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Home My WebLink AboutWest Village Apts 12/31/2013Commonwealth 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: 16 Pool/SPA Certification Date: May 13, 2011 PERMIT EXPIRES: December 31, 2013 pool/SPA Certification Expires: May 13, 2016 Person Certified: MICHAEL MASON Pool/SPA Certification Date: March 20, 2013 Pool/Spa Certification Expires: March 20, 2018 Person Certified: SEAN THOMPSON 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: BEHRINGER HARVARD WEST VILLAGE PROJECT OWNER, LLC for the operation of a ❑ Public at: Method of water treatment is Bathing load not to exceed F./I Semi -Public 792 WEST STREET ❑ Special Purpose Pool CHLORINE/CHLORINATOR RAINBOW 300 93 bathers Number of Lifeguards required at all times the pool is open is: "NO LIFEGUARD ON DUTY" sign is required. Scott Leite, Heaah Agent None 9k2D Issued 55 Town of Mansfield - Board of Health Swimming Pool Application NAME OF OWNER: BEHRINGER HARVARD WEST VILLAGE PROJECT OWNER, LLC ADDRESS: 792 WEST STREET (508) 787-1005 CITY: MANSFIELD STATE: MA ZIP: 02048 TELEPHONE: (509) 261-0500 Town of Mansfield 6 Park Row Mansfield, MA 02048 PERMIT NUMBER: 16 ❑ Public POOL OPERATION:❑ Semi -Public ❑ Special Purpose Pool POOL LOCATION: 792 WEST STREET TYPE/POOL: GUNITE SEMI-PUBLIC LENGTH: 56' WIDTH: 25' VOLUME: 42,000 GALLONS FAX: (508) 261-0501 EMAIL: LAURA.PREBLE@BHRES.COM WWW.LIVEWESTVIL MIN/MAX DEPTH: 4 ft. FED ID/SS NO: 45-1501972 --- SWIM AREA: 1,400 sq. ft. FEE PER POOL: $75.00 WATER SOURCE: TOWN EvCertification Expires e y - Years. W/W DISPOSAL: TOWN SEWER Permit Expires December 31st Yearly.TYPE OF FINISH: PLASTER PERSON CERTIFIED: )cF}C� �SOrlSCUM GUTTER: N/A Pool/SPA Certification Date: 5/13/11 6"14 DECK TYPE: CONCRETE Pool/SPA Certification Expires:5-1113 J6 � SKMMR WEIR LENGTH: 8" DIVE AREA: N/A PERSON CERTIFIED: ec,r p TREATMENT SYSTEM: ASTRAL SAND FILTER Pool/SPA Certification Date:�oz/ DISINFECT METHOD: CHLORINE/CHLORINATOR RAINBOW 300 Pool/SPA Certification Expires: 3/c> CHEMICAL TREATMENT: CHLORINE certification remarks(if necessary): NUMBER OF BATHERS: 93 REMARKS: I "NO LIFEGUARD ON DUTY" sign is required. w , SIGNATURE: _ 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. Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health �rmit to Operate a Swimming Pool PERMIT NUMBER: 18 Pool/SPA Certification Date: March 13, 2011 PERMIT EXPIRES: December 31, 2013 Pool/SPA Certification Expires: March 13, 2016 Person Certified., MICHAEL MASON Pool/SPA Certification Date: March 20, 2013 Pool/Spa Certification Expires: March 20, 2018 Person Certified: SEAN THOMPSON 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: BEHRINGER HARVARD WEST VILLAGE PROJECT OWNER, LLC for the operation of a ❑ Public ❑ Semi -Public Special Purpose Pool at. 792 WEST STREET Method of water treatment is CHLORINATOR/SAND FILTER Bathing load not to exceed. 8-10 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. Scott Leite, Heaah .Agent 96ADate Issued .7" � 1> Town of Mansfield - Board of Health �6 r y Swimming Pool Application NAME OF OWNER: BEHRINGER HARVARD WEST VILLAGE PROJECT OWNER, LLC ADDRESS: 792 WEST STREET CITY: MANSFIELD STATE: MA ZIP: 02048 TELEPHONE: (508) 261-0500 Town of Mansfield 6 Park Row Mansfield, MA 02048 PERMIT NUMBER: 18 ❑ Public POOL OPERATION: ❑ Semi -Public ❑v Special Purpose Pool POOL LOCATION: 792 WEST STREET TYPE/POOL: SPA/HOT TUB LENGTH: N/A WIDTH: N/A VOLUME: 1500 GAL. FAX: (508) 261-0501 EMAIL: LAURA.PREBLE@BHRES.COM WWW.LIVEWESTVIL MINIMAX DEPTH: 3.5 FT. FED ID/SS NO: 45-1501972 SWIM AREA: N/A DIVE AREA: N/A FEE PER POOL: ( $7500 WATER SOURCE: TOWN Certification Expires Every 5 Years. W/W DISPOSAL: TOWN SEWER Permit Expires December 31St Yearly. / TYPE OF FINISH: PLASTER PERSON CERTIFIED: f J/e� SCUM GUTTER: N/A Pool/SPA Certification Date: 5113111 2`2.� DECK TYPE: CONCRETE Pool/SPA Certification Expires: /f 3//�D25 2 4r, SKMMR WEIR LENGTH: 8" PERSON CERTIFIED: �c TREATMENT SYSTEM: CHLORINE Pool/SPA Certification Date: 312o113 DISINFECT METHOD: CHLORINATOR/SAND FILTER Pool/SPA Certification Expires: 3ca1 CHEMICAL TREATMENT: CHLORINE certification remarks(if necessary): REMARKS: NO LIFEGUARD ON DUTY" sign is required. No lifeguard on duty. Sign is required. SIGNATURE: NUMBER OF BATHERS: 8-10 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. * Signatu a of Individual or Corporate Name (Mandatory) m By: Corporate Officer (Mandatory, if applicable) k ** 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 IV www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: I Address: 9�5 � (-V V U City/State/Zip: ZLC,t2 5f), I _ C ie Phone #: n_ tl - 0 Are you an employer? Check the appropriate box: Business Type (required): CE I am a employer with employees (full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2. ❑ I 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] g• ❑Non-profit 3. ❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per e. 152, §1(4), and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]* 11 ❑ Health Care 4. ❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers'. comp, insurance req.] 1 12. El OtherUd>r(" i 10 ..kir) F5164 *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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name: 11 ln5ornom CD C t Insurer's Address:T� City/State/Zip: p g J Policy # or Self -ins. Lic. # a ,91135 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 Investigations of the DTA for insurance coverage verification. I do hereby cert, . �;'rndfr a pains and penalties of perjury that the information providel above is true and correct. Phone #: SCIF ` a n5 ") 0 Official use only. Do not write in this area, to be completed by city or town official City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Contact Person: Permit/License # 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office www.mass.gov/dia Phone # ZZ C D b DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 - http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above-mentioned chapter by insuring with: NAME OF INSURANCE COMPANY 175 Water Street, 18th Floor New York, NY 10038 ADDRESS OF INSURANCE COMPANY 000292113 3/1/2013 to 3/1/2014 POLICY NUMBER EFFECTIVE DATES Marsh USA Inc. Comerica Dank Tower, 1717 Main St. Dallas, TX 75201 214 303 8450 NAME OF INSURANCE AGENT ADDRESS • Behringer Harvard Holdings, LLC. 15601 Dallas Parkway, Ste. 600 EMPLOYER ADDRESS Addison, TX 75001 EMPLOYER' S WORKERS' COMPENSATION OFFICER (IF ANY) MEDICAL TREATMENT DATE The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance vAnth the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the ser- vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER April 3, 2013 Sean Thompson 101 School Street Mansfield, MA 02048 Dear Sean, Congratulations upon your successful completion of the CERTIFIED POOL/SPA OPERATOR course in NORWOOD, MA from 3/19/2013 to 3/20/2013! 1 hope that your experience was a positive one. You will be receiving your certification from the National Swimming Pool Foundation within 6-8 weeks. You can use this letter as proof of certification until your certificate arrives, The networking through your classmates can be a valuable resource to you and visiting www.pooloperationmanagement.com. You are also invited to enhance your knowledge by participating in future CERTIFIED POOL/SPA OPERATOR courses, As a POM student, you are eligible for discounted services, You can have one of our CPO instructors aid you in making your job easier and your facility safer. Call us to schedule an inspection of your facility. Also, be sure to visit our website to find all the CPO products and services you need to run a safe facility. Thank you for your participation. If you should have need of our services in the future, please contact us. Sincerely, Trevor Sherwood Vice President 68 EDWARDS ROAD . BRICK, NJ 08723 ® PHONE (732) 451-1040 ® FAX (732) 451-1630 www.pooloperationmanagement.com, F,��Ujv Pool Operation Management April 3, 2013 Sean Thompson 101 School Street Mansfield, MA 02048 Dear Sean, Congratulations upon your successful completion of the CERTIFIED POOL/SPA OPERATOR course in NORWOOD, MA from 3/19/2013 to 3/20/20131 1 hope that your experience was a positive one. You will be receiving your certification from the National Swimming Pool Foundation within 6-8 weeks. You can use this letter as proof of certification until your certificate arrives. The networking through your classmates can be a valuable resource to you and visiting www.pooloperationmanagement.com, You are also invited to enhance your knowledge by participating in future CERTIFIED POOL/SPA OPERATOR courses. As a POM student, you are eligible for discounted services. You can have one of our CPO instructors aid you in making your job easier and your facility safer. Call us to schedule an inspection of your facility. Also, be sure to visit our website to find all the CPO products and services you need to run a safe facility. Thank you for your participation. If you should have need of our services in the future, please contact us. Sincerely, Trevor Sherwood Vice President 68 EDWARDS ROAD • BRICK, NJ 08723 • PHONE (732) 451-1040 • FAX (732) 451-1630 www.pooloperationmanapement.com. { ! § km &« �! a # ¥ \§ ) ` §7 NAME OF CITY OR TOWN STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 CMR 435.000 SWIMMING POOL INSPECTION REPORT IMMU n -V DnnT . UT TRT T(` n RRMT-PT TRT .TC SPECIAL PURPOSE POOL ❑ I l l i l. 1 ---. NAME OF POOL --- a o , "' ADDRESS OWNER ADDRESS DATE OF _, POOL CAPACITY INSPECTED BY J INSPECTION j� �% # OF GALS METHOD OF WATER BATHER # OF LIFEGUARDS WATER SOURCE: TREATMENT LOAD Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of 105 CMK 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 circulation filtration 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 .30 Water testing equipment. DPD kit provided for Bromine 2.0-6.0 m* chlorine and bromine. Unbreakable thermometer for Total orme special purpose pools. Alkalin 50-150 m .31 Water clarity Fr Chlorine 1.0-3.0 m .32 Water clarity maintenance. Filtration system operating Cyanuric Acid (30-100 ppm) continuously. omb. Chlorine (0.0-0.2 ppm) .32 Special purpose pool drained, cleaned and every 14 Water Temp. 104°F. days. pH level (7.2-7.8) Maximum Operating Temperatures for Special Purpose * arts per million Pools. (SPP). ther .33 a. Thermostatic control provided for each SPP. .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 rREGU OTION 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. a. 4 SIGNED SIGNED Operator Board of Health/Health Department NAME OF CITY OR TOWN STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 CMR 435.000 SWIMMING POOL INSPECTION REPORT 9 -1,M -C nn nnnT . DT MT 10 n RRMT-PT TRT.TC: ❑ SPECIAL PURPOSE POOL NAME OF POOL -- ADDRESS OWNER ADDRESS DATE OF POOL CAPACITY INSPECTED BY L� INSPECTION Z4 4 OF GALS METHOD OF WATER BATHER # OF LIFEGUARDS WATER SOURCE: TREATMENT LOAD Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of 105 C;WK 435.000. Items marked with a "✓" are satisfactory. REGULATION X/✓ VIOLATIONS/COMMENTS .03 Bathhouse and sanitary tacilities adequate ugnting; 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 circulatio filtration 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 until repairs can be made. 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. Healthwarnin signs posted for special purpose pools. .23 Lifeguards required: Yes El 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* Total Qblbrine Alkalin 50-150 m Fr hlorine 1.0-3.0 m Cyanuric Acid (30-100 ppm) eomb. Chlorine (0.0-0.2 ppm) Water Temp. 104°F. pH level (7.2-7.8) * parts per million I 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 REGULATION NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE w� .34I I Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. ^„ --4SIGNED Z�4 / Operator SIGNED Board of Health/Health Department