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Home My WebLink AboutHoldiay Inn 12/31/2003TOWN 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 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: Mansfield Realty Limited Partnership for the operation of a ❑ Public EKSemi-Public ❑ Special Purpose Pool at: Holiday Inn 31 Hampshire St. Method of water treatment is: Sand 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, 2003 t ssued S eite, Health Agent TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Name of Owner: Mansfield Realty Limited Partnership Address: 31 Hampshire St./ fro (i ) City: Mansfield State: MA Zip:02048 Telephone: 508-339-2200 Fax: Fed ID/SS No.: 04-3282038 Pool Location: 31 Hampshire St. Type/pool: Semi Public Pool Length: 76' Width: 26' Volume: 1*;00 40,000 gal Min/Max. depth: 4ktW8' 3' to 5' Swim Area: 1,976 s. f. Dive Area: None Water Source: Town W/W Disposal: Town Sewer Type of Finish: Fiberglass over gunite Scum Gutter: Lower and Upper Deck Type: Plaster Skmmr weir length: 16" Treatment System: Sand Disinfect Method: VrZydaa Chlorine Chemical Treatment: Mtm 30 lb/auto feed chlorinator No. of Bathers: 83 Remarks: Permit No.:3 Fee per pool: $75.00 Permit Expires December 31St yearly /1V Mansfield Realty Limited Partnership by its General Partner Mansfield Realty Corp. SIGNATURE:," Gerald S. Fineberg, Presicwnt DATE: 11/6/02 Please make appropriate changes. Sign, date and enclose checkpayable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048. RAHealth\Pat's Documents\PEMT APPLICATIOWS WRYM NG 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 Partner, Mansfield Realty Corp. By: Corporate Officer Gerald S. F neberg, 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. r CORP One Washington Street, Suite 402 Wellesley, Massachusetts 02481 Tel: 781-431-1108 ® Fax: 781-431-7130 Via First Class Mail November 6, 2002 Pat Byrnes, Administrative Secretary Town of Mansfield, Board of Health 6 Park Row Mansfield, MA 02048 Licensee: Mansfield Realty Limited Partnership Location: Holiday Inn Mansfield Re: 2003 License Renewal Applications Dear Pat: Enclosed please find the following materials in connection with the license renewals for the above referenced property: 1. Swimming Pool Permit Renewal Application 2. Application fee in the amount of $75.00 3. Hot Tub/Special Use Permit Renewal Application 4. Application fee in the amount of $75.00 5. Tax certification forms Please contact me if you have any questions. Sinc 1y 4 f � Maria 'I C- "Rota Counsel MCR/km Enclosures TOWN ON MANSFIELD BOARD OF HEALTH SIX PARK ROW MANSFIELD, MA 02048 STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 CMR 435.000 SWIMMING POOL INSPECTION REPORT rvoc nc onn1 of IQ1 in n C1=IU1_P1 IRI 1('. I SPFr[Al PURPOSE POOL n NAME OF POOL 04M_ ADDRESS OWNER /111 ------ ---------------------------------------------------------------------- ADDRESS r --L"- -- --- -- --------------------------------------------------------------------- -05 Location, structural- stabi*, finish. ----------------------------------------------------------------- -- ---- DATE OF INSPECTION;.., .06 Water.pirculation & filtration systems. Filter effluent flow meter reading: POOL CAPACITY INSPECTED BY r —. ---------------- ------ .O6 Suitable automatic-equipmdinfectionofpoow_ # OF GALS. r .06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders METHOD OF WATER __ _ anchored_ _Inaccessible to public,adequate ventilation provided. BATHER - If OF LIFEGUARDS WATER SOURCE: TREATMENT (,JI 6 - LOAD ;, .08 Main drain suction outlets covered with suitable protective covers or w.Til_< Regulation 105 CMR 435.UUU I ne Items marKea De1ow wan an -x- lnaicate ine vlulateu pruvlbwnb ui ova %AviM woa.wv. Items marked with a "4" are satisfactory. REGULATION x/4 VIOLATIONS/COMMENTS .03 Bathouse and sanitary facilities adequate lighting; ventilation; sanitary condition. -------------------------------------------------------------------- .03 Adequate enclosure around pool. Gate self -latching wAatch 4 ft above ------ ---------------------------------------------------------------------- ___ 919und. -04 Sewage Disposal ____ ------------------------------------------- ------------------------------------------------------------- --L"- -- --- -- --------------------------------------------------------------------- -05 Location, structural- stabi*, finish. ----------------------------------------------------------------- -- ---- ---------------------------------------------------------------------- .06 Water.pirculation & filtration systems. Filter effluent flow meter reading: ---- -- '-' -- fpm_ # of turnovers- - ---i- --- ----- - ------------ ---------------- ------ .O6 Suitable automatic-equipmdinfectionofpoow_ ---------------------------------------------------------------------------------------- ---------------- .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 till 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 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. .08 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 gap ._ _ _ _ _ _ _ _ _ _ _ _ _ ------------------------------------ -- ----------------------------------------------------------------------------- --------------------------------------------------------------------- .10 Skimmingfacilities_50% of re -circulation drawn from surface of pool._ ------------------------------------------------ --------- i ' --------------------------------------------------------------------- Line with floats separates non -swimmer area from deeper water.,,,. ------------------- -------------------------------------------------------------- .12 Water depth markings on deck and walls. Properly spaced. Boundary line Other f on pool floor and walls. Step edges marked with contrasting color, ' ------------------------------------------ 13Walkwayanddecks4feetwide,safe condition_ ----- - ------------------------ ----- ------_14 _ _______________----------------------------- Ladders, steps — one per 75 feet:Not less than 2 ladders. ----------------------------------- -`--- ------------ ----- --- ------ -- --- -- --------- ----- ------ 15Diving equpment insafe condition. .17 Pool supervision — Pool supervision provided. Effective Jan 1, 1999, pool ------ ---------------------------------------------------------------------- _ _ _ supervisor certified aspool operator from YMCA or NSPF_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - ---------------------------------------------------------------------- .21 Permit requirements — Permit issued. Adequate maintenance and testing ... records maintained. Records initialed byperson making tests. v _ _ = ----------------------------- .22 Health Regulations: Signs Posted. Health warning signs posted for special purpose pools. .23 Lifeguards required; Yes ❑ No D f 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 Total Chlorine ri Alkalinity and backboard withstraps atpools attended by a lifeguard_ Free Chlorine` v. --------------------------------------------------------------------- .25 First aid equipment provided. First aid kit complete. - Comb. Chlorine m --------------------------------------------------------------------- .25 Emergency Communication System at the pool and in working order. arts per million Emergency communication device in unlocked area and available at all Other f 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. ------ ---------------------------------------------------------------------- -------------------------------------------------------------------- .29Chemical standards. POOLSIDE READINGS Bromine Total Chlorine ri Alkalinity Free Chlorine` v. Cyanuric Acid Comb. Chlorine m Water Tem arts per million Other 29 Pool water testedvdithappropriatefrequency__________________________ ------------------------ .30 Water testing equipment. DPD kit provided for chlorine and bromine. --- Unbreakable -thermometer for specialpurp ss 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 a pool operator .38 General sanitation. ---------------------------------------------------------------------I REGULATION NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE .34I I Closure of the pool. POOL MUST BE CLOSED UNITL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. SIGNED co SIGNED Board of Health/Health Department TOWN 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 Special Purpose Pool at: Holiday Inn 31 Hampshire St. Method of water treatment is: Bathing load not to exceed: 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, 2003 e Issued Scott I�.ealth Agent TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Name of Owner: Mansfield Realty Limited Partnership Address: 31 Hampshire St. f '/d Zt -,4 , City: Mansfield State: MA Zip:02048 Telephone: 508-339-2200 Fax: Fed ID/SS No.: 04-3282038 Pool Location: 31 Hampshire St. Type/pool: Hot Tub / Special Use Pool Length: 15' Round Width: Volume: 500 gal Min/Max. depth: 4' Swim Area: N/A Dive Area: N/A Water Source: Town W/W Disposal: Town Sewer Type of Finish: Marble with Tile Scum Gutter: N/A Deck Type: Brick Skmmr weir length: 16",'Xbatritl9VSUnWVUr Treatment System: Sand Disinfect Method: Chlorine Chemical Treatment: 10 Lb Chlorinator No. of Bathers: 6 — ,g Remarks: Permit No.:4 Fee per pool: $75.00 Permit Expires December 31sT yearly Mansfield Realty Limited Partnership by its General Partner Mansfield Realty Corp. SIGNATURE: ll°q��o�� `-�. Gerald S. Fineberg, Presi ent DATE: 11/6/02 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\PaPs DocumentsTERNUT APPLICATIONS\SWIMMING POOLS APP.doo 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 Partner, Mansfield Realty Corp. By: Corporate Officer Gerald S. Fin erg, 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 ❑ SEMI -PURR IC, ❑ SPFCIAI Pi IRPnSF Pnoi j_ -i - NAME OF POOL ADDRESS ' �3 �" 4 t��i. B r� � -�3 •k°'`'"`= k .s'�e. ....--•................................................•--•-•----........---................ .03 Adequate enclosure around pool. Gate self -latching w/ "'=` 6,^�' t � .&-- d OWNER ...... latcb.4 f P. Qme.ground----------------------•-------••------...........,_:.......................................................-------- ADDRESS ...................................... DATE OF ..... POOL CAPACITY .05 Location, structural stability, finish. ..........................................•--..........------------......----•-.............. INSPECTED BY ---------............................._..........------------------•-•-•----------................. INSPECTION # OF GALS.1 — --...... ........... .................. ......... - ............................ METHOD OF WATER BATHER water. ............. ................................................................................ # OF LIFEGUARDS WATER SOURCE: TREATMENT LOAD adequate. CO2 cylinders anchored. Inaccessible to; Kegulatlon 105 GMK 435.000 The items marked below with an "X" indicate the violated provisions of 105 CMR 435.000. Items marked with a "✓" are satisfactorv. .ua rsainnouse ana santary tacimies aaequate ngnting; ventilation; sanitary condition. ....--•................................................•--•-•----........---................ .03 Adequate enclosure around pool. Gate self -latching w/ •-----................................................------..........................---•--------- ...... latcb.4 f P. Qme.ground----------------------•-------••------...........,_:.......................................................-------- ...................................... .04 -Sewage Disposal ......................... ........ ..... ............................................•--•--------................................----------- .05 Location, structural stability, finish. ..........................................•--..........------------......----•-.............. f ---------............................._..........------------------•-•-•----------................. .06 Water circulation( & filtration systems. Filter efflu t flow meter reading gpm. # of turnovers — --...... ........... .................. ......... - ............................ .06 Suitable automatic equipment for disinfection of pool Ile water. ............. ................................................................................ ..................... .............................................................................. .06 Carbon dioxide (CO2) equipment for pH control adequate. CO2 cylinders anchored. Inaccessible to; Rub(ic,.adequet�.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 use of tools. Open area does not provide entrapment of fingers, toes, etc. At least one ....... ntivortexAmin.provided....................•----............................-•--------•------...................................•--•-------................................... .08 Each system outlet protected against user entrappment by antivortex cover or other means. Minimum of 2 suction outlets provided for each pump, properly 'F ...... 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. .ua Special purpose pool and wading pools equipped with emergency shut off pump switch. Accessible and Total Chlorine prominently marked. ........................................................................................... ............... .09 Cross connections. Potable water supplied through air Comb. Chlorine gap. pH Level .......................................................................................................... .10 Skimming facilities. 50% of recirculation drawn from Other surface of pool: ........ .12 Line with floats separates non -swimmer area from Z' deeper water. ....................................................................................... ...................... ............... .12 Water depth markings on deck and walls. Properly spaced. Boundary line floor Step on pool and walls. 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. ,'. U1, ....................................................................................................................................... .15 Diving equipment in safe condition. ....................................................................................... . ;. .17 Pool supervision -Pool supervision provided. Effective Jan. 1, 1999, pool supervisor certified as pool Total Chlorine operator from YMCA or NSPF. .......................................................................................................... Free Chlorine .21 Permit requirements - Permit issued. Adequate Comb. Chlorine maintenance and testing records maintained. Records pH Level initialed by person making tests. Other .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 and bullhorn provided. ........................................................................................................... .24 Safety equipment. Ring buoys and rescue hook Rescue tube backboard provided. and 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. 4.e ..................................................................................... .26 Waste and backwash water disposal properly ........ .............. discharged. No direct connection to sewer system. Separation tank provided for diatomaceous earth filter J backwash water. .................................................................................................... .29 Chemical standards. POOLSIDE READINGS Bromine Total Chlorine Alkalinity; Free Chlorine Cyanuric Acid Comb. Chlorine Water Temp._140 pH Level *parts per million Other .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. NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE X!✓ .34 I 1 Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. SIGNED I SIG Aerator