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Home My WebLink AboutMansfield Meadows 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 Meadows Assoc for the operation of a ❑ Public emi-Public ❑ Special Purpose Pool at: Bonney Lane Method of water treatment is: 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.: 7 Date of Expiration: December 31, 2002 Date Iss d Scott Leite, Health Agent TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Name of Owner: Mansfield Meadows Assoc Address: 12 Bonney Lane #9 City: Mansfield State: MA Zip:02048 Telephone: 508-339-3357 Fax: 508-339-9761 Fed ID/SS No.: Pool Location: Bonney Lane Type/pool: Residential Length: 40' Width: 22' Volume: Min/Max. depth: Swim Area: 40'x22' Dive Area: None Water Source: Town W/W Disposal: Town Sewer Type of Finish: Concrete Scum Gutter: Deck Type: Cement Slab Skmmr weir length: Treatment System: Disinfect Method: Chlorinating sticks, plus to increase ph Chemical Treatment: calle and iron remover. Automatic chlori No. of Bathers: 43 Remarks: Permit No.: Fee per pool: $75.00 Permit Expires December 3 V yearly SIGNATURE:,,,- DATE: IGNATURE: DATE: 1% _ 1?5--o / { 200, Please make appropriate changes. Sign, date and enclose checkpayable to Town ofMansfiield. Mail to: Board of Health, Town ofMansfield, Six Park Row, Mansfield, MA 02048. CAPaPs DocumentsWERMIT APPLICATIONSISWIMMING 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) By. Corporate Officer andatory, if applicable) 0y_34J033oP1/ **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. N&)�(10V-D NAME OF CITY OR TOWN STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 CMR 435.000 SWIMMING POOL INSPECTION REPORT 0r1A r nTroT Tn rh QPF!'TAT ATTRPC)OP P(l(1T. F1 1 111+ V1 1 NAME OF POOL -- y yr ADDRESS g t f r OWNER ADDRESS DATE OF INSPECTION l ' POOL CAPACITY # OF GALS INSPECTED BY - `' �% Z� METHOD OF WATER TREATMENT BATHER LOAD # OF LIFEGUARDS WATER SOURCE: Regulation 105 CMR 435.000 The items marked below with an "A" inaicate the vioiatea provisions of ivj to -).V V V. Items marked with a "✓" are satisfactory. REGULATION X/✓ VIOLATIONS/COMMENTS .03 Bathhouse and sanitary facilities adequate lighting; 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. LIZ .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. LV .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. .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. .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 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 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 V L/ V/ POOLSIDE READINGS .29 .30 Water testing equipment. DPD kit provided for Bromine chlorine and bromine. Unbreakable thermometer for Total Chlorine Alkalin .31 Water clarity Free Chlorine 131,04% 0'r m Cyanuric Acid (30 1t -0Comb. days. Maximum Operating Temperatures for Special Purpose Chlorine 4° Water Temp. 104°fix ,r pH level b. Thermostatic control only accessible to the pool * arts Der million operator Other .38 General sanitation Pool water tested with appropriate frequency. .29 .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. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE X/✓ .34 Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUIGH 435.31. SIGNED SIGNED