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Home My WebLink AboutCanoe River CG 12/31/2017Commonwealth 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: 1 PERMIT EXPIRES: December 31, 2017 Person Certified: MARK A. BURMEISTER Pool/SPA Certification Date: October 25, 2013 Pool/SPA Certification Expires: October 25, 2018 Person Certified: PHILIP J. CARROLL Pool/SPA Certification Date: October 25, 2013 Pool/Spa Certification Expires: October 25, 2018 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: CANOE RIVER CAMPGROUND for the operation of a ❑ Public Semi -Public F] Special Purpose Pool located at: 137 MILL STREET Method of water treatment is CHLORINE Bathing load not to exceed: 94 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. .Amy Donovan-PaCmer, Health .Agent - I Date Issued .0 i I NOV 2016 [3v. Town of Mansfield Town of Mansfield - Board of Hddl&- 6 Park Row Mansfield, MA 02048 Swimming pool Application PERMIT NUMBER 1 FEE: $125 NAME OF OWNER: CANOE RIVER CAMPGROUND ADDRESS: 137 MILL STREET CITY: MANSFIELD STATE: MA ZIP: 02048 TELEPHONE: (508) 339-6462 FAX: (508) 339-5237 EMAIL: c7 t",C(t C`' C—`k.) r t ✓C-- C�,'li FED ID/SS NO: 04-2375571 Certification Expires Every 5 Years. Permit Expires December 31st Yearly. PERSON CERTIFIED: MARK A. BURMEISTER Pool/SPA Certification Date: 10/25/2013 Pool/SPA Certification Expires: 10/25/2018 PERSON CERTIFIED: PHILIP J. CARROLL Pool/SPA Certification Date: 10/25/2013 ❑ Public POOL OPERATION: Semi -Public ❑ Special Purpose Pool POOL LOCATION: 137 MILL STREET TYPE/POOL: CEMENT LENGTH: 57' VOLUME: 60,000 MIN/MAX DEPTH: T-10' SWIM AREA: 57'x30' WATER SOURCE: TOWN W/W DISPOSAL: TOWN SEWER TYPE OF FINISH: CEMENT SCUM GUTTER: DECK TYPE: CEMENT SKMMR WEIR LENGTH: 4 TREATMENT SYSTEM: SAND DISINFECT METHOD: CHLORINI WIDTH: 30' Poo/VSP.A Certification Expires: 10/25/2018 CHEMICAL TREATMENT: AUTOMATIC certification remarks(if necessary): REMARKS: "NO LIFEGUARD ON DUTY" sign is required. NUMBER OF BATHERS: 94 DIVE AREA: NONE SIGNATURE- C ye.µ: DATE: Please make appropriate changes. Sign, date and enclose check payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048. 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. * Signature of Individual or Corporate Name (Mandatory) By: Corporate Officer (Mandatory, if applicable) 7I ** Social Security Number (Voluntary) or Federal Identification Number * This license will not be issued unless the 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 Mass. General Laws, Chapter 62C, Section 49A. REGULATION NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE w✓ .34 Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. Qm� �wv D��"k—L SIGNED SIGNED Operator Board o Health/Health Department STATE SANITARY CODE: CHAPTER 165 CMR 43STANDARDS A DARDS FOR SWIMMING POOLS, SWIMMING L INSPECTION TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC1A SPECIAL PURPOSE POOL ❑ NAME OF POOL ADDRESS ventilation; sanitary condition. .03 Adequate enclosure around pool. Gate self -latching w/ OWNER ADDRESS .04 Sewage Disposal DATE OF POOL CAPACITY INSPECTED BY .06 Water circulatioW-1 filtration systems. Filter Effluent flow INSPECTION # OF GALS Suitable automatic a ui ment ft'or disi fection o 00 q p � `tion po METHOD OF WATER SO—VZ' BATHER # OF LIFEGUARDS WATER SOURCE: TREATMENT LOAD ��r\ public, adequate ventilation provided. 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 satisfactory. REGULATION X/✓ VIOLATIONS/COMMENTS .03 Bathhouse and sanitary facilities adequate lighting; ventilation; sanitary condition. .03 Adequate enclosure around pool. Gate self -latching w/ latch 4 ft above ground. .04 Sewage Disposal .05 Location, structural stability, finish. ✓ .06 Water circulatioW-1 filtration systems. Filter Effluent flow meter reading: C; gpm. # of turnovers Suitable automatic a ui ment ft'or disi fection o 00 q p � `tion po .06 water. .06 Carbon dioxide (CO2) equipment for pH control �U 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 v 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, J broken, loose or can be removed without tools .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,Voper 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 POOLSIDE READINGS Bromine 1 (2.0-6.0 rmm' Alkalinity 50-150 ppm) Cyanuric Acid (30-100 ppm) Water Temp. 104°F. ' * parts per million VA .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 M Total Chlorine Free Chlorine 1.0-3.0 m Comb. (0.0-0.2 ppm) pH level (7.2-7.8) Other