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Home My WebLink AboutWillow Crossing 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 II L 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: Cottages at Willow Crossings LP for the operation of a ❑ Public at: Method of water treatment is: i -Public ❑ Special Purpose Pool 25 Cobb St. Hayward C-50OLF Brominator Bathing load not to exceed: 22 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. Permit No.: 11 Date of Expiration: December 31, 2003 f Date Issued TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Name of Owner: Cottages at Willow Crossings LP Address: 25 Cobb Street City: Mansfield State: MA Zip:02048 Telephone: 508-261-1333 Fax: Fed ID/SS No.: 0 6' v . Pool Location: 25 Cobb St. Type/pool: Gunite Concrete Length: 32' Width: 14' Volume: 12,544 Min/Max. depth: 31611 to 3'9" Swim Area: 448 sf Dive Area: None Water Source: Town W/W Disposal: Town Sewer Type of Finish: White Marbleite Scum Gutter: None Deck Type: Concrete Skmmr weir length: 8.5" Treatment System: Hayward C-50OLF Brominator Disinfect Method: Bromine Chemical Treatment: Bromine No. of Bathers: 22 Remarks: Permit No.: 11 Fee per pool: $75.00 Permit Expires December 31St yearly SIGNATURE: DATE: �N 0 11 20(x;' 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\Pafs DocumentAPERMIT APPLICATIONS\SWIMMING POOLS APP.doc 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 �ceei of 101 it- 17-1,"gPFRIAI PI 1RPORF POOL n Regulation 105 CMR 435.UUU I ne Items marKeo oeiUW will] ari n inuicaiG lilt vwIQLVU PIUVIOIUII�Wl..� �+.-..- ��•��• Items marked with a '1' are satisfactory. REGULATION x/4 VIOLATIONS/COMMENTS .03 Bathouse and sanitary facilities adequate lighting; ventilation; sanitary condition. ---- --- ---- - -- - ---- - - - ------------------- -----I ------------------------------------------------------------------ .03 Adequate enclosure around pool. Gate self -latching w/latch 4 ft above round. -------------------------- ---- .04 Sewage Disposal ----------------------------------------------------------------------- - - .05 Location, structural stabili , finish. 06 Water circulation & filtration systems. Filter effluent flow meter reading: - _____gpm_ #ofturnovers------------------------------------ -------- - - - -- - --- -------------------------------------- ----------------- -- ------------- ---------- -- .06Suitableautomaticequipmentfordisinfectionofpoolwater_______________ _ '--______---------_-_---------_-------_-------____---__-------_---_-__ ---------------------- .06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders ---aanncchhoorred. Inaccessible topublic, adequate provided. - - --------- - - --- ----------- ----- ------ ---------- .08 Inlets and outlets- Inlets located to produce uniform circulation. Over rim fill spout 6" above maximum water level_ Properly shielded and located_ --- "p --1--------------------------------------------------------------------- 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, ro erl located and plumbed r .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. NAME OF POOL f ADDRESS _ - OWNER ADDRESS ' DATE OF INSPECTION POOL CAPACITY ` F INSPECTED BY c ° # OF GALS.. F" METHOD OF WATER - BATHER -. - # OF LIFEGUARDS WATER SOURCE: TREATMENT� v"'tt`�`�. � LOAD Regulation 105 CMR 435.UUU I ne Items marKeo oeiUW will] ari n inuicaiG lilt vwIQLVU PIUVIOIUII�Wl..� �+.-..- ��•��• Items marked with a '1' are satisfactory. REGULATION x/4 VIOLATIONS/COMMENTS .03 Bathouse and sanitary facilities adequate lighting; ventilation; sanitary condition. ---- --- ---- - -- - ---- - - - ------------------- -----I ------------------------------------------------------------------ .03 Adequate enclosure around pool. Gate self -latching w/latch 4 ft above round. -------------------------- ---- .04 Sewage Disposal ----------------------------------------------------------------------- - - .05 Location, structural stabili , finish. 06 Water circulation & filtration systems. Filter effluent flow meter reading: - _____gpm_ #ofturnovers------------------------------------ -------- - - - -- - --- -------------------------------------- ----------------- -- ------------- ---------- -- .06Suitableautomaticequipmentfordisinfectionofpoolwater_______________ _ '--______---------_-_---------_-------_-------____---__-------_---_-__ ---------------------- .06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders ---aanncchhoorred. Inaccessible topublic, adequate provided. - - --------- - - --- ----------- ----- ------ ---------- .08 Inlets and outlets- Inlets located to produce uniform circulation. Over rim fill spout 6" above maximum water level_ Properly shielded and located_ --- "p --1--------------------------------------------------------------------- 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, ro erl located and plumbed r .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 _____________________ .09 Cross connections. Potable water supplied through air gap._ ............. ------------------------ -------- -.-10 Skimming facilities, 50% of recirculation 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 Ladders, steps — one per 75 feet. Not less than -2 ladders. --------------------------------------------------- 15Divinpequipmentinsafecondition_ _______________________. .17 Pool supervision — Pool supervision provided. Effective Jan 1, 1999, pool supervisorcertified aspool operator from -YMCA -or NSPF----------------- .21 Permit requirements — Permit issued. Adequate maintenance and testing records maintained._ Records initialed byper cT making tests ------------- .22 ____________.22 Health Regulations: Signs Posted. Health warning signs posted for special __purposepools------------------------------- r`-____ -------- 23 Lifeguards required; Yes El No 0 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 atpools 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 properly discharged. No direct connection to sewer system. Separation tank provided for diatomaceous earth filter backwash water. ------------------------------------------------------------------- .29 Chemical standards. -------------------------------------------------------------------- POOLSIDE READINGS Bromine 20 ,50fit' Total Chlorine. 7777777777 Alkalinit0,—�f�a0it';.� Free Chlorine C anuric Acid 3Q `-1p0► Comb. Chlorine Water Tem 104 F H Level * arts per million Other .29 Pool water tested with appropriate frequency -------------------------- -I_ -- -------------------------------------------------------------------- .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. --------------------------------------------------------------------------- i- -------------------------------------------------------- Maximum Operating Temperatures for Special Purpose Pools. (SPP). .33 a. Thermostatic control provided for each SPP. b_Thermostaticcontrolonlyaccessibletothepooloperator______________ _" ¢_-____-___-____-___-_______-___-______---__--________---------------- .38 General sanitation. REGULATION NO. THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE XIII Closure of the pool. POOL MUST BE CLOSED UNITL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. .34 SIGNED Operator SIGNED oard of Health/Health Department 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. Corporate Name (Mandatory) By: Corporate Officer (Mandatory, if applicable) at- — 3 4t bS9� ** 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.