HomeMy WebLinkAboutHockomock Y 12/31/2000TOWN OF MANSFIELD
BOARD OF HEALTH
SIX PARK ROW, MANSFIELD 02048
PERMIT TO OPERATE A SWIMMING POOL
In accordance with the provisions of Chapter III, 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:
Hockomock Area YMCA -Mansfield
for the operation of a [] Public, [ Semi -Public or [] Special Purpose Pool
at:
40 Balcom Street
Method ofwater treatment is: Earth Diaomaceous
Bathing load not to exceed 40 bathers.
Number of Lifeguards required at all times the pool is open is None.
"NO LIFEGUARD ON DUTY" sign is required.
Permit No.: 12
Date of Expiration: December 31, 2000
`7 , /3 -
Date Issued
Scott Leite, Health Agent
TOWN OF MANSFIELD, SIX PARK ROW, MANSFIELD 02048
SWIMMING POOL APPLICATION
ro 04 - M P1
Name of Owner:
Address: L/0 Ccl;"
City: mck"Vs )J -
State: M A- zip: 0 X00/
Telephone: 339-3066
Fax: �'5
Fed 11D/SS No.: O g -j q�
Pool Location: 14 c) 6 cu Q c, �
Type/pool: 4 b c v o e) u ^ (I
Length: ;�- 1,3 g Width:
Min/Max depth: 14I'll 2-
Swim area:
Dive area:
Water source:
W/W Disposal: ,S,2
Type of finish: tom. ,4fit.i� Ctrs
Scum gutter:
Deck type: "W(VAeo
Skmmr weir Igth:
Treatment systm: -4446++1tc, eIC4 -r'T�4'
Disinfct method:
Chemical trtmnt: C.
No. of Bathers:
Reinark.s:
Permit No:
Fee: $75.00
Volume: -.0 9c/ ma j0'X--
Please review information and make any applicable changes. Return to BOH office at
above address with check payable to town of Mansfield, $75.00 each pool. Permit
expires December 31 st yearly. Thank you.
TOWN OF MANSFIELD
BOARD OF HEALTH
SIX PARK ROW, MANSFIELD 02048
PERMIT TO OPERATE A SWIMMING POOL
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:
Mansfield Children's Ctr.
for the operation of a [] Public,emi-Public or [J Special Purpose Pool
at: 1100 School Street
Method of water treatment is: Sand filter
Bathing load not to exceed 43 bathers.
Number of Lifeguards required at all times the pool is open is None.
"NO LIFEGUARD ON DUTY" sign is required.
Permit No.: 8
Date of Expiration: December 31, 2000
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D6 Issued
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;ongratulations on successfully completing a YMCA of the USA training certification. 1.' you have any questions, call the Y1" 1CA of the USA
ertifications office at 800-411-9648 or 312-977-0031, To correct or update your records ol, to request a transcript, a duplicate card, or a
ertificate, see directions on the reverse side, a r c a 11 r.: 9
99'EF—AG103B-9027
020-34-2174
KEITH FALLON
+1132 SCHCCL S1
MAKSFIELb.. MA 02('48
fCri � FAL'LCN
HaoL ;Cperator or 'L,cce tion-
( 8 ( C L )
Dale
Issued: d1CL/99
IN
Mansfield Board of Health Date
We Dryt�r�� I�py2 i� request a w
Permit Fee for the following reason pyV
Thank you.
Si ature
Title
waiver