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Home My WebLink AboutHoliday 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 ❑ Semi -Public Ul!gIp"ecial Purpose Pool at: Holiday Inn, Hot Tub, 31 Hampshire St. Method of water treatment is: Bathing load not to exceed: bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. Permit No.: 4 Date of Expiration: December 31, 2002 Date Issued Name of Owner: Address: City: State: MA Telephone: Fax: Fed ID/SS No.: Pool Location: Type/pool: Length: 15'Round Min/Max. depth: Swim Area: Dive Area: Water Source: W/W Disposal: Type of Finish: Scum Gutter: Deck Type: Skmmr weir length: Treatment System: Disinfect Method: Chemical Treatment: No. of Bathers: Remarks: Permit No.: Fee per pool: TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Mansfield Realty Limited Partnership 31 Hampshire St. Mansfield Zip:02048 508-339-2200 04-3282038 31 Hampshire St. Hot Tub Width: 4' N/A N/A Town Town Sewer Marble with Tile N/A Volume: 1 6","Cartridge Sand","Br $75.00 i f �.� O V00 Permit Expires December 31" yearly Mansfield Realty Limited Partnership by its General Partner, Mansfield Realty Corp. SIGNATURE: -Gerald S. Fid erg, President DATE: 11-2-01 / Please make appropriate changes. Sign, date an -enclose checkpayable to Town ofMansfreld. Mail to: Board of Health, Town ofMansfield, Six Park Row, Mansfield, MA 02048. CAPats DocumentsWERMIT APPLICATIONSVSWIMMING 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 Partngr Mansfield Realty Corp. y: Corporate Officer Gerald Y. Fineberg, 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. 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 ❑ S - _ SPECIAL PURPOSE POOL NAME OF POOL ADDRESS ................................................................................................. .03 Adequate enclosure around pool. Gate self -latching w/ ......Igtoh.4 ft.ab4ve.ground................................... ................... 11-1.1 ....•-•----...............------.........................---...................................... OWNER - f,' _ ADDRESS - DATE OF ----------- •-------------- •------ •------------------------ •----------------- —*....... ............ POOL CAPACIfFY .......................................................... INSPECTED BY .06 Water circulation & filtration systems. Filter effluent flow meter reading:'_ gpm. y # of turnovers ' INSPECTION i � , ' -# OF GALS. .06 Suitable automatic equipment for disinfection of pool . j ~' METHOD OF WATER ........................ ......................... .................................................. BATHER # OF LIFEGUARDS WATER SOURCE: TREATMENT ! .08 Inlets and outlets - Inlets located to produce uniform LOAD circulation. Over rim fill spout 6" above maximum Regulation 105 CMR 435.000 The items marked below with an "A" indicate the violated provisions of 105 GMK 435.000. Items marked with a "✓" are satisfactory. .us batnnouse ana sanitary tacimies aoequate ognting; ventilation; sanitary condition. ................................................................................................. .03 Adequate enclosure around pool. Gate self -latching w/ ......Igtoh.4 ft.ab4ve.ground................................... ................... 11-1.1 ....•-•----...............------.........................---...................................... :04 Sewage Disposal.____ ----------- •-------------- •------ •------------------------ •----------------- —*....... ............ .05 Location, structural stability, finish. ........... ........................................................................ ... .......................................................... .........................------................--- .06 Water circulation & filtration systems. Filter effluent flow meter reading:'_ gpm. y # of turnovers ' i � . .................... .-----.......... a� ......... ............... ...................... ..................................... .06 Suitable automatic equipment for disinfection of pool water. ......................... .................................................................... ........................ ......................... .................................................. .06 Carbon dioxide (CO2) equipment for pH control adequate. CO2 cylinders anchored. Inaccessible to Ruf�liG,.adaquate.vent�lat�on.RroYided........................... ......... ................................................................................................... .08 Inlets and outlets - Inlets located to produce uniform circulation. Over rim fill spout 6" above maximum water level, Properly shielded and located. ................................................................................................I......... .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 antivortexAin.p(ovided.......-----•..............•--............................----..................-----•--------........................----.......---................--- .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 r 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. 58 Special purpose pool and wading pools equipped with emergency shut off pump switch. Accessible and prominently marked. . .....---••....................................... ... ............................... .09 Cross connections. Potable water supplied through air �A gap. ................ ................................................................... ................................. ................................. .10 Skimming facilities. 50% of recirculation drawn from surface of pool: .................................... I.................... `....... r .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 Lifeg..uard.s.requ..ired:.Y.es 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 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 V.. Free Chlorine M. Cvanuric Acid a ; Comb. Chlorine parts per million I I vtner .29 Pool water tested with appropriate frequency. .......................................................................................................................... % .30 Water testing equipment. DPD kit provided for chlorine and bromine. Unbreakable thermometer for f special purpose pools. ................••---•-------........--•----•---•--.................� i.�` ............................ .31 Water ct Y....----........ ............................................. ...................... ........ ............................ .32 Water clarity maintenance. Filtration system operating continuously. .................................................. ............................. ...... ........ ..................... .32 purpose pool drained, cleaned and every 14 pp � ( �Special days. 9u Maximum Operating Temperatures for Special Purpose .------•-•--•- Pools. (SPP). .33 a. Thermostatic control provided for each SPP. b. Thermostatic control only accessible to the pool r' ....... ...operator ............................................................... ... .38 General sanitation. 1 TION NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE 34 1 1 Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. 17 SIGNED p rator