HomeMy WebLinkAboutHockomock Y 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 I H. Section 127,4 of the Massachusetts
General Laws, and Regulations established by the Massachusetts Department of Public
Health (105 CMR 435.00). permit is hereby issued to:
Hockomock Area YMCA -Mansfield
for the operation of a ❑ Public Ll Semi -Public ❑ Special Purpose Pool
at:
40 Balcom Street
Method of water treatment is: Sand Filter
Bathing load not to exceed. 40 bathers
Number of Lifeguards required at all times the pool is open is: None
"NO LIFEGUARD ON DUTY" sign is required.
Permit No.: 12
Date of Expiration: December 31, 2002
Da ssued
Scott Leine, Health Agent
WIN
1 . 1 .3e e
Name of Owner: Hockomock Area YMCA -Mansfield
Address:
40 Balcom Street
City:
Mansfield
State: MA
Zip:02048
Telephone:
508-339-3066
Fax:
Fed ID/SS No.:
04-2131749
Pool Location:
40 Balcom Street
Type/pool:
Above -ground
Length: 38'
Width: 18' Volume:
Min/Max. depth:
3' to 4'6"
Swim Area:
Dive Area:
None
Water Source:
Town
W/W Disposal:
Septic System
Type of Finish:
Steel w/vinly liner
Scum Gutter:
Deck Type:
Wooden
Skmmr weir length:
1.5 to 2'
Treatment System:
Sand Filter
Disinfect Method:
Chlorine
Chemical Treatment:
Chlorine
No. of Bathers:
40
Remarks:
Permit No.:
Fee per pool: $75.00
Permit Expires December 31St yearly
SIGNATURE: `VC
D
Please make appropriate changes. Sign, date and enclose checkpayable to Town ofMansfield. Mail to:
Board of Health, Town ofMansfield, Six Park Row, Mansfield, MA 02048.
CAPats Documents\PERMH APPLICATION&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.
4ciL/oriioce AL,64
*Signature of Individual or
Corporate Name (Mandatory)
By: 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.
We build strong kids, strong families, strong communities.
Board of Health,
Town of Mansfield ;t=
Six Park Row
Mansfield, Ma 02048 Q�
Dear Mr. Scott Leite,
The Hockomock Area YMCA Mansfield Branch operates a swimming pool on a seasonal
basis. In the past, the Mansfield of Health has waived our fee for the swimming pool
application. As a non — profit organization, we were granted the privilege of receiving our
application free of charge. We would like to request that you waive our fee again this
year.
The Town of Mansfield has been very supportive to the YMCA and we greatly appreciate
your help in providing quality, dependable programs to the children in Mansfield. Thank
you for your consideration of this matter.
Sincerely,
Susan Cinelli
Hockomock AreaYMCA • Mansfield Branch 40 Balcom Street • Mansfield, MA 02048
Tel. (508) 339-3066 Fax (508) 337-8479
January 10, 2002
TOWN OF MANSFIELD, MASSACHUSETTS
Susan Cinelli
Hockomock Area YMCA
Mansfield Branch
40 Balcom St
Mansfield, MA 02048
RE: 2002 Permit for Swimming Pool
Dear Susan:
Six Park Row, Mansfield, MA 02048
In regards to your request for the fee to be waived for your swimming pool
application, this written request must be addressed and -submitted to the Board of Health,
Town of Mansfield, Six Park Row, Mansfield, MA 02048, as it has been in the past.
Also I am returning your application to be dated. Please re -submit your signed
and dated application along with your written request to my attention.
If you have any questions or require additional information, please contact me at
(508) 261-7366.
Si rel '
Scott Leite
Health Agent, Board of Health
Enclosed
HOCKOMOCK
AREA YMCA
• North Attleboro
® • Franklin • Mansfield
We build strong kids, strong families, strong communities.
Mansfield Board of Selectmen
Chairman David McCarter
6 Park Row
Mansfield, MA 02048
Dear Mr. McCarter and Selectmen:
DEC � 8 zoos
The Hockomock Area YMCA Mansfield Branch operates a swimming pool on a
seasonal basis. In the past, the Mansfield Board of Selectmen has waived our fee for the
swimming pool application. As a non — profit organization, we were granted the privilege
of receiving our application free of charge. We would like to request that you waive our
fee again this year.
The Town of Mansfield has been very supportive to the YMCA and we greatly
appreciate your help in providing quality, dependable programs to the children in
Mansfield. Thank you for your consideration of this matter.
Sincerely,
Susan Cinelli
Hockomock AreaYMCA • Mansfield Branch • 40 Balcom Street • Mansfield, MA 02048
Tel. (508) 339-3066 • Fax (508) 337-8479