HomeMy WebLinkAboutMansfield Depot I 12/31/2007TOWN Dr
BOARD OF
M PARK ROW9 MANSFIELD 02048
In accordance with the provisions of Chapter 111. Section 127A of the Massachusetts
General Laws, and Regulations established by the Massachusetts Department of Public
Health (105 CMR 435.00). permit is hereby issued to:
Village at Mansfield Depot I
f a ❑
for the operation o Public Semi -Public E]Special Purpose Pool
at:
The Village at Mansfield Depot I
Method of water treatment is: Haywood Chlorine Feeder/Tabs/CH 200
Bathing load not to exceed: 70 bathers
Number of Lifeguards required at all times the pool is open is: None
"NO LIFEGUARD ON DUTY" sign is required.
Permit No.: 5
Date of Expiration: December 31, 2007
Date ssued
Name of Owner:
Address:
City:
State: MA
Telephone:
Fax:
Fed ID/SS No.:
Pool Location:
Type/pool:
Length: 48'
Min/Max. depth:
Swim Area:
Dive Area:
Water Source:
W/W Disposal:
Type of Finish:
Scum Gutter:
TOWN OF MANSFIELD, BOARD OF HEALTH
SIX PARK ROW, MANSFIEELD 02048
SWIMMING POOL APPLICATION
Village at Mansfield Depot I
14 Page Terrace
Stoughton _ is V, 3I00
Zip:02072
508-339-3583
04-2946285
The Village at Mansfield Depot I
Semi -Public
Width: 24'
3' to 9'
36'x24'
None
Town
Town Sewer
Vinyl Print
N/A
Volume: 65,000
Deck Type: 24' concrete
Skmmr weir length: 2 shimmers
Treatment System: 1 Hayward 3600 c& 1 Hayward 4800 Bath Filter
Disinfect Method: GPM 75 Backwash 60
Chemical Treatment: Haywood Chlorine Feeder/Tabs/CII 200
No. of Bathers: 70 /
Name of Certified Pool Operator:
Permit No.:5
Fee per pool: $75.00
Permit Expires December 31" yearly
SIGNATURE:
DATE:
Please make appropriate changes. Sign, date and enclose checkpayable to Town ofMansfield. Mail to:
Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048.
RA Health\PaPs DocumentAPERMIT APPLICAnOWSWIMMING POOLS APP.doc
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.
IV
* Signature Ot Individual or
Corporate Name (Manda
** Social Security Number (Voluntary) or
Federal Identification Number
Q�� a %a- (�8s
* 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.
a04;-(l611b
NAME OF CITY OR TOWN
STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS,
105 CMR 435.000
SWIMMING POOL INSPECTION REPORT
OT"k AT TTfTTIT Tr r2r OWT70TAT PUPPOW.. MCN. n
1 11 1'L Vl' 1 V VL. LFV
NAME OF POOL
-
ADDRESS
-t
OWNER
ADDRESS
DATE OF
POOL CAPACITY
SPE BY
INSPECTION
# OF GALS
METHOD OF WATER
BATHER
# OF LIFEGUARDS
WATER SOURCE:
TREATMENT
€
LOAD
Ci
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
ventilation; sanitary condition.
03 Adequate enclosure mound pool. Gate self -latching w/
latch 4 ft above ground.
.04 Sewage Disposal
.05 Location, structural stability, finish.
.06 Water circulation & filtration systems. Filter E nt flow
meter reading: `7 pm. # of turnovers
.06 Suitable automatic equipment for disinfection 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 pod immediately if outlet covers missing,
broken, loose or can be removed without tools
until repairs can be made.
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 Slimming 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. Property
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
Water Temp. 1044E
n
ladders.
* arts per million
.15 Diving equipment in safe condition.
Other
.29 Pool water tested with appropriate frequency.
.17 Pool supervision - Pool supervision provided.
`
.30 Water testing equipment DPD kit provided for
Effective Jan. 1, 1999, pool supervisor certified as pool
chlorine and bromine. Unbreakable thermometer for
operator from YMCA or NSPF.
special purpose pools.
.21 Permit requirements - Permit issued. Adequate
.31 Water clarity
maintenance and testing records maintained. Records
.32 Water clarity maintenance. Filtration system operating
initialed by person making tests.
continuously.
14
.22 Health regulations: Signs posted. Health warning
.32 Special purpose pool drained, cleaned and every
signs posted for special purpose pools.
days.
.23 Lifeguards required: Yes ❑ No
Maximum Operating Temperatures for Special Purpose
If lifeguards required. Proper credentials, proper suits
Pools. (SPP).
a. Thermostatic control provided for each SPP.
and garments wom. Whistle and bullhorn provided
.33
.24 Safety equipment Ring buoys and rescue hook
b. Thermostatic control only accessible to the pool
provided. Rescue tube and backboard with straps at
operator
pools attended by a lifeguard.
.38 General sanitation
.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 property
discharged. No direct connection to sewer system.
Separation tank provided for diatomaceous earth fitter
backwash water.
.29 Chemical standards
POOLSIDE READINGS
otal Chlorin
Bromine -2." 0= "
Chlorine
Alkalini S? t? Mree
Cyanuric Acid X30-iU0ifim
Comb.
Water Temp. 1044E
n
pH level
* arts per million
Other
.29 Pool water tested with appropriate frequency.
.30 Water testing equipment DPD kit provided for
mss'
chlorine and bromine. Unbreakable thermometer for
special purpose pools.
.31 Water clarity
.32 Water clarity maintenance. Filtration system operating
continuously.
14
.32 Special purpose pool drained, cleaned and every
days.
Maximum Operating Temperatures for Special Purpose
Pools. (SPP).
a. Thermostatic control provided for each SPP.
.33
b. Thermostatic control only accessible to the pool
operator
.38 General sanitation
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 HeaithMeaM Department