HomeMy WebLinkAboutCedar Heights 12/31/2007TOWN OF MANSFIELD
BOARD OF
SIX PARK ROW, MANSFIELD 02048
In accordance with the provisions of Chapter 111. Section 127A of the Massachusetts
General Lc vs, and Regulations established by the Massachusetts Department of Public
Health (105 CMR 435.00). permit is hereby issued to:
for the operation of a ❑ Public
at:
Method of water treatment is:
Cedar Heights
Semi -Public
10 Connors Ave
Bathing load not to exceed: 61 bathers
❑ Special Purpose Pool
Number of Lifeguards required at all times the pool is open is: Mone
"NG LIEFEGUA ON DUTY" sign is required.
Permit No.: 13
Date of Expiration: December 31, 2007
Scott Leite, Health Agent
Date Issu d �iA7
POOL OPERATION MANAGEMENT°
Amanda E. Turner
39 Aspen Hollow ®rive
North Easton, MA 02356
Congratulations upon your successful completion of the CERTIFIED POOL/SPA
OPERATOR course! I 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. You are
also invited to enhance your knowledge by participating in future CERTIFIED
POOUSPA OPERATOR courses.
As a POM student,you eligible • discounted - - You - one of our
pleaseCPO 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,
•
Sincerely,
<,IAOV� J
Trevor Sherwood
Vice President
68 EDWARDS ROAD 0 BRICK, NJ 08723 e PHONE (732) 451-1040 • FAX (732) 451-1630
www.pooloperationmanagement.com
TOWN OF MANSFIELD, BOARD OF HEALTH
SIX PARK ROW, MANSFIELD 02048
SWIMMING POOL APPLICATION
Namc of Owner: Cedar Heights
Address:
10 Connors Ave
City:
Mansfield
State: MA
Zip:02048
Telephone:
508-823-6303
Fax:
508-823-2045
Fed 1D/SS No.:
562332452
Pool Location:
10 Connors Ave
Type/pool:
Gunite/plaster
Length; 42'6"
Width: 27'
Min/Max. depth:
3'-5'
Swim Area:
917
Dive Area:
None
Water Source:
Town
W/W Disposal:
Town
Type of Finish:
Plaster
Scum Gutter:
None
Deck Type:
Concrete
Skmmr weir length:
81/2"
Treatment System:
Chlorine
Disinfect Method:
Chlorine
Chemical Treatment:
Chlorine
No, of Bathers:
61
Name of Certified Pool Oporamor:_ -�
Pcimit No, :13
Fee per pool:
575.00
S1GNA'
Volume: 27,510 gallons
Permit Expires December 31' yearly
DATE: PV " "' 1 V z Cc C:-
1
Please make appropriate changes. Sign, date and enclose check payiable to Town ofMansfield. Mail to;
Board ofHealth, Town of Mansfield, Six Park Row. Mansfield MA 02048.
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The Commonwealth of Massachusetts
Deparment ofindustrW A"idents
600 Washh"n Sired, 7* Floor
Boston, Mau 02111
Workers' COM usadon I=arwm AMdavit - Gen" Businesses
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lam anemployer providing worlm'empensadoo for' myMV10yeas wockingon this job.
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I am a sole prqnimr and have hired the inslepandent contractors lined below who have tM following W*Um'
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FaRare to oteare errerop as reqaired wider Section 25A of P40L 152 too lead to the impoddoo of grialad ponaltim of a am up to SIMAO &&d1or
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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.
" Signature of al or
Corporate Name (Mandatory)
ru
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13y: Corporate Officer
(Mandatory, if applicable)
Social Security Number (Voluntary) or
Federal Identflication Number
R This license will not be issued unless the cerdflcation 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 Hoense suspension or revocation. This request is made under
the authority of Mass. General Laws, Chapter 62C, Section 49A.
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Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an exgdoyee is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An employar is defined as an individual, partuptship, association, corporation or other legal entity, or any two or mote of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver
or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of
another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds
or building appurtenant thereto shall noi because of such employment be deemed to be an employer.
MGI, chapter 152 section 25 also states that every state or local licensing agency shall wlthboW the issuance or
.renewal of a license or perml: to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the Insurance coverage required.
Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract fbr the
performance of public work until acceptable evidence of compliance with the insurance requkemauts of this chapter have
boon presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by chocking the box that applies to your situation. Please
supply cempany tee► address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirm$tion of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if
you are required to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
Pioaso be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the pemut(license number which will be used as a reference number. The affidavits tray be returned to
-the Department by mail or FAX unless other arrangements have been made,
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's addtt ss, telephone and hx number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
81kedl- —do 01 1
600 Washington Street, 7" Floor
1 Boston, Ma. 02111
Gut M (617) 727-7749
phone #: (617) 7274900 act. 406
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004506 J
NAME OF CITY OM2 TOWN
STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS,
105 CMR 435.000
SWIMMING POOL INSPECTION REPORT
TVPR 0-[ Pr1r7T.• PTMT.Tr`. h CF:MT-PTTRT.Tr SPF.C,TAT. PTTRPOSR P(X)T. ❑
NAME OF POOL
ADDRESS
1 r /
OWNER
ADDRESS
DATE OFPOOL
.04 Sewage Disposal
CAPACITY
SPE BY
INSPECTION
# OF GALS
meter reading: pm. # of tumovers
METHOD OF WATER
TREATMENT
.06 Suitable automatic equipment for disinfection of pool
BATHER
LOAD
# OF LIFEGUARDS
WATER SOURCE:
.06 Carbon dioxide (CO2) equipment for pH control
0
adequate. CO2 cylinders anchored. Inaccessible to
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 around pool. Gate self -latching w/
latch 4 it above ground.
.04 Sewage Disposal
.05 Location, structural stability, finish.
.06 Water circulation &�fittration systems. Filter Effluent flow
meter reading: pm. # of tumovers
.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 pod immediately if outlet covers missing,
broken, loose or can be removed without tools
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. 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
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 wom. 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 property
discharged. No direct connection to sewer system.
Separation tank provided for diatomaceous earth filter
backwash water.
.29 Chemical standards
POOLSIDE READINGS
Bromine tt Q, *
Total Chlorine F _
Alkalini(
Free Chlorine ', -
Cyanuric Acid
Comb.
Chlorine
Water Temp.U4°F
pII levelIli
* narts 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
REGULATION I
NO. THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE
.34I I 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 HealtWeallh Department