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Home My WebLink AboutMansfield Meadows 12/31/2014Commonwealth 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: 7 Pool/SPA Certification Date: October 10, 2012 PERMIT EXPIRES: December 31, 2014 Pool/SPA Certification Expires: August 31, 2017 Person Certified: NEMANJA MIKIC Pool/SPA Certification Date: Pool/Spa Certification Expires: Person Certified: 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: BEACON COMMUNITIES, LLC for the operation of a ❑ Public at. Method of water treatment is Bathing load not to exceed. ❑v Semi -Public 12 BONNEY LANE #9 CHLORINE TABLET 51 bathers Number of Lifeguards required at all times the pool is open is: "NO LIFEGUARD ON DUTY" sign is required. Scott Leite, Heaah .Agent ❑ Special Purpose Pool None Date Issued Town of Mansfield - Board of Health Sivininting Pool Application NAME OF OWNER: Q,Q (OVA `" VA\" U"" ADDRESS: � 2 &"A e -Y L o-v.,L. CITY:i�a'os�;sZ« STATE: m A- ZIP: V ZO t(1R TELEPHONNE: r%J��7j(� FAX: -5VC) _ 2 �� J� (0 C EMAIL: \ 0 0 lJ0 ski �L v�� 1 1 OaI `> W VAA FED ID/SS NO: D 2--? g01)J0 FEE PER POOLA Z Town of Mansfield 6 Park flow Mansfield, MA 02048 PERMIT NUMBER FEE: $125 [] Public POOL OPERATION: M Semi -Public [] Special Purpose Pool POOL LOCATION: � �:M cAa l o W S TYPEIP00L: "ULA V\ LENGTH: 40 \ WIDTH: ZZ\ VOLUME: " co �O� ah V1'� MINIMAX DEPTH: SWIM AREA: W) WATER SOURCE: 0W Vl DIVE AREA: 0 /A - SIGNATURE: WA 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 02098. On �. U0v_ NO jUN 03 2014 r r w *€fig Town of Mansfield - Board of Health Sivininting Pool Application NAME OF OWNER: Q,Q (OVA `" VA\" U"" ADDRESS: � 2 &"A e -Y L o-v.,L. CITY:i�a'os�;sZ« STATE: m A- ZIP: V ZO t(1R TELEPHONNE: r%J��7j(� FAX: -5VC) _ 2 �� J� (0 C EMAIL: \ 0 0 lJ0 ski �L v�� 1 1 OaI `> W VAA FED ID/SS NO: D 2--? g01)J0 FEE PER POOLA Z Town of Mansfield 6 Park flow Mansfield, MA 02048 PERMIT NUMBER FEE: $125 [] Public POOL OPERATION: M Semi -Public [] Special Purpose Pool POOL LOCATION: � �:M cAa l o W S TYPEIP00L: "ULA V\ LENGTH: 40 \ WIDTH: ZZ\ VOLUME: " co �O� ah V1'� MINIMAX DEPTH: SWIM AREA: W) WATER SOURCE: 0W Vl DIVE AREA: 0 /A - SIGNATURE: WA 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 02098. I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. N�AIUB VlQ.V1�J-tT0A t)vIS * Signature of In'tilvidual or Corporate Name (Mandatory) By: Corporate Officer (Mandatory, if applicable) ** 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. Ellis & Associates ILTPTM Course Completion International Lifeguard Training Program TM Last Name: First Name: Petrovic Ana Mailing Address: 8520 Corridor Road, Suite B Country: US LTP Course type: (Please Shallow Lifeguard Shallow Lifeguard Personal Information Middle Name: City: Savage Date of Birth: I Certificate Number: 09/16/19 9101-300-1020-2579 State/Province: Postal Code: MD 20763 Email: Home Phone: Work Phone: 301-498-1000 Course Information Training Course Type: Pool Lifeguard Special Lifeguard F,/1 New - Original I ❑ Renewal (with Open Water Training includes conscious, unconscious and suspected neck and back rescue skills for water depths not to exceed 5 feet, excluding open water environments. AAOS/ACEP (Emergency Care & Safety Institute-ESCl.org) Healthcare Provider CPR, AED, Oxygen Administration and Standard First Aid training included. ILTP - Continental Pools, Inc Completion Date: 03/30/2014 Pool Lifeguard Training includes conscious, unconscious and suspected neck and back rescue skills for water depths not exceeding 16 feet -excluding open water environments. AAOS/ACEP (Emergency Care & Safety Inslitute- ESCI.org) Healthcare Provider CPR, AED, Oxygen Administration and Standard First Aid training included. Expiration Date: 3/30/2015 Special Facilities Lifeguard Training includes conscious,unconscious and suspected neck and back rescue skills for water depths not exceeding 16 feet including wave pools and open water environments. AADS/ACEP (Emergency Care & Safety Institute-ESCLorg) Healthcare Provider CPR, AED, Oxygen Administration & Standard First Aid training included. City: State: Savage I MD ILTPTM Course Completion Acknowledgment I acknowledge that I have received and understand the ILTPTm Training Program curriculum and demonstrated said skills and knowledge to required competencies. I further understand that it is my personal responsibility to maintain my skills and knowledge demonstrated during the ILTPT"' course through regular and consistent in-service training. It is also the responsibility of my employer to provide site specific orientation and in-service training prior to working as a lifeguard. I further understand and acknowledge that Ellis & Associates and/or ILTP does not provide any protection whatsoever to my employer or myself. Lifeguard Name (Please Print). Lifeguard Signature Ana Petrovic -An cknL I e -CV 0 v1 e_ ILTPTM Instructor Validation Information I hereby certify that the holder of this ILTP T"' Course Completion Credential has successfully met all required skins competencies tjj iuuuu 1g uuL 1 limited to Prerequisite screening, rescue skills, BLS Skills, written and practical exams) and curriculum requirements as prescribed by the International Lifeguard Training Progra MPA for the lifeguard classification indicated above. I have also reviewed the ILTPT'" Course Completion Acknowledgment with 'ts holder and am satisfied the card holder clearly understands said acknowledgment. Date: Max Water Depth:_] ft/m Updated Max Water Depth: ft/m Instructor Name: InstructorID: Instructor Name (Please P'ro,ti Instructor Signature: a Emosi Vodo ry For additional information regarding the International Lifeguard Training ProgramTM please call or write to Jeff Ellis & Associates, Inc. Business Office, 508 Goldenmoss Loop Ocoee, FL 34761 Office: 1-800-742-8720 Facsimile: 407-654-1723 E-mail: business@iellis com Distribution: This certificate is issued from Jeff Ellis & Associates, Inc. Corporate Headquarters, Kingwood, TX. Revised 1/2011 Last Name: DNJ Mailing Address: 3� woody' Country: U (A Ellis & Associates ILTPTM Course Completion International Lifeguard Training Program TM First Name: [4� STo lz Information - Middle Name: Date of Birth: Certificate Number. t�,� CUCK 04,/oii�nkS 101-300®1026-2040 City: State/Province: Postal Code: orU" ILTP Course I ype: (urease r F� Shallow Lifeguard Shallow Lifeguard Training includes conscious, unconscious and suspected neck and back rescue skills for water depths not to exceed 5 feet, excluding open water environments. AAOSIACEP (Emergency Care & Safety Institute-ESCI.org) Healthcare Provider CPR, AED, Oxygen Administration and Standard First Aid training included. Training Center of Kecora: ILTP - Continental Pools; Inc Completion Date, Pool Lifecluard Training includes conscious, unconscious and suspected neck and back rescue skills for water depths not exceeding 16 feet -excluding open water environments. AAOS/ACEP (Emergency Care & Safety Institute- ESCl.org) Healthcare Provider CPR, AED, Oxygen Administration and Standard First Aid training included. Special Facilities Lifeguard Training includes conscious,unconscious and suspected neck and back rescue skills for water depths not exceeding 16 feet including wave pools and open water environments. AAOS/ACEP (Emergency Cate & Safety Institute-ESCI-org) Healthcare Provider CPR, AED, Oxygen Administration & Standard First Aid training included City: Savage Expiration Date: 0� — T--20 f State: MD I acknowledge that I have received and understand the iLTPTm Training Program curriculum ana aemonsuaiau Baru u �...., 7 required competencies. I further understand that it is my personal responsibility to maintain my skills and knowledge demonstrated during the ILTPTm course through regular and consistent in-service training. It is also the responsibility of my employer to provide site specific orientation and in-servioe training prior to working as a lifeguard. I further understand and acknowledge that Ellis & Associates and/or ILTP'"'' does not provide any protection whatsoever to my employer or myself. Lifeguard Name (Please Print): Lifeguard Signature: L\m - . i1t) I hereDy cerary incl[ ute nuruai w uu� I" I Fw4.� ��•••r•��- -. ___.._-- --- _ limited to Prerequisite screening, rescue skills, BLS Skills, written and practical exams) and curriculum requirements as prescribed by the International Lifeguard Training Program"" for the lifeguard classification indicated above. I have also reviewed the ILTPTT' Course Completion Acknowledgment with its holder and am satisfied the card holder clearly understands said acknowledgment. Date: Max Water Depth:_�ft/m Updated Max Water Depth: ft/m Instructor Name: InstructorlD; Instructor Name (Please Print): G Instructor Signature: For additional information regarding the International Lifeguard Training Program-' please call or write to: Jeff Ellis & Associates, Inc. Business Office, 508 Goldenmoss Loop Ocoee, FL 34761 Office: 1-800-742-8720 Facsimile: 407-654-1723 E-mail: businessCa'Diellis.com Distribution: This certificate is issued from Jeff Ellis & Associates, Inc. Corporate Headquarters, Kingwood, TX. Revised 1/2011 Ellis & Associates ILTPTM Course Completion International Lifeguard Training Prograrn TM Personal Information ; Last Name: First Name: Middle Name: Date of Birth: Certificate Number: �1Jr-'1Is KC. Ad Ttt05 0;1 ca, �Igc� 101®300-1020®205 Mailing Address: City: State/Province: Postal Code: k OZ Country: Email: Home Phone: Work Phone: Usk mceui iSII �11�� i1� r �o�i -t�2 tformaton` _ ILTP Course Type: (Please Check One) Training Course Type: Shallow Lifeguard Pool Lifeguard E] Special Lifeguard 0 New - Original I ® Renewal ❑with Open Water Shallow Lifeguard vard Pool Lifec Special Facilities Lifeguard Training includes conscious, unconscious and Training includes conscious, unconscious and suspected Training includes conscious,unconscious and suspected neck and back rescue skills for water depths not to exceed 5 feet, excluding open water neck and back rescue skills for water depths not exceeding 16 feet -excluding open water environments_ suspected neck and back rescue skills for water depths not exceeding 16 feet including wave pools environments. AAOS/ACEP (Emergency Care & AAOS/ACEP (Emergency Care & Safety Institute- and open water environments. AADS/ACEP Safety Institute-ESCI,org) Healthcare Provider ESCLorg) Healthcare Provider CPR, AED, Oxygen (Emergency Care & Safety Institute-ESCLorg) CPR, AED, Oxygen Administration and Standard First Administration and Standard First Aid training included. Healthcare Provider CPR, AED, Oxygen Administration & Standard First Aid training included. Aid training included. Training Center of Record: City: State: ILTP - Continental Pools, Inc Savage MD Completion Date: Expiration Date: A le gment IL�PT!!'Course Completion I acknowledge that I have received and understand the ILTP"'' Training Program curriculum and demonstrated said skills and knowledge to required competencies. 1 further understand that it is my personal responsibility to maintain my skills and knowledge demonstrated during the ILTP'"' course through regular and consistent in-service training. It is also the responsibility of my employer to provide site specific orientation and in-service training prior to working as a lifeguard. I further understand and acknowledge that Ellis & Associates and/or ILTP"m does not provide any protection whatsoever to my employer or myself. Lifeguard Name (Please Print): Lifeguard Signature ILTPTM Ins00 1lal(datlon Information I hereby certify that the holder of this ILTP n^ Course Completion Credential has successfully met all required skills competencies (including but not limited to Prerequisite screening, rescue skills, BLS Skills, written and practical exams) and curriculum requirements as prescribed by the International Lifeguard Training Program"m for the lifeguard classification indicated above. I have also reviewed the ILTPTM Course Completion Acknowledgment with its holder and am satisfied the card holder dearly understands said acknowledgment. Max Water Depth:6ft/m updated Max Water Depth: ft/m Instructor Name: InstructorID: Date: Instructor Name (Please Print): Instructor Signature: e—mot9 O Moe- qacFor Foradditional information regarding the International Lifeguard Training Program" please call or write to- Jeff Ellis & Associates, Inc. Business Office, 508 Goldenmoss Loop Ocoee, FL 34761 Office: 1-800-742-8720 Facsimile: 407-654-1723 E-mail: businesspeellis.com Distribution: This certificate is issued from Jeff Ellis & Associates, Inc. Corporate Headquarters, Kingwood, TX, Revised 1/2011 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 i www,nlass.govIdia Workers' Compensation Insurance Affidavit: General Businesses Applicant Informationcc Please Print Legibly Business/Organization Name: (� � �n�tln ) VA&i ��ook Address: 05ZO (,ti MC)�� City/State/Iip: U��%'vlx"a v-,Zy % Phone #: Are you an employer? Check lite appropriate box: 1. I am a employer with employees (full and/ Business Type (required): 5. 0 Retail or part-time).* 6. j] Restaurant/Bar/Eating Establishment 2. ❑ 1 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. Non-profit [No workers' comp. insurance required]S• 3.0 We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, § 1(4), and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]* 4.0 We are a non-profit organization, staffed by volunteers, 11.0 Health Care ,.,/ 12.t_y' Other i1J t-VkA wi with no employees. [No workers'•eomp. insurance req.] *Any applicant that checks box # l must also fill out the section below showing their workers' compensation policy information. **lithe corporate officers have exempted theinwives, but the corporation has other employees, a workers' compensation policy is requited and such an organization should chock box t11. I am an employer that is providing workers' cora ensatlot+ Insrtranrce for my en+ployees Belonp is the policy infornrallon. Insurance Company Name: t (,t��i� S 10,1 � W "I Insurer's Address:. W sok D -w av i ! City/State/Zip., UW(GV `s Policy 9 or Self -ins. Lie. h lU L �C7� �US l 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 Ind 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 DTA for insurance coverage verification. Ido hereby certify, antler t re pains andpenallies ofperjnry that the infornrallon provided above is true and correct i i 1 ` CionahtYe_ �, i Date: Phone 9, do� �IQOO Official rise only. Do not lvrite in this area, to be completer) by city or town offlelal City or Town: Permit/License 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 Person: Plione wwsv.mass.gov/dna � �� DATE (MMlOD1YYYY) CERTIFICATE OP LIABILI Y INISURv � 10/28/2013 THIS CERTIFICATE is ISSUED AS A MATTER OF INFORMATION ONLY CONFERSAND ALTER RIGHTS COVERAGE AFFORDED UPON THE TE THE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR 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 be endorsed. If SU@ROGAT{ON IS WANED, 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). CONTACT RODUCER NAVE:FAX PHONE 2- 7- 1 A1C No :4 - 7 Iliant insurance Services, Inc. 415 East Camelback Rd E-MAIL ADDREss: i rk w lli n . m "Ue 420 7 -- - ^ - - `-1N5URER(Sj AFFORDING Cr`( MAIC rY-- hoenir. AZ 35016-4266 II GJE�i i+Gc _ _._i_r n,-.,.,...Ih. mm�anv x.044.3 VSURED - ;ontinental Pools, LLC INSURERC:� .520 Corridor Rd., #B INsuRERo:' 'avage, MD 20763 INSURER E: OVERAGES CERTIFICATE NUMBER: 1826910975 REVISION NUMBER: POLICIES RTIFY THAT THE 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THIS IS—TO CE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED I IEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUER POLICY EFF POLICY EXP LIMITS VSR POLICY NUMBER MIDD MMIDD TRTYPE OF INSURANCE 1 SR 100001724604 0!2512013 0/2512014 EACH OCCURRENCE $2,000,000 �GEE�NMERALLIM—IJTY I 1 __r- -m n _c,_! a i PREMISES Ea ocwnence S1 000,000 X COtdMERCtAL GENERAL L,ABILiTY t CLAIMS -MADE a OCCUR I MED EXP (Any one person) $ 111 I PFRSONAL & ADV INJURY $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mora space is required) TE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W Proof Of insurance ACCORDANCE WITH THE POUCY PROVISIONS, Continental Pools, LLC 852-6, Coiffi'dcr ,, ad -amu I-,- AUiitO}i2E1� GaRESEtFAT1E Savage MD 20763 ° ACORD 25 (2040105) U i988-20`10 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Li j GENERAL AGGREGATE $2,000,000 PRODUCTS -COMPIOPAGG $2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: i Policy Aggregate $$10,000,000 POLICY X PRO X LOC gl IAFDR5r1DS791 012512013 012512014 fEa Pr;Jen11 $1,00-000 1 + AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE X NON -OWNED XJX Peraccideml—�..�__ HiRED AUTOS AUTOS $ CAEX000001953102 0/25/2013 0/25!2014 EACH OCCURRENCE $10,000,000 = UMBRELLALiAB X OCCUR AGGREGATE 510,000,000 EXCESS LIAB CLAIMS MADE 4s- UtD REiL-Ci1iUNS- 05085005189 0115!2013 WCSTA7U- OTti- 0/`L5/LU14 X 3 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN EJ- EACH ACCIDENT 51,_000 ,000 - ANY PROPRIETORiPARTNEPJEXECUTIVE LJNIA OFFICERIMEMBEREXCLUDED? i i E.LDiSEASE-EAEMPLOYE .0,000,000 (6landatory in NH) lips, descriheundet ' E.LDISEASE-POLiCYLIf�iT 51,000,000 DESCRIPTIO,"? OF OPERATIONS treidty F13EXC7613611V 0125/2013 0/2512014 Each Occurrence $10,000,000 General Aggregate $10,000,000 D EXCESS AUTOMOBILE DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mora space is required) TE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W Proof Of insurance ACCORDANCE WITH THE POUCY PROVISIONS, Continental Pools, LLC 852-6, Coiffi'dcr ,, ad -amu I-,- AUiitO}i2E1� GaRESEtFAT1E Savage MD 20763 ° ACORD 25 (2040105) U i988-20`10 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD l"b" =.•tom eft.=♦ .:. rr.r „<•'+ r, <,,=k'.x`,'rr .``'3 f s`s.*,t..€.?r yt°t++i'trs"a rj{h beff�ark=*s9..;aaa�,'a:a�.,�.f'.yf�8_e.acsfe ixneit�6�afes.¢*'�.r°}. "Ysasfaaf:t:rar Jay}!fif--- ARA 'd== is =:Pie—'asa.,Pa vensM1,,�; ft §_ rbra � �y.�� i_ tz F== ¢1fr£ 1di ivi- v14 ki ��z�t�i € va msm ow I a� A ® o F� V� NAME OF CITY OR TOWN STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 CMR 435.000 SWIMMING POOL INSPECTION REPORT mcrnn ter. nnnT . TITTDT Tf, r9 cT7A,TT_DTTRT T(' CPR('TAT. P1TRPn0,P P()()T. 11 NAME OF POOL ADDRESS OWNER �" ADDRESS DATE OF INSPECTION P06L CAPACITY # OF GALS INSPECTED BY e METHOD OF WATER TREATMENT , BATHER LOAD # OF LIFEGUARDS WATER SOURCE: 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 A3 Bathhouse and sanitary Tacmtles adequate ugming; 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 circulatioation systems. Filter Effluent flow meter reading: gpm. # 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 .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 POOLSIDE READINGS Bromine 2.0-6.0 m* otal Chlorine chlorine and bromine. Unbreakable thermometer for Alkalinity 50-150 ppm) special purpose pools. Free Chlorine 1 .0-3.0 m .31 Water clarity Cyanuric Acid (30-100 ppm) ` / Comb. hlorine (0.0-0.2 ppm) v Water Temp. 104°F. H level kther (7.2-7.8) *parts per million Maximum Operating Temperatures for Special Purpose Pools. (SPP). .29 Pool water tested with appropriate frequency. .30 Water testing equipment. DPD kit provided for chlorine and bromine. Unbreakable thermometer for i / special purpose pools. �/ .31 Water clarity ` / .32 Water clarity maintenance. Filtration system operating v continuously. V .32 Special purpose pool drained, cleaned and every 14 days. ,n_ ��'J Maximum Operating Temperatures for Special Purpose Pools. (SPP). n .33 a. Thermostatic control provided for each SPP. r6 b. Thermostatic control only accessible to the pool operator / .38 General sanitation V I,- REGULATION ' NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE .34 Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. SIGNED SIGNED Operator Board of Health/Health Department