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Home My WebLink AboutMansfield Apartments I - 12/31/2019Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health Permit to Operate a Swimming Pool PERMIT NUMBER: PERMIT EXPIRES: 8 December 31, 2019 Person Certified: MICHAELLA J. (JOHNSON) SAMPSON Pool/SPA Certification Date: April 25, 2018 Pool/SPA Certification Expires: April 25, 2023 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: CONIGIN MANAGEMENT, LLC MANSFIELD APARTMENTS I, LLC for the operation of a ❑ Public 0 Semi -Public ❑ Special Purpose Pool located at: 10 CONNORS AVENUE Method of water treatment is CHLORINE Bathing load not to exceed. 61 bathers Number of Lifeguards required at all times the pool is open is: "NO LIFEGUARD ON DUTY" sign is required. Amy Donovan -Palmer, Heaah Agent None 9 /Z4/7, Date Issued app fiyL 4u*ja Wat> 777s , r'-^-. } 1 a MAY 16 Town a Mansfield Town of Mansfield - Board of H ---------i&?ark-Row Mansfield, MA 02048 Swimming Pool Application ��j�l ��cYa.elaflGG{A�� NAME OF OWNER: i1S e A r' pw mt0f. 17, 4"` OPERATION: ADDRESS: /O &nnms �' tlt u -C CITY: IM an:34.610` `, STATE:: I r I A ZIP: V a o y D TELEPHONE: (So?)-337-v0Ll0 FAX:(sod) 3 3 7 -boo2 EMAIL: MSampson uv cog-To.�� FED ID/SS NO: Certification Exvires Every 5 Years. Permit Expires December 31 st Yearly, PERSON CERTIFIED;ChaLjj4_ \3a�t,Pson Pool/SPA Certificati/o'n'� Date: q _ Pool/SPA Certification Expires: Z S zD Z3 PERSON CERTIFIED: Pool/SPA Certification Date: Pool/SPA Certification Expires: certification remarks(if necessary): REMARKS: SIGNATURE: Sign, date and enclose check payable to Park Row, Mansfield, MA 02048. PERMIT NUMBER FEE: $150 Public Re -inspection fee: $100 ly Semi -Public Special Purpose Pool POOL LOCATION: D it'll6-1Z J V.0 ft -'u_ TYPEIPOOL: 6 J, ,11 (f ,L LENGTH: 4? ? 1/ P at WIDTH: a r1 I VOLUME: 01-7 7f 5-M n,,,, bA5 MINIMAX DEPTH: 3 I /.S- II n SWIM AREA: 917 s1. 74. 4 DIVE AREA: IIIA WATERSOURCE: /OW n W/W DISPOSAL: 7a w fi TYPE OF FINISH: p/E(164ax_ SCUM GUTTER: 100 &L DECKTYPE: Co(10,0--� SKMMR WEIR LENGTH: b I/01 It TREATMENT SYSTEM: AI_ IOU DISINFECT METHOD: O'kIPKiw CHEMICAL TREATMENT: Gn I pe" NUMBER OF BATHERS: U II 1(_ DATE:3f) Mail to: Board of Health, To vn of Mansfield, Six 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. i"ftans-11dGt 4"I, J5 l U e- Signature of Individual o i Corporate Name By: Corporate dificer a tdatq , if Applicable) 38- �113011P "Social Security No. (Voluntary) 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. C:\Uscrs\sleite\Desktop\Scott's Documents\Food Establishments- Temp\TAX CERTIFICATION FORM.doc Department of Industrial Accidents Office of Investigations UIV 600 Washington Street Boston, MA 02111 wpi,minass,gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization \ C,� Address: L ,3 -,- - T Phone #: �.t. Aree you an employer? Check the appropriate box: Business Type (required): 1. L't�] I am a employer with 54 employees (full and/ 5. ❑ Retail or part-time).* 2. C3 6. ❑/(; staurant/Bar/Eating Establishment am a sole proprietor or partnership and have no 7_ [� Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8• ❑ Non-profit 3. ❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, § 1(4), and we have lo .❑ Manufacturing no employees. [No workers' comp. insurance required]* 4. ❑ We by 11 ❑ health Care are a non-profit organization, staffed volunteers, with no employees. [No workers' comp. insurance req.] 12.❑ Other -Any applicant that checks box It I nmst also fill out the section below showing their workers' compensation policy infommtion. -*If the corporate officers hove exempted theinselves, but the corporation bas other employees, a workers' compensation policy is required and such mt organization should check box #I, 7 an+ an en+ployer ilia(is providing +vorkers' coa+peasatiott insurrutce for ray eatployees Belory is the policy information. Insurance Company Name:_Lau t;V yt , n n S. (_ D L' i i k)0f L(A— Insurer's _Insurer's Address: City/State/Zip: V . Ac , k�_ Policy N or Self -ins. Lie. # � � `� '"�" ,y �`�. � � t Expiration Dale: i i ,)moi FGF 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 Investigations of the DIA for insurance coverage verification. I do herebv certifit under the of perjury &at the Official use only. Do not write in this area, to be completed by city or toren official. City or Town: Permit/License true and correct. Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact Persaw Phone www,ntass.gov/dia ISSUING COMPANY Workers' Compensation INDEMNITY INS. CO. OF NORTH AMERICA NCCI CARRIER CODE and Employers Liability 25437 Insurance Policy Information Page POLICY NUMBER ❑ New ❑X Renewal ❑ Rewrite Symbol: RWC Number: C6 57 74 85 9 PREVIOUS POLICY NO. ❑ Individual ❑Partnership Association Symbol: RWC Number: C6467884A ❑X Corporation ❑ Joint Venture ❑ Other Legal Entity Item 1. INSPERITY, INC. L/C/F Inter/Intrastate ID No.: Named CORIGIN MANAGEMENT LLC Insured 19001 CRESCENT SPRINGS DRIVE Federal Employer ID No.: 760479645 KINGWOOD TX 77339 Mailing Address L_ Employer's ID No.: PITC CODE: 6798 For other named insured see Extension of Information Page — Schedule of Named Insured, WC 99 99 99 A For other workplaces see Extension of Information Page — Schedule of Other Workplaces, WC 99 99 99 B Item 2. Policy period: From 10-01-2018 To 10-01-2019 12:01 A.M., standard time at the named insured's mailing address. Item 3A. Workers' Compensation Insurance: Part One of the policy applies to the Workers' Compensation Law of the states listed here NY Item 3B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee Item 3C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: ALL STATES EXCEPT ND,OH,WA,WY, AND STATES DESIGNATED IN ITEM 3.A Item 3D. This Policy includes these endorsements and schedules: See schedule of Forms and Endorsements WC999999D Item 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. SEE EXTENSION OF INFORMATION PAGE -CLASSIFICATIONS If indicated here, interim add''ustments of premium will be made: F1emi-Annually Quarterly ❑ Monthly PRODUCER NAME AND MAILING ADDRESS LOCKTON COMPANIES LLC 3657 BRIARPARK DRIVE SUITE 700 HOUSTON TX 77042 Minimum Premium collected in NY $ Total Estimated Premium $ Deposit Premium $ PRODUCER CODE: 279114 20-3354970 DAU MARKETING OFFICE: DALLAS BRANCH ISSUE DATE: 09/28/2018 Authorized Representative WC 00 00 01A (05/88) Copyright 1987 National Council on Compensation Insurance INSURED COPY EXTENSION OF INFORMATION PAGE Named Insured Endorsement Number INSPERITY, INC. L/C/F Policy Number CORIGIN MANAGEMENT LLC 19001 CRESCENT SPRINGS DRIVE Symbol: RWCNumber: C65774859 Policy Period Effective Date of Endorsement 10-01-2018 TO 10-01-2019 10-01-2018 Issued By (Name of Insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. SCHEDULE OF NAMED INSURED ITEM 1., NAMED INSURED, OF THE INFORMATION PAGE IS EXTENDED AS FOLLOWS: NAMED INSURED FEIN INSPERITY, INC. L/C/F 760479645 CORIGIN MANAGEMENT LLC ADMINISTAFF COMPANIES, INC. 760487432 ADMINISTAFF PARTNERSHIPS HOLDING II 880507135 , INC. ADMINISTAFF PARTNERSHIPS HOLDING III 880507138 , INC. ADMINISTAFF PARTNERSHIPS HOLDING, INC. 760584086 CORIGIN MANAGEMENT LLC 452150835 INSPERITY BUSINESS SERVICES, LP 300345628 INSPERITY EMPLOYMENT SCREENING, LLC 261836188 INSPERITY ENTERPRISES, INC. 741555611 INSPERITY GP, INC. 760690601 INSPERITY HOLDINGS, INC. 760178498 INSPERITY INSURANCE SERVICES, LLC 760672046 INSPERITY PEO SERVICES, LP 760689539 For the state of CA refer to state specific endorsement. Authorized Representative WC 99 99 99 A (10/06) Page 1 of 2 EXTENSION OF INFORMATION PAGE Named Insured Endorsement Number INSPERITY, INC. L/C/F CORIGIN MANAGEMENT LLC Policy Number 19001 CRESCENT SPRINGS DRIVE Symbol: RWCNumber: C65774859 Policy Period Effective Date of Endorsement 10-01-2018 TO 10-01-2019 10-01-2018 Issued By (Name of Insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the ereparation of the policy. SCHEDULE OF NAMED INSURED ITEM 1., NAMED INSURED, OF THE INFORMATION PAGE IS EXTENDED AS FOLLOWS: NAMED INSURED INSPERITY RETIREMENT SERVICES, LP INSPERITY SERVICES, LP INSPERITY SUPPORT SERVICES, LP For the state of CA refer to state specific endorsement. FEIN 562375265 760584087 760691478 Authorized Representative WC 99 99 99 A (10/06) Page 2 of 2 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number INSPERITY, INC. L/C/F CORIGIN MANAGEMENT LLC Policy Number 19001 CRESCENT SPRINGS DRIVE Symbol: RWC Number: 065774859 Policy Period Effective Date of Endorsement 10-01-2018 TO 10-01-2019 10-01-2018 Issued By (Name of Insurance Company) INDEMNITY INS, CO. OF NORTH AMERICA Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subse uent to the preearation of the policy. NEW YORK OPTIONAL LABOR CONTRACTOR ENDORSEMENT As used in this endorsement, employee leasing means an arrangement whereby an entity contracts with another entity to lease some or all of its workers. The entity providing the workers shall be referred to as the "labor contractor." The entity utilizing the workers shall be referred to as the "client." This endorsement applies only with respect to bodily injury to the workers provided to the client identified in Item I.A. of the Information Page and named in the Schedule below by the Labor Contractor identified in I.A. of the Information Page under an employee leasing arrangement. This arrangement is for long-term leasing services, rather than for temporary help services to meet seasonal or short-term conditions. This policy provides coverage for the workers leased to the client. Coverage for these leased employees may be provided by either the leasing firm or the client which are both considered to be named insureds under this policy. This policy does not satisfy the client's duty for the complete payment of any obligations it may have under the Workers' Compensation Law for non -leased employees or that the labor contractor may have for direct employees engaged by it. Part One (Workers Compensation Insurance) and Part Two (Employers Liability Insurance) will apply as though the labor contractor is an insured. Under Part One, we will reimburse the labor contractor named in Item 1.A. of the Information Page for the benefits required by the Workers' Compensation Law if we are not permitted to pay the benefits directly to the persons entitled to them. Part Four (Your Duties if Injury Occurs) applies to the labor contractor and client. The labor contractor and the client will recognize our right to defend under Parts One and Two and our right to inspect under Part Six (Conditions). We will not ask any other insurer of the client to share losses with us covered by this policy. We will charge premium for the workers leased to the client company by the labor contractor. If we cancel this policy, we will send notice to the labor contractor and to the client at the address shown in the Schedule below. The labor contractor will separately maintain payroll records needed to compute the premium for the workers leased to the client, to satisfy the obligations under Part Five (Premium). We will charge the labor contractor premium for workers leased to the client. Name of Client CORIGIN MANAGEMENT LLC CORIGIN MANAGEMENT LLC CORIGIN MANAGEMENT LLC WC 31 03 20 (01/99) Ptd. in U.S.A. Schedule Address 80 LAFAYETTE ST NEW YORK, NY 10013-4057 321 BOWERY NEW YORK, NY 10003-7105 505 5TH AVE NEW YORK, NY 10017-4917 Authorized Representative WC 31 03 20 (01/99) Ptd. in U.S.A. k" .0 I The Commonwealth of Massachusetts r Executive Office of Health and Human Services Department of Public Health " Division of Community Sanitation MITT ROMNEY 305 South Street, Jamaica Plain, MA 02130-3597 GOVERNOR (617) 983-6761 (617) 983-6770 - Fax KERRY HEALEY LIEUTENANT GOVERNOR RONALD PRESTON SECRETARY CHRISTINE C. FERGUSON COMMISSIONER Fecal, Vomit and Blood Incidents in Swimming Pools I. FECAL INCIDENT PREVENTION IN SWIMMING POOLS Although the actual health and safety risks associated with fecal accidents are considered to be minimal, provided that proper pool chemical levels are maintained, fecal incidents do pose a significant interruption in pool operations. As such, prevention of fecal incidents should be stressed. The following preventative measures shall be implemented at all pools: A. Patrons must be directed to take a cleansing shower before entering the pool. B. Do not permit diaper changing at poolside. Do not allow young children to be "dipped" or rinsed off in the pool as part of the diaper -changing process. C. Patrons who are ill or have suffered from diarrhea within the previous two (2) weeks should be denied admittance into the water. It has been shown that persons with cryptosporidiosis continue to shed crypto oocysts (the infectious form of the organism) in their stool for 2 weeks after their diarrhea has ended and can therefore infect others. D. All persons wearing diapers, or who would be of diaper -wearing age (e.g. infants and toddlers), should wear swimsuit diapers or tight -fitting rubber or plastic pants which will contain fecal matter and prevent it from entering the pool. E. Do not allow pets in the pool area. See 304 CMR 12.08. F. Maintain the chemical feed equipment and chemicals at optimal levels. This includes maintaining the disinfectant levels (residual chlorine levels between 2.0 and 3.0 ppm); optimal pH (7.4-7.6); alkalinity (80-120 ppm); and calcium hardness (200-400 ppm). Note: Lack of proper pH can greatly affect disinfection effectiveness in chlorinated pools. II. FECAL INCIDENT PROCEDURE IN SWIMMING POOLS There is a concern regarding the potential transmission of cryptosporidium parvum (a parasite excreted in the feces of infected humans and other mammals) and escherichia coli 0157:H7 (a harmful strain of coliform bacteria living in the digestive tracts of humans and other animals). Most organisms found in properly chlorinated pool water, including E.coli 0157:117, are killed very quickly. In fact, usually only a few seconds of disinfection are needed to kill 99.9% of these organisms. Those organisms that are more resistant to disinfection, such as cryptosporidia, are typically introduced into pool water via very watery diarrhea. This is seldom noticed or reported. Thus, solid stool is unlikely to contain cryptosporidia. This knowledge thus requires a two-pronged approach to managing a fecal incident. (The following information was adapted from "Responding to Fecal Accidents in Disinfected Swimming Venues. " Morbidity and Mortality Weekly Report, May 25, 2001,Centers for Disease Control and Prevention httv://www.edc. gov/mrnwr/ydf/wk/mm502O.pd A. Formed stool (solid, nonliquid) 1. Direct everyone to leave all pools into which water containing the feces is circulated. Do not allow anyone to enter the contaminated pool(s) until all decontamination procedures are completed. 2. Remove as much of the fecal material as possible using a net or scoop and dispose of it in a sanitary manner. Clean and disinfect the net or scoop (e.g., after cleaning, leave the net or scoop immersed in the pool during disinfection). Vacuuming stool from the pool is not recommended*. 3. Raise the free available chlorine concentration to 2 ppm (mg/L), pH 7.2-7.5, if it is <2.0 ppm (mg/L). Ensure this concentration is found throughout all co -circulating pools by sampling at least three widely spaced locations away from return water outlets. This free available chlorine concentration was selected to keep the pool closure time to approximately 30 minutes. 4. Maintain the free available chlorine concentration at 2.0 ppm (mg/L), pH 7.2-7.5, for at least 25 minutes before reopening the pool. In the presence of chlorine stabilizers such as chlorinated isocyanurates, a level of 3.0 ppm (mg/L) of free available chlorine must be achieved. Ensure that the filtration system is operating while the pool reaches and maintains the proper free available chlorine concentration during the disinfection process. 5. Establish a fecal accident log. Document each fecal accident by recording date and time of the event, formed stool or diarrhea, free available chlorine concentration at the time or observation of the event and before opening the pool, the pH, the procedures followed to respond to the fecal accident (including the process used to increase free chlorine residual if necessary), and the contact time. B. Diarrhea (liquid stool) 1. See Al. 2. See A2. 3. Raise the free available chlorine concentration to 20 ppm (mg/L) t and maintain the pH between 7.2 and 7.5. Ensure this concentration is found throughout all co -circulating pools by sampling at least three widely spaced locations away from return water outlets. This chlorine and pH level should be sufficient to inactivate Cryptosporidium and should be maintained for at least 8 hours (one turnover for a standard pool). If necessary, consult an aquatics professional to determine and identify the feasibility, practical methods, and safety considerations before attempting the hyperchlorination of any pool. 4. Ensure that the filtration system is operating while the pool reaches and maintains the proper free available chlorine concentration during disinfection. 5. Backwash the filter thoroughly. Be sure the effluent is discharged directly to waste and in accordance with state or local regulations. Do not return the backwash through the filter. Where appropriate, replace the filter media. 6. Swimmers may be allowed into the pool after 8 hours and when the free available chlorine level has been returned to the normal operating range (1.0-3.0 ppm). Maintain the free available chlorine concentration and pH (7.2-7.8) at standard operating levels. If necessary, consult state or local regulatory authorities for recommendations on bringing the free available chlorine levels back to an acceptable operating range. 7. See A5. III. Vomit and Blood Incident Procedures in Swimming Pools A. Vomit Vomiting while swimming is frequently due to swallowing too much water and is probably not infectious. It is possible for Noroviruses, also known as Norwalk -like viruses, to be spread by vomit; therefore if the entire stomach contents are vomited, respond to the vomit incident as you would the "Formed Stool' procedure above. The procedure is: 1. Direct everyone to leave all pools into which water containing the vomit is circulated. Do not allow anyone to enter the contaminated pool(s) until all decontamination procedures are completed. 2. Remove as much of the vomit material as possible using a net or scoop and dispose of it in a sanitary manner. Clean and disinfect the net or scoop (e.g., after cleaning, leave the net or scoop immersed in the pool during disinfection). Vacuuming stool from the pool is not recommended*. 3. Raise the free available chlorine concentration to 2 ppm (mg/L), pH 7.2-7.5, if it is <2.0 ppm (mg/L). Ensure this concentration is found throughout all co -circulating pools by sampling at least three widely spaced locations away from return water outlets. This free available chlorine concentration was selected to keep the pool closure time to approximately 30 minutes. 4. Maintain the free available chlorine concentration at 2.0 ppm (mg/L), pH 7.2-7.5, for at least 25 minutes before reopening the pool. In the presence of chlorine stabilizers such as chlorinated isocyanurates, a level of 3.0 ppm (mg/L) of free available chlorine must be achieved. Ensure that the filtration system is operating while the pool reaches and maintains the proper free available chlorine concentration during the disinfection process. 5. Establish a vomit accident log. Document each vomit accident by recording date and time of the event, free available chlorine concentration at the time or observation of the event and before opening the pool, the pH, the procedures followed to respond to the vomit accident (including the process used to increase free chlorine residual if necessary), and the contact time. B. Blood Disease -causing organisms found in blood (e.g., Hepatitis B virus or HIV) are spread only through activities that involve the exchange of infected bodily fluids, such as, in sexual contact and sharing needles with an infected individual. According to the CDC, that agency is not aware of any of these organisms being transmitted to swimmers from a blood spill in a pool; therefore, there is no recommended procedure to be followed after a blood spill in a swimming pool. As a matter of comfort, the pool operator may choose to close the pool temporarily to satisfy patrons. Cleaning Up Body Fluid Spills on Pool Surfaces Body fluids, including blood, feces, and vomit are all considered potentially contaminated with bloodborne or other germs. Therefore, spills of these fluids on the pool deck should be cleaned up and the contaminated surfaces disinfected immediately. Appropriate Disinfectants Bleach One of the most commonly used chemicals for disinfection is a homemade solution of household bleach and water. Since a solution of bleach and water loses its strength quickly, a fresh mixture should be made before each clean-up to make sure it is effective. Other Disinfectants Recipe for Bleach Disinfecting Solution 9 parts cool water 1 part household bleach Add the household bleach to the water. Gently mix the solution. A listing of other approved commercial disinfectants can be found at www.epagov/ oppad001/chemregindex.htm and www.fda.gov/cdrh/ode/gerrnlab.htrnl. These disinfectants are effective when used according to the manufacturer's instructions. Clean-up Procedure Using Bleach Solution 1. Block off the area of the spill from patrons until clean-up and disinfection is complete. 2. Put on disposable gloves to prevent contamination of hands. 3. Wipe up the spill using paper towels or absorbent material and place in plastic garbage bag. 4. Gently pour bleach solution onto all contaminated areas of the surface. 5. Let the bleach solution remain on the contaminated area for 20 minutes. 6. Wipe up the remaining bleach solution. 7. All non -disposable cleaning materials used such as mops and scrub brushes should be disinfected by saturating with bleach solution and air dried. 8. Remove gloves and place in plastic garbage bags with all soiled cleaning materials. 9. Double -bag and securely tie-up plastic garbage bags and discard. Healthy Swimming These recommendations are for responding to fecal incidents in chlorinated aquatic venues (for example, pools and water playgrounds). Improper handling of chlorine -based disinfectants can cause injury, Follow proper occupational safety and health requirements when following these recommendations. For more pool chemical safety information, visit vy�wwcdc.gov/healthMater/ swimming/aquatics-professionals/preventing-pool-chemical-events html. CLOSURES: Fecal incidents are a concern and an inconvenience to both aquatic staff and patrons. Aquatic staff should carefully explain to patrons why the aquatic venue needs to be closed in response to a fecal incident. Explaining the reasons for closing the venue (for proper disinfection and protection of swimmer health) is likely to promote patron understanding and minimize their frustration. Closures allow chlorine to do its job—kill germs and help prevent recreational water illnesses (RWIs). Hot tubs/spas, and some water playgrounds, can have much smaller amounts of water. In response to formed or diarrhea) fecal incidents in small -volume venues, it might be more efficient to completely drain as much water as possible from the venue and associated plumbing; scrub and clean all accessible surfaces in contact with contaminated water; replace or clean filter media when appropriate, and refill with uncontaminated water from an approved source (for example, municipal water system). j Released September 15, 2016 CS266599A vl', lfhFJj,I[, (d](n) a, Dula.,... formed fecal matter (poop) in the water? Formed fecal incidents pose a risk for spreading germs, including moderately chlorine tolerant Giardia. To disinfect the water following a formed fecal incident, aquatic staff should follow the steps below, which are based on killing or inactivating Giardia. 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 disinfection 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 disinfection). VACUUMING FECAL MATTER FROM THEWATER IS NOT RECOMMENDED. Step 3: Using unstabilized chlorine (for example, sodium hypochlorite), raise the waters free chlorine concentration to 2 parts per million (ppm), if less than 2 ppm. Maintain free chlorine concentration at 2 ppm and water at pH 7.5 or less for 25-30 minutes.' Other concentrations or closure times can be used (see table). State or local regulators may require higher free chlorine concentration in the presence of chlorine stabilizers,' which are known to slow the rate at which free chlorine inactivates or kills germs. Step 4: Confirm that the filtration system is operating while the water reaches and is maintained at the proper free chlorine concentration and pH for disinfection. Step S: Allow swimmers back into the water only after the disinfection process has been completed and the free chlorine concentration and pH are within the operating range allowed by the state or local regulatory authority. I. Ideally, the water temperature should be 77°F (25°C) or higher during the disinfection process. 2. Chlorine stabilizers include compounds such as cyanuric acid, dichlor, and trichlor. 3. These closure times are based on 99.9% kill or inactivation of Giardia cysts by chlorine at pH 75 or less and temperature of 77°F (25°C) or higher.The closure times were derived from the U.S. Environmental Protection Agency (EPA) Disinfection Profiling and Benchmarking Guidance ManualShese closure times do not take into account"dead spots' and other areas of poor pool water mixing. 2 diarrhea in the water when chlorine stabilizer' is NOT in the water? A diarrhea) 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 diarrheal 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 waters free chlorine concentration (seeTable 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 flter.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 77T (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 4.7.3.3.2.4 (current edition of the MAHC is available at w .cdc.gov/mahcicurmntedition/index.htm 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. S. Shields JM, Hill VK Arrowood MJ, Beach MJ. Inactivation of Cryptosporidium porvum under chlorinated recreational water conditions.I Water Health. 2008;6(4):513-20. * 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 20-40 ppm (such as those used in the food industry) or make dilutions for use in a standard DPD test kit using chlorine -free water, 3 _r,(I4j)((D) tit � 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 diarrheal 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 ppm5 and maintain it for 28 hours or • Raise the free chlorine concentration to 30 ppm5 and maintain it for 18 hours or • Raise the free chlorine concentration to 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 S: 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. 40 ppm5 and maintain it for 8.5 hours 1. Chlorine stabilizers include compounds such as cyanuric acid, dichlor, and trichlor. 2, Ideally, the water temperature should be 77T (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 oocysU 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 w.cdcgov/mahcicurrenteditlon/indexhtmll or draining the aquatic venue(s). 4. Murphy f 4 Haas CN,Arrowood Mf, Hlaysa MC, Beach MJ, Hill VR Efficacy of chlorine dioxide tablets on inactivation of Cryptosporidium oocysts. Environ Sci Technol. 2014;48(10):5849-56, 5, 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 20-40 ppm (such w 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 hyperchlorination destroys Crypto's infectivity, it does not necessarily destroy the structure of the parasite. 4 Vomit in Pool Water Vomiting in the pool while swimming is a common event. Often, vomiting results from swallowing too much water, meaning that the vomit is probably not infectious. However, if the contents of the stomach are vomited, it is important to act immediately. Responding to a vomit incident (when vomit contains more than regurgitated water) The germs most likely to be spread by vomit are noroviruses (also known as Norwalk -like viruses). Respond to the vomit incident as you would respond to a formed fecal incident, using CDC's Fecal Incident Response Recommendations for Pool Staff [PDF -4 pages]. The time and chlorine level combinations needed to kill noroviruses and Giardia are similar. Since killing Giardia is the basis for CDC's formed fecal incident response recommendations, this protocol should be adequate for disinfecting a potentially infectious vomit incident. Town of Mansfield �^ 'Q 6 Park Row, Mansfield, Massachusetts 02048 508-261-7366 �y£AA9 h09�@ Health Department Amy Donovan -Palmer, Health Agent STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 CMR 435.000 SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC ❑ RFMT-PTTRT.TC - CDRCTAr. nrranncr~ nnnT n NAME OF POOL ADDRESS OWNER ADDRESS DATE OF S �� POOL CAPACITY —t O INSPECTED BY INSPECTION # OF GALS METHOD OF WATER BATHER# rr OF LIFEGUARDS WATER SOURCE: TREATMENT LOAD C. -P ` Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of 105 CMR 435.000. Items marked with a "✓" are satisfactorv. I REGULATION X/✓ VIOLATIONS/COMMENTS I .03 Adequate enclosure around pool. Gate self -latching w/ latch 4 ft above ground. .04 Sewage Disposal .05 Location, structural stability, finish. .06 Water circulation & filtration systems. Filter Effluent Flow meter reading: Cdq pm. # of turnovers .06 Suitable automatic equipment for disinfection of pool water. .06 Carbon dioxide (CO2) equipment for pH control adequate. CO2 cylinders anchored. Inaccessible to public, adequate ventilation provided. .08 Inlets and outlets - Inlets located to produce uniform circulation. Over rim fill spout 6" above maximum water level. Properly shielded and located. .08 Main drain suction outlets covered with suitable protective covers or grates. Cannot be removed without the use of tools. Open area does not provide entrapment of fingers, toes, etc. At least one antivortex drain provided. .08 Each system outlet protected against user entrapment by antivortex cover or other means. Minimum of 2 suction outlets provided for each pump, properly located and plumbed. .08 Suction outlet covers in place, unbroken and secure and cannot be removed except with the use of tools. Close pool immediately if outlet covers missing, broken, loose or can be removed without tools hc.�� JSunGve-'C �Ihay.v cel .08 Special purpose pool and wading pools equipped with emergency shut off pump switch. Accessible and prominently marked. .09 Cross connections. Portable water supplied through air gap. .10 Skimming facilities. 50% of recirculation drawn from surface of pool. .12 Line with floats separates non -swimmer area from deeper water. .12 Water depth markings on deck and walls. Properly spaced. Boundary line on pool floor and walls. Step edges marked with contrasting color. .13 Walkway and decks 4 feet wide, safe condition. 14 Ladders, steps - one per 75 feet. Not less than 2 ladders. 15 Diving equipment in safe condition. 17 Pool supervision - Pool supervision provided. Effective Jan. 1, 1999, pool supervisor certified as pool operator from YMCA or NSPF. .21 Permit requirements - Permit issued. Adequate maintenance and testing records maintained. Records initialed by person making tests. .22 Health regulations: Signs posted. Health warning signs posted for special purpose pools. —/ .23 Lifeguards required: Yes ❑ No [� If lifeguards required. Proper credentials, proper suits and garments worn. Whistle and bullhorn provided .24 Safety equipment. Ring buoys and rescue hook provided. Rescue tube and backboard with straps at pools attended by a lifeguard. .25 First Aid equipment provided. .25 Emergency Communication System at the pool and in working order. Emergency communication device in unlocked area and available at all times to staff and the public. Operating instructions and emergency numbers posted. .26 Waste and backwash water disposal properly discharged. No direct connection to sewer system. Separation tank provided for diatomaceous earth filter backwash water. .29 Chemical standards Alkalin 50-150 to CJ I Free Chlorine (1.0-3.0 m , ' .O Cyanuric Acid (30-100 ppm) " Comb, (0`.0-0.2 ppm)' , d Water Temp. 104°B. pH lever -78) * nartts ner million Other .29 Pool water tested with appropriate frequency. .30 Water testing equipment. DPD kit provided for chlorine and bromine. Unbreakable thermometer for special purpose pools. .31 Water clarity .32 Water clarity maintenance. Filtration system operating continuously. .32 Special purpose pool drained, cleaned and every 14 days. Maximum Operating Temperatures for Special Purpose Pools. (SPP). .33 a. Thermostatic control provided for each SPP. b. Thermostatic control only accessible to the pool operator .38 General sanitation CORIGIN May 1, 2019 Board of Health Town of Mansfield Attn: Amy Donovan -Palmer 6 Park Row Mansfield, MA 02048 Certified Mail, Return Receipt Requested RE: 2019 Swimming Pool Permit Enclosed please find a completed Swimming Pool Application, Worker's Compensation Insurance Affidavit, Insurance Policy Declaration Page, a copy of my CPO Certificate, tax Certification Form, written policy on fecal/vomit/blood incidents and a check in the amount of $150.00. Should you have any questions or require anything further, please feel free to contact the office. Also, here is my email which was requested: msampson@corigin.com Thank you; Michaella)J Sampson Property ;Manager 505 Fifth Avenne New York NY 10017 1 212.775.1111 1 wmNw.corigin.cnm