inactivate or kill Crypto.The CT inactivation value refers to the concentration of free chlorine in parts per million (ppm) multiplied by time in minutes at a specific pH and temperature. Step 5: Confirm that the filtration system is operating while the water reaches and is maintained at the proper free chlorine concentration and pH for hyperchlorination. Step 6: Backwash the filter thoroughly after reaching the CT inactivation value. Be sure to discharge directly to waste and according to state or local regulations. Do not return the backwash through the filter. Where appropriate, replace the filter media. Step 71: Allow swimmers back into the water only after the required CT inactivation value has been achieved and the free chlorine concentration and pH are within the operating range allowed by the state or local regulatory authority. I. Chlorine stabilizers include compounds such as cyanuric acid, dichlor; and trichlor 2. Ideally, the water temperature should be 77°F (25°C) or higher during the hyperchlorination process. 3. Alternative options could include circulating the water through a secondary disinfection system (for example, ultraviolet light or ozone) to theoretically reduce the number of Crypto oocysts in the aquatic venue(s) below one oocyst/100 mL as outlined in the Model Aquatic Health Code (MAHC) standard 4.7.3.3.2A (current edition of the MAHC is available at v ..cdc gov/mahc/cur-ented'Con/index ht nl) or draining the aquatic venue(s). 4 CDC does not recommend testing the water for Crypto after hyperchlorination is completed. Although hyperchlorination destroys Crypto's infectivity, it does not necessarily destroy the structure of the parasite. 5 Shields JM, Hill VR, Arrowood. MJ, Beach MJ. Inactivation of Cryptosporidium parvum under chlorinated recreational water conditions. J Water Health. 200113 —20. • Many conventional test kits cannot measure free chlorine concentrations this high. Use chlorine test strips that can measure free chlorine in a range that includes 20-90 ppm (such as those used in the food industry) or make dilutions for use in a standard DPD test kit using chlorine -Gee water, 3 diarrhea in the water when chlorine stabilizer' is in the water? A diarrheal incident is a high-risk event for contamination caused by Cryptosporidium (or "Crypto''), an extremely chlorine -tolerant parasite.Therefore, it is important that aquatic staff educate patrons not to swim when ill with diarrhea.To disinfect the water following a diarrhea[ incident, aquatic staff should hyperchlorinate, or raise the free chlorine concentration to a high concentration for a long period of time. If necessary, before attempting to hyperchlorinate, consult an aquatic professional to determine the feasibility, the most optimal and practical methods, and needed safety considerations. Step 1: Close the aquatic venue to swimmers. If you have multiple venues that use the same filtration system—all of the venues will have to be closed to swimmers. Do not allow anyone to enter the venue(s) Until the hyperchlorination process is completed. Step 2: Remove as much of the fecal matter as possible (for example, using a net or bucket) and dispose of the fecal matter in a sanitary manner. Clean and disinfect the item used to remove the fecal matter (for example, after cleaning, leave the net or bucket Immersed in the water during hyperchlorination). VACUUMING FECAL MATTER FROM THE WATER IS NOT RECOMMENDED. Step 3: Using unstabilized chlorine (for example, sodium hypochlorite), raise the water's free chlorine concentration (see bullets below) and maintain water at pH 7.5 or less.' Step 4: Hyperchlorinate? Chlorine stabilizer slows the rate at which free chlorine inactivates or kills Crypto, and the more stabilizer there is In the water the longer it takes to kill Crypto. If the cyanuric acid concentration is 1-15 parts per million (ppm)^ • Raise the free chlorine concentration to 20 ppins and maintain it for 28 hours or • Raise the free chlorine concentration to 30 ppms and maintain it for 18 hours or If the cyanuric acid concentration is more than 15 ppm, lower the concentration to 1-15 ppm by draining partially and adding fresh water without chlorine stabilizer before attempting to hyperchlorinate. Step 5: Confirm that the filtration system is operating while the water reaches and is maintained at the proper free chlorine concentration and pH for hyperchlorination. Step 6: Backwash the filter thoroughly after hyperchlorination has been completed. Be sure to discharge directly to waste and according to state or local regulations. Do not return the backwash through the filter.Where appropriate, replace the filter media. Step 76: Allow swimmers back into the water only after hyperchlorination has been completed and the free chlorine concentration and pH are within the operating range allowed by the state or local regulatory authority. • Raise the free chlorine concentration to 40 ppms and maintain it for 8.5 hours ` I. Chlorine stabilizers include compounds such as cyanuric acid, dichlor and trichlor 2. Ideally, the water temperature should be 77°F (25°C) or higher during the hyperchlorination process. 3. Akemacw, options could include circulating the water through a secondary disinfection system (for example, ultraviolet light or ozone) to theoretically reduce the number of Crypto oocysts in the aquatic venue(s) below one oocyst/ 100 mL as outlined in the Model Aquatic Health Code (MAHC) standard 4.7.3.3.2.4 (current edition of the MAHC is available at v .cdc gov/mahc/cunentedition/indexhtml) or draining the aquatic venue(s). 4. Murphy JL, Arrowood MJf Lu, X, Hlaysa MC, Beach MJ and Hill VR. Effect of cyanuric acid on the inactivation of Cryptosporidium parvum under hyperchlorination conditions. Environ Sci & Technoi. 2015;49:7348-55. 5. Many conventional test kits cannot measure ft no chlorine concentrations this high. Use chlorine test strips that can measure free chlorine in a range that includes 20-40 ppm (such as those used in the food industry) or make dilutions for use in a standard DPD test kit using chlorine -free water, 6. CDC does not recommend testing the water for Crypto after hyperchlorination is completed. Although hyperchiorination desk oys Crypto's infectivity, it does not necessarily destroy the structure of the parasite. 4 Commonwealth of Massachusetts Town of Mansfield Board of Health Permit to Operate a Swimming Pool PERMIT NUMBER: 3 PERMIT EXPIRES: December 31, 2017 Town of Mansfield 6 Park Row Mansfield, MA 02048 Person Certified., ROB MERCIER Pool/SPA Certification Date: June 09, 2017 Pool/SPA Certification Expires: June 09, 2022 Person Certified. Pool/SPA Certification Date: Pool/Spa Certification Expires: In accordance with the provisions of Chapter 111. Section 127A of the Massachusetts General Law, and Regulations established by the Massachusetts Department of Public Health (105 CMR 435.00), permit is hereby issued to: POORVU CONSTRUCTION, CO., INC. -AGENT FOR TWIM OAKS ASSOCIATES, LLC for the operation of a ❑ Public I./] Semi -Public ❑ Special Purpose Pool located at. 149 OAKLAND STREET Method of water treatment is CHLORINE Bathing load not to exceed., bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. .filmy Donovan-PaCmer, HeaCth Agent iq � � _1,35:) o I t Date Issued