HomeMy WebLinkAboutMansfield Depot I 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
Cenral Laws, and Regulations established by the Massachusetts Department of Public
Health (105 CMR 435.00). permit is hereby issued to:
Keith Properties, Inc.
for the operation of a Public Semi -Public Special Purpose Pool
at:
The Village at Mansfield Depot I
Method of water treatment is: 2 Sand Filters/jacuzzi MFM24 F
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.: 5
Date ofExpiration: December 31, 2002
1
4at&sued
TOWN OF MANSFIELD, BOARD OF HEALTH
SIX PARK ROW, MANSFIELD 02048
SWIMMING POOL APPLICATION
Name of Owner: Keith Properties, Inc.
Address:/y totems
City: Stoughton
State: MA Zip:02072
Telephone: 508-339-3583
Fax:
Fed ID/SS No.:
Pool Location: The Village at Mansfield Depot I
Type/pool : Semi -Public
Length: 48' Width: 24' Volume:
Min/Max. depth: 3' to 9'
Swim Area: 36x24'
Dive Area: None
Water Source:
Town
W/W Disposal:
Town Sewer
Type of Finish:
Vinyl Print
Scum Gutter:
N/A
Deck Type: 24' concrete
Skmmr weir length: 2 skimmers
Treatment System: 2 Sand Filters/jacuzzi MFM24 F
Disinfect Method: GPM 75 Backwash 60
Chemical Treatment: Haywood Chlorine Feeder/Tabs/CH 200
No. of Bathers: 70
Remarks:
Permit No.:
Fee per pool: $75.00
Permit Expires December 31s` yearly
SIGNATURE:
DATE: f
Please make appropriate changes. Sign, date and enclose check payable to Town of'Mansfield. Mail to:
Board ofHealth, Town ofMansfield, Six Park Row, Mansfield, MA 02048.
CAPats DocumentsTERMU APPLICAUONS\SNVIMMING 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.
-V,5-
Signature of Individual or
Corporate Name (Mandatory) ,/
/ /
Corporate Officer
(Mandatory, 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.
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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
INSPECTION
POOL CAPACITY
OF GALS
INSPECTED BY
at
METHOD OF WATER
TREATMENT
BATHER
LOAD
g
�(�
# OF LIFEGUARDS
WATER SOURCE:
Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of 105 CMM 435.000.
Items marked with a "✓" are satisfactory.
REGULATION X/✓ VIOLATIONS/CONVdENTS
ventilation; sanitary condition.
.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: _qpm. # 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.
.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.
million
.14 Ladders, steps - one per 75 feet. Not less than 2
Other
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
POOLSIDE READINGS
Bromine
Total Chlorine
Alkalinity
Free Chlorine
Cyanuric Acid
Comb.
j
ti 5
Chlorine
Water Tem
Temp. I,Q4�
pH level
* arts per
.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
million
Other