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HomeMy WebLinkAboutHoliday Inn 12/31/2004TOWN OF MANSFIELD BOARD OF HEALTH SIX PARK 1 MANSFIELD 02048 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 ❑Special Purpose Pool at: Method of water treatment is: Bathing load not to exceed: 31 Hampshire St. 10 lb Chlorinator 6 to 8 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, 2004 Scott 1 'te, Health Agent Date Issued g-iollolffilmus,11;� "AN -4 IS �16 O Name of Owner: Mansfield Realty Limited Partnership Address: 31 Hampshire St. City: Mansfield State: MA Zip:02048 Telephone: 508-339-2200 Fax: Fed lD/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: 04-3282038 31 Hampshire St. Hot Tub Width: Volume: 500 4' N/A N/A Town Town Sewer Marble with Tile N/A Brick 16" Treatment System: Sand Disinfect Method: Chlorine Chemical Treatment: 101b Chlorinator No. of Bathers: 6 to 8 Remarks: Permit No. A Fee per pool: $75.00 Permit Expires December 31st yearly Mansfield Realty Limited Partnership, by its General Partner, Mansfield Real y Corp. SIGNATURE: zje-t� SL Gerald'S. Fineberg, President DATE: 11/13/03 Please make appropriate changes. Sign, date and enclose check payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048. RAHealth\Pat's Documents\PERMIT APPLICATIONS\SWIMMING POOLS APP.doc The Commonwealth of Massachusetts Department of Industrial Accidents x Offlee ofhv®sfiff0ons 600 Washington Street, 7rh Floor "K Boston, Mass. 02111 Workers' Compensation Insurance Affidavit - General Businesses Applicant information: Please PRINT ledbly name Mansfield Realty Limited Partnership d/b/a Holiday Inn Mansfield 31 Hampshire Street City Mansfield state MA zip: 02048 phone #. 508-339-2200 ❑ I am a sole proprietor and have no one BusinessT pe: ❑ Retail ❑ Restaurant/Bar/Eating Establishment working in any capacity. Office ❑ Sales (including Real Estate, Autos etc.) X❑ I am an employer with employees (full & part time). Q Other HOTEL ❑ I am an employer providing workers' compensation for my employees working on this job, company name: Holiday Inn Mansfield address: 31 Hampshire Street city Mansfield phone#: 508-339-2200 insurance co American & Foreign policy # AcTC463968 ❑ I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: company name: address: city phone #• insurance co policv # company name: address: city phone #: Attach additional sheet if necessary - Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties o erjury that the information provided above is true and correct : Date 11/13/03 -_ Print name Mansfield Realty Corp., it al Partner (;Prnld S. Finebera. President official use only do not write in this area to be city or town: ❑ check if immediate response is required contact person: (revised Sept. 2003) by city or town official 781-431-1108 permi"cense # ❑Building Department ❑Licensing Board ❑Selectmen's Office ❑Health Department phone #; ❑Other TOWN MAN - I BOARDSIX PARK ROW ., 0. CODE:STATE SANITARY CHAPTERMINIMUM STANDARDS .SWIMMING -•. 105 CMR 435.000 INSPECTIONSWIMMING POOL TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC ❑ SPECIAL PURPOSE POOL NAME OF POOL t ADDRESS OWNER > ADDRESS POOL UAPACITY DATE OF INSPECTION t # OF GALS. INSPECTED BY c METHOD OF WATER BATHER # OF LIFEGUARDS WATER SOURCE: TREATMENT - t LOAD` ' Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of 105 CMR 435.000. items marked with a '1' are satisfactory. REGULATION VIOLATIONSICOIVIMENTS .03 Bathouse and sanitary facilities adequate lighting; ventilation; sanitary condition.` -------------------------------------------------------------------- .03 Adequate enclosure around pool. Gate self -latching watch4 ft above - - ----------------------------------------- - - - ---around_ --------------------------------------------------------- ---------------------- ------------------------------------------------------- __04 Sewage Disposal------------------------------------------------ - - - ---------------------------------------------------------------------- 05 Location structural stabilit finish .06 Water circulation & filtration systems. Filter effluent flow meter reading: # ofturnovers ------- ----------------------------------- --------------------------------------------------------------------- ---------- -ppm_ r' _.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 prov_ided------------- ____________________________________________________________________________ .08 Inlets and outlets- Inlets located to produce uniform circulation. Over rim fill spout6" abovemaximumwaterlevel_ Properly_shielded_and located. ________________________________________________________ .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 antivortex drain,> --- rovided. ------------------------------------------------------------- -------------- .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 are made. _09 Cross connections_ Potable water supplied through air gap_ _______ __10 Skim*,gtacilities_50% of recirculation drawn -from surface of pool. .12 Line with floatsseparates 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 _________________________14 Ladders, steps — one per 75 feet. Not less than 2 ladders. ----------- __15 Divinpegupment in safe -condition ----------------------------------- .17 Pool supervision — Pool supervision provided. Effective Jan 1, 1999, pool supervisor certifiied as -----------------------------------------------ool oerator 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 El No L 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_ ... __ t" 1_.25 First aidequipment provided__Firstaid--co --mplete._____________________1-_V_ .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 emergencyr ---numbers posted--------------------------------------------------- --V--- ----- - ------ - -- - - ---- ----- --- - - -- -- - - ,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 Alkalinity 5fl 150 p hl Cyanuric Acid - 3(7 1flff p m ,: ,£Total Chlorine Free Chlorine 1 fl 3 fl m' Comb. Chlorine {fl fl-'fl2 prr ' Water Temp. E,...-' pH Level f7 2:7.8 �� *parts per million Other _29 Pool water tested with appropriatefreguency- --- ------------------- - ------------------------------------------------------------------- ------ .30 Water testing equipment. DPD kit provided for chlorine and bromine. r Unbreakable thermometer fors _ecial u ose pools 31 Water clarity. - - -------------------------- _32 Water clarity maintenance. Filtration systemoperatingcontinuously_ _I `�______________________________________________________________________I _32 specialpurpose pool drained, cleaned and every 14 -days ................ ____________--___-___-____________--__-____--_____--------------------I Maximum Operating Temperatures for Special Purpose Pools. (SPP). .33 a. Thermostatic control provided for each SPP. b_ Thermostatic -control onlcc yaessibletothepooloperator____________ __________________________________________________________________________ .38 General sanitation. REGULATION NO. I THE SPADE BELOW DESCRIBES VIOLATIONS MARKED ABOVE .34 � I Oiosore of the pool. POOL MUST BE CLOSED u&ralTl_ IT 11WEETS THE STANDARDS ,09 OF mm. - THROUGH 435.31. SIGNED SIGNED Board of Health/Health TOWN OF MANSFIELD BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 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 ❑ Special Purpose Pool at: 31 Hampshire St. Method of water treatment is: 301b auto feed chlorinator Bathing load not to exceed: 83 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. Permit No.: 3 Date of Expiration: December 31, 2004 Scott cite, Aealth Agent Date Issued Name of Owner: Address: City: State: MA Telephone: Fax: Fed ID/SS No.: Pool Location: Type/pool: Length: 76' Min/Max. depth: Swim Area: Dive Area: Water Source: W/W Disposal: Type of Finish: Scum Gutter: Deck Type TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Mansfield Realty Limited Partnership 31 Hampshire St. Mansfield Zip:02048 508-3392200 04-3282038 31 Hampshire St. Semi Public Width: 26' 3' to 5' 1,976 sf None Town Volume: 40,000 Town Sewer Fiberglass over gunite Lower and Upper Plaster Skmmr weir length: 16" Treatment System: Sand Disinfect Method: Chlorine Chemical Treatment: 301b auto feed chlorinator No. of Bathers: 83 Remarks: Permit No.:3 Fee per pool: $75.00 Permit Expires December 31St yearly Mansfield Realty Limited Partnership by its General Partner, Mansfield Realty Corp. SIGNATURE: g° Gerald S. Fineberg, President DATE: 11/13/03 Please make appropriate changes. Sign, date and enclose check payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MM 02048. R-.WealthiPaPs DocumentAPERMU APPLICATIOWSW"AING POOLS APP.doc `—_ The Commonwealth of Massachusetts x) Department of Industrial Accidents OfficeOfINVOS fyOUNS -_- 600 Washington Street, 7r" Floor a4 Boston, Mass. 02111 Workers' Compensation Insurance Affidavit -General Businesses Applicant information: Please PRINT legibly name: Mansfield Realty Limited Partnership, dba Holiday Inn Mansfield 31 Hampshire Street Mansfield state MA zip: 02048 phone# 508-339-2200 city work site location full address): same ❑ I am a sole proprietor and have no one Business'r e: ❑ Retail ❑ Restaurant/Bar/Eating Establishment working in any capacity. [� Office ❑ Sales (including Real Estate, Autos etc.) ❑x I am an employer with employees (full & part time). x❑ Other HOTEL ❑ I am an employer providing workers' compensation for my employees working on this job. Holi_dav Inn Mansfield address: 31 Hampshire Street city Mansfield phone #: 508-339-2200 insurance co American & Foreign policy # A2TC463968 ❑ I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: address: city phone #- insurance co policy # address: city phone # insurance co. policy # Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penaltiSof perju hat the information provided above is true and correct. Print name Mansfield Realty Corp General Gerald S. Fineberg, President 11/13/03 781-431-1108 official use only do not write in this area to be completed by city oown official city or town: permittlicense # FIBuilding Department ❑Licensing Board ❑ check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone #; (tevised Sept. 2003) TOWN ON f BOARD OF SIX PARK J i ROW MANSFIELD, MA 02048 STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOL] 105 R 435.000 SWIMMING POOL -INSPECTION REPORT TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC ❑ SPECIAL PURPOSE POOL NAME OF POOL ADDRESS = OWNER ADDRESS .03 Bathouse and sanitary facilities adequate lighting; ventilation; sanitary condition. DATE OF INSPECTION 4 POOL CAPACITY # OF GALS. 40, 6 INSPECTED BY k ` t METHOD OF WATER �r BATHER ------ # OF LIFEGUARDS WATER SOURCE: TREATMENT v-- LOAD - -_05 Location, structural stability, finish -------------------------------------- Regulation 905 CMR 435.000 The items marked below with an °X" indicate the violated provisions of 105 CMR 435.000. items marked with a "4' are satisfacto . REGULATION - ----- -------- ------------------------------------------------------------ VIOLATIONS/COMMENTS - .03 Bathouse and sanitary facilities adequate lighting; ventilation; sanitary condition. ti -------------------------------------------------------------------- .03 Adequate enclosure around pool. Gate self -latching wllatch 4 ft above --- round. ---------------------------------------------------------------- ------ ---------------------------------------------------------------------- 04 Sewage Disposal------------------------------------------------- - -- ---------------------------------------------------------------------- -_05 Location, structural stability, finish -------------------------------------- ------ ----------------------------------------------------------------- --------------------------------------------------------------------- .06 Water circulation & filtration systems. Filter effluent flow meter reading: .06 ofturnovers------ gpm._# ------------------------------ - ----- -------- ------------------------------------------------------------ - -- -- ----- _06 Suitable automaticequipment fordisinfectionofpool water ______________ _'�_-___________________________-_________------------------------------- .06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders anchored. -Inaccessible to public, adeqtqtqyqqtlation_provided -------------______________ ------- .08 Inlets and outlets- Inlets located to produce uniform circulation. Over rim--------------------------------' fiilspout6" above maximum water level, _Properlyshielded and located. ____________________________________________________________________ .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 antivortex drain V� -- rovided.--------------- ------------------------------------------------- --------------------------------------------------------------------------- - .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 re airs are made. _09 Cross connections. Potable water supplied through air gap_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __10 Skimming facilities_50% of re circulation 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 __________13 Walkway_ and decks -4 feet wide, safe condition._ _ _ _ _ _ _ _ _ _ _ _ _ ----------- .14 __________.14 Ladders, steps_oneper 75 feet _Not less than 2 ladders. _15 Diving egupmentinsafe condition. __________________________ .17 Pool supervision — Pool supervision provided. Effective Jan 1, 1999, pool ... supervisor certified as pool operator from -YMCA -or NSPF---------------- 21 _______________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 Lifeguard required; proper credentials, proper suits and garments worn. Whistle andbullhornprovided._________ _____________________________ 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 ________ .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 property discharged. No direct connection to sewer system. Separation tank provided for diatomaceous earth filter backwash water. .29 Chemical standards. POOLSIDE READINGS Bromine (2 ©0 ppm*} = Total Chlorine Alkalinity (50 ,150; ro Free Chlorine 1 0__,,=3 Ox m} Cyanuric Acid 307. 10fT. p m Comb. Chlorine i0 0= 0 pm Water Temp. X904 F,,„ , pH Level E7 *parts per million Other .29 Pool water tested withappropriatefreguency_ ______________ _ ' --- - - -- ----------------------------------------------------------------- .30 Water testing equipment. DPD kit provided for chlorine and bromine. Unbreakable -thermometer for -special purposepools.----- 31 Water clarity-.----------------------------------------------------- --'�-- ---- -----� __32Waterclarity_maintenance_ Filtration systemoperatin9conjk uously______ ------I----------------- _____________________________________________________ _ _32 specialpurpose 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 ------------- J6 ____________.38 General sanitation. REGULATION NO. I THE SPACE BELOW DESCRIBES VIOLATIONS tV1ARi(E® ABOVE .34 Closure of the pool. POOL MMUST BE CLOSED UNIT L IT BrIEETS THE STANDARDS 05 C11"R 435.29 THROUGH 435.31. SIGNED SIGNED Board of Health/Health