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Home My WebLink AboutHoldiay Inn 12/31/2002TOWN 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 Realty Limited Partnership for the operation of a ❑ Public ErSemi-Public ❑ Special Purpose Pool at: Holiday Inn, 31 Hampshire St. Method of water treatment is: Sand Bathing load not to exceed. 83 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. Permit No.: 3 Date of Expiration: December 31, 2002 Date Issued Scott Left, Health Agent TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Name of Owner: Mansfield Realty Limited Partnership Address: 31 Hampshire St. City: Mansfield State: MA Zip:02048 Telephone: 508-339-2200 Fax: Fed ID/SS No.: 04-3282038 Pool Location: 31 Hampshire St. Type/pool: Sand Length: 76' Width: 26' Volume: Min/Max. depth: 4' to 8' Swim Area: 83 Dive Area: None Water Source: Town WAV Disposal: Town Sewer Type of Finish: Scum Gutter: Lower and Upper Deck Type: Plaster BF� Ar ! v ?001 s'r Fee per pool: $75.00 Permit Expires December 3I't yearly Mansfield Realty Limited Partners '•'p by its General Partner, Mansfield Realty Corp. SIGNATURE: Gerald S. Fine erg, Preside t DATE: 11-2-01 Please make appropriate changes. Sign, date and enclose check payable to Town ofMansfteld. Mail to: Board of Health, Town ofMansfield, Six Park Row, Mansfield, MA 02048. CAPafs DocumentsWERMIT APPLICATIONS\SWIMMING POOLS APP.doc Skmmr weir length: Treatment System: Sand Disinfect Method: Bromine Chemical Treatment: 501bs. No. of Bathers: 83 Remarks: Permit No.: BF� Ar ! v ?001 s'r Fee per pool: $75.00 Permit Expires December 3I't yearly Mansfield Realty Limited Partners '•'p by its General Partner, Mansfield Realty Corp. SIGNATURE: Gerald S. Fine erg, Preside t DATE: 11-2-01 Please make appropriate changes. Sign, date and enclose check payable to Town ofMansfteld. Mail to: Board of Health, Town ofMansfield, Six Park Row, Mansfield, MA 02048. CAPafs DocumentsWERMIT APPLICATIONS\SWIMMING POOLS APP.doc 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. *Signature of Individual or Corporate Name (Mandatory) Mansfield Realty Limited Partnership by its General Partner, Mansfield Realty Corp. y' p ate bVWrTerald S. neberg, President (Mandatory, if applicable) 04 328 2038 **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. COR One Washington Street, Suite 402 Wellesley, Massachusetts 02481 Tel: 781-431-1108 ® Fax: 781-431-7130 Via First Class Mail November 5, 2001 Board of Health Town of Mansfield 6 Park Row Mansfield, MA 02048 Licensee: Mansfield Realty Limited Partnership Location: Holiday Inn Mansfield Re: 2002 Swimming Pool & Hot Tub Permits To Whom It May Concern: Enclosed please find the following materials in connection with the license renewals for the above referenced property: 1. Swimming Pool Permit Renewal Application with tax certification form 2. Check in the amount of $75.00 for renewal application fee 3. Hot Tub Permit Renewal Application with tax certification form 4. Check in the amount of $75.00 for renewal application fee Please contact me if you have any questions. n S'ncerely, a C. Rota Counsel MCR/km Enclosures APPENDIX 12 NAME OF CITY OR TOWN STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 CMR 435.000 SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC SPECIAL PURPOSE POOL Cl NAME OF POOL ADDRESS ..--•......................•-------••---•----------•--.............------.............-- .03 Adequate enclosure around pool. Gate self -latching w/ ---.....................---•--.................................................................... ....... latcbAft.ab9ve.ground............................ .........•-•--•-•-- c OWNER-< t P ADDRESS DATE OF , POOL CAPACITY '36, %,- INSPECTED BY — INSPECTION OF GALS. .06 Suitable automatic equipment for disinfection of pool METHOD OF WATER TREATMENT BATHER LOAD .................................................................................. .06 Carbon dioxide (CO2) equipment for pH control # OF LIFEGUARDS WATER SOURCE: adequate. CO2 cylinders anchored. Inaccessible to tzublic,.adequate.ventilobon.Pro.tided .............................. ........-----.......................................-----...................................... Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of 1 Ub UMK 435.000. Items marked with a "✓" are satisfactory. ventilation; sanitary condition. ..--•......................•-------••---•----------•--.............------.............-- .03 Adequate enclosure around pool. Gate self -latching w/ ---.....................---•--.................................................................... ....... latcbAft.ab9ve.ground............................ .........•-•--•-•-- ...:. :----•-•----...........--•-----.....................--•-----•---••----............................. :04 Sewage•Disposal.-----------•....................... .05 Location, structural stability, finish. .06 Water circulationA filtration systems. Filter effl� t�Pw meter reading_ ,,Z2 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 tzublic,.adequate.ventilobon.Pro.tided .............................. ........-----.......................................-----...................................... .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 use of tools. Open area does not provide entrapment of fingers, toes, etc. At least one ....... antivQrteX.drain.provided........................... ........................ .....................................................................------........................ .08 Each system outlet protected against user entrapment I 1 by antivortex cover or other means. Minimum of 2- 0,•r` 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 are made. ...................... ............................................................... ........------•--..........---..................----.........-----.......................................... 15 Diving equipment in safe condition. (V •, ,. .17 Pool supervision - Pool supervision provided. .08 5peciai purpose pool and wading pools equippeo wan emergency shut off switch. Accessible and Effective Jan. 1, 1999, pool supervisor certified as pool pump prominentlymarked................................................ ..................... ...... .....-• operator from YMCA or NSPF. ...........................•------•------••---•---.................................. ------------...... .09 Cross connections. Potable water supplied through air maintenance and testing records maintained. Records gap. .................. ......... ... ............. ..................................................... ...... ...... 10 Skimming facilities. 50% of recirculation drawn from .1 ¢ .............. surface of pool. .......................................... ............ .23 Lifeguards required: Yes 1 No .12 Line with floats separates non -swimmer area from deeper If lifeguard required; proper credentials, proper suits water. ........................................................................................... and garments worn. Whistle and bullhorn provided. .................. .12 Water depth markings on deck and walls. Properly Step provided. Rescue tube and backboard with straps at spaced. Boundary line on pool floor and walls. Or pools attended by a lifeguard. edges marked with contrasting color. ....................................... .............................................. .25 First aid equipment provided. First aid kit complete -----............ ...............................-----------.................----........---......... .13 Walkway and decks 4 feet wide, safe condition. K ...... ......... .. working order. Emergency communication device in .14 Ladders, steps - one per 75 feet. Not less than 2 unlocked area and available at all times to staff and the ladders. public. Operating instructions and emergency ...................... ............................................................... ........------•--..........---..................----.........-----.......................................... 15 Diving equipment in safe condition. (V •, ,. .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 1 No If lifeguard 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. First aid kit complete -----............ -•.............•---•----..............................---------.........---.......... .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 ..... . f ......-----.... discharged. No direct connection to sewer system. Separation tank provided for diatomaceous earth filter backwash water. ............ ............................................................................... .29 Chemical standards. .. POOLSIDE READINGS ne Free Water Temp. pH I "parts per million Othe .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. NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE Xl./ 34 1 1 Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. SIGNED � f SIGNED perator