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Home My WebLink AboutRed Roof Inn 12/31/2004TOWN OF MANSFIELD BOARD OF HEALTH S -V, PARK ROW, MANSFIELD 02048 I► I 1 � ., SII In accordance with the provisions of Chapter II L Section 127A of the Massachusetts General Laws, and Regulations established by the Massachusetts Department ofpublic Health (105 CMR 435.00). permit is hereby issued to: Red Roof Inn, Inc. #7274 for the operation of a ❑ Public ❑ Semi -Public ❑ Special Purpose Pool at: Method of water treatment is: Bathing load not to exceed: 60 Forbes Blvd. Manually as required 55 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. Permit No.: 10 Date of Expiration: December 31, 2004 Scott Leite, l4ealth Agent Date Issued Remarks: Per daily testing pool maintained. Permit No.:10 Fee per SIGNA' DATE: irly 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. R:\Health\Pat's Documents\PERMIT APPLICATIONS\SWp&,u JG POOLS APP.doc TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Name of Owner: Red Roof Inn, Inc. #7274 Address: P.O. Box 117508 City: Carrolton State: TX Zip:75011 Telephone: 508-339-2323 Fax: Fed ID/SS No.: 31-1393666 Pool Location: 60 Forbes Blvd. Type/pool: Concrete, In -ground Length: 40' Width: 20' Volume: 22,000 Min/Max. depth: 3' to 8' Swim Area: 800sf Dive Area: None Water Source: Town W/W Disposal: Town Sewer Type of Finish: Gunite Scum Gutter: None Deck Type: None Skmmr weir length: Two baskets Treatment System: Diatomaceous Disinfect Method: Automatic Chlorine Chemical Treatment: Manually as required No. of Bathers: 55 Remarks: Per daily testing pool maintained. Permit No.:10 Fee per SIGNA' DATE: irly 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. R:\Health\Pat's Documents\PERMIT APPLICATIONS\SWp&,u JG POOLS APP.doc The Commonwealth of Massachusetts Department of Industrial Accidents oifieeof1MMY890HS 600 Washington Street, 7rh Floor Boston, Mass. 02111 Workers' Compensation Insurance Affidavit - General Businesses M _ city l c i i C'�"� state zip' phone #<` �+ -.5 v ❑ I am a sole proprietor and have no one Business T e: ❑ Retail ❑ RestaurantBar/Bating Establishment working in any capacity. [J Office ❑ Sales (including Real Estate, Autos etc.) ❑ I am an employer with employees (fall & part time). ❑ Other I am an employer providing workers' compensation for my employees working on this job. company name address: . , V( i v b city i £ A V a- I I—L, i shone # i insurance co \�- 11 policy # , Al A I C° ❑ I am a sole proprietor and have hired the independent contractors listed below who have the ivuvw—r, compensation polices: comlpanY name: address: city phone #• insurance co policy # company name: address: city phone #: insurance co policy # Attach additional sheet if necessary Failure to secure coverage as _ required sender Section 25A of MOL 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_,poorwgrdeWtothe ce-oj,Investigations of the DIA for coverage verification. I do hereby certify lander the ns and penalties o0erjury that the information provided above is true and correct Print name official use only do not write in this area to be completed by city or town official city or town: ❑ check if immediate response is required contact person: (revised Sept. 2003) permit/license # ❑Building Department ❑Licensing Board ❑Selectmen's Office ❑Health Department phone #; ❑Other r TOWN ON MANSFIELD BOARD OF HEALTH SIX PARK ROW t MANSFIELD, MA 02048 STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 CMR 435.000 SWIMMING POOL INSPECTION REPORT •,+ rs-1 coE:f'IAI Dr IRDrICF P()rll n I Tyr- yr rvvL. rUDu%. LI NAME OF POOL �-•�,• _+ _ - - ADDRESS condition. ADDRESS OWNER ---- -- ----------------------------------------------------------- .Os Adequate enclosure around pool. Gate self latching w/latch 4 ft above � DATE OF INSPECTION ` E (BOOL CAPACITY 6I # OF GALS. �� A INSPECTED BY [METHOD OF WATER TREATMENT --------------------------------------------------------------------- _05 Location, structural stability, finish._ _ _ _ _ ___ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ BATHER LOAD - # OF LIF , U RDS WATER SOURCE: D Aqr, Ann Regulation 105 GMK 435.000 I ne items marreu ueIuw w,U, a„ ^ uJun.a►c ui� v.v. F .•...+•.� �• - -•- - •-- --- Items marked with a "4' are satisfactory. REGULATION X14 VIOLATIONS/COMMENTS is .03 Bathouse and sanitary facilities adequate lighting; ventilation; sanitary condition. ---- -- ----------------------------------------------------------- .Os Adequate enclosure around pool. Gate self latching w/latch 4 ft above ------ 11 ---------------------------------------------- --ground. ---------------------- ----------------------- Ll� ------ ---------------------------------------------------------------------- -=04 Sewage Disposal------------------------------------------------ --- --------------------------------------------------------------------- _05 Location, structural stability, finish._ _ _ _ _ ___ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - .06 Wat ' ulation & filtration systems. Filter effluent flow meter reading: --- -- _ gpm_ of turnovers -- - -------- ---- - --------------------------------------------------- _06 Suitable automatic equipment for disinfection of poo! water ._ ____________ ------ .06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders anchored_ Inaccessible to public, adequate vent44ionprov_ided_ __ _________________________________________________________________ill/vi____________ .08 Inlets and outlets- Inlets located to produce uniform circulation. Over rim j ... fillspout6"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 p!umbed.-------------------------------------- ------ ---------------------------------------------------------------------- .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. 08 Special purpose pool and wading pools equipped with emergency shut off _ pumpswitch: Accessible and prominently marked. __________________ -.09 Cross connections _ Potable water supplied)I through air_gap _ _ _ _ _ _ _ _ _ _ _ _ _ _ _10 Skimminpfacilities_50% of recirculation dtawn from surface of pool._ _12 Line with floats separates non -swimmer area from deeper water_ .12 Water depth markings on deck and wallsIroperly spaced. Boundary line on pool floor and walls_ Step edges mark _ _ with contrasting color_ -.13 Walkway and decks 4 feet wide, -safe condition ------------------------- .14 _________________________14 Ladders, steps - oneper 75 feet. Not less than 2 ladders. _15 Divi ngegupmentinsafe condition, ___________________________- .17 Pool supervision — Pool supervision provided. Effective Jan 1, 1999, pool superyisor certi_fi_ed @spool operator from YMCA or NSPF------------------------------ .21 _ _ _, .21 Permit requirements — Permit issued. Adequate maintenance and testing records maintained. Records initialed byperson 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 wom. ___ Whistle and bullhorn proyided._______________________________________ .24 Safety equipment. Ring buoys and rescue hook provided. Rescue tube and backboard with straps at pools attended by_ a lifeguard_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .25 First aid equipmentprovided_ 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. -- ----em------------------------------------------------------------- .29 Chical standards. POOLSIDE READINGS Bromine R-5; '#+WINE fiotal Chlorine Free Chlorine Alkalinity C anuricAcid `� Comb. Chlorine Water Temp.- *parts per million pH Level Other 29 Pool water tested with appropriate freguency-------------------------- .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 ------- .AZ ___-___32 sp_ _ _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. l