HomeMy WebLinkAboutMilhaus 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:
Milhaus @ MansCondo Trust
for the operation of a ❑ Public Semi -Public ❑ Special Purpose Pool
at:
150 Rumford Ave.
Method of water treatment is: Haywood 3000
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.: 9
Date of Expiration: December 31, 2002
E3
Date Issued
TOWN OF MANSFIELD, BOARD OF HEALTH
SIX PARK ROW, MANSFIELD 02048
SWIMMING POOL APPLICATION
Name of Owner: Milhaus @ MansCondo Trust
Address:
150 Rumford Avenue
City:
Mansfield
State: MA
Zip:02048
Telephone:
508-339-7531
Fax:
Fed ID/SS No.:
Pool Location:
150 Rumford Ave.
Type/pool:
Gunite
Length: 60'
Width: 30' Volume:
Min/Max. depth:
4', 7, 10',14'
Swim Area:
18,000sf
Dive Area:
None
Water Source:
Town
W/W Disposal:
Town sewer
Type of Finish:
Concrete
Scum Gutter:
yes
Deck Type:
Concrete 16'
Skmmr weir length:
4, 8' apart
Treatment System:
Haywood 3000
Disinfect Method:
Automatic Chlorinator Marc Mac, 22 psi
Chemical Treatment:
Sodium Hypochlorite
No. of Bathers:
70
Remarks:
Permit No.:
Fee per pool:
$75.00
Permit Expires December 31" yearly
SIGNATURE:
DATE:
Please makY appropriate changes. Sign, date and enclose check payable to Town of Mansfield. Mail to:
Board of Health, Town ofMansfield, Six Park Row, Mansfield, MA 02048.
CAPats Documents\PERMU 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.
1
*Signature of Individual or
Corporate Name (Mandatory)
.e Officer
if applicable)
**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.
V440'12- (I K � D
NAME OF CITY OR TOWN
STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS,
105 CMR 435.000
SWIMMING POOL INSPECTION REPORT
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NAME OF POOL
ADDRESS
OWNER
ADDRESS
DATE OF
�1
POOL CAPACITY
INSPECTED BY
INSPECTION
/ ��
# OF GALS
METHOD OF WATER
BATHER
76
# OF LIFEGUARDS
I WATER SOURCE:
TREATMENT
LOAD
Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of lU5 CMK 435.000.
Items marked with a "✓" are satisfactory.
REGULATION X/✓ VIOLATIONS/COMMENTS
ventilation; sanitary condition. -& JI
.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
until repairs can be made.
09
.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.
Total Chlorine
.15 Diving equipment in safe condition.
Free Chlorine 0
.17 Pool supervision - Pool supervision provided.
Comb.
Effective Jan. 1, 1999, pool supervisor certified as pool
i S
Chlorine , ?
operator from YMCA or NSPF.
pH level
Permit requirements - Permit issued. Adequate
Other
.21
maintenance and testing records maintained. Records
initialed by person making tests.
.22 Health regulations: Signs posted. Health warning
signs posted for special purpose pools.
11,�
�11
.23 Lifeguards required: Yes ❑ No
If lifeguards required. Proper credentials, roper suits
'V
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
V
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 b0, rij _..v
Total Chlorine
Alkalin 0.1$0 _ , :
Free Chlorine 0
Cyanuric Acid (30:40'
Comb.
5 s
i S
Chlorine , ?
Water Temp.Q4°11
pH level
* arts per 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
f'
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.
11,�
�11
b. Thermostatic control only accessible to the pool
operator
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.38 General sanitation
REGULATION I
NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE
xw�
.34 Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF
105 CMR 435.29 THROUGH 435.31.
SIGNED
Operator
SIGNED
Board of Health/Health Department