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Home My WebLink AboutMilhaus 12/31/2003TOWN OF MANSFIELD BOARD OF HEALTH PARK ROW, MANSFIELD 1 14 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: Milhaus ansCondo 'Trust for the operation of a ❑ Publicf!]-Semi-Public ❑ Special Purpose Pool at: 150 Rumford Ave. Method of water treatment is: Haywood 3000 Bathing load not to exceed: 70 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DITTY" sign is required. Permit No.: 9 Date of Expiration: December 31, 2003 Date Issued ' TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Name of Owner: Milhaus @ MansCondo Trust Address: 150 Rumford Avenue City: Mansfield State: MA Zip:02048 Telephone: 508-339-7531 Fax: Concrete 16' Fed ID/SS No.: 04-6551192 Pool Location: 150 Rumford Ave. Type/pool: Gunite Length: 60' Width: 30' Volume: 44, Min/Max. depth: 4', 7',10',14' Swim Area: 18,000sf Dive Area: None Water Source: Town W/W Disposal: Town sewer Type of Finish: Concrete Scum Gutter: yes Deck Type: Concrete 16' Skmmr weir length: 4, 8' apart Treatment System: Haywood 3000 Disinfect Method: Automatic Chlorinator Marc Mac, 22 psi Chemical Treatment: Sodium Hypochlorite No. of Bathers: 70 Remarks: Permit No.:9 Fee per pool: $75.00 Permit Expires December 31St yearly SIGNATURE: DATE:�- 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:H-IealthiPat'sDocuments\PE MIT APPLICATIOWSWIMMM 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. J * Signature of Individual or Corporate Name (Mandatory) By: Corporate Officer (Mandatory, if applicable) ** Social Security Number (Voluntary) or Federal Identification Number C)+— 6'yl / V * 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. 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 QC11A1 C311131 in 171 CPFftlal PI IRPC)SF Pnr)l n NAME OF POOL ADDRESS condition. OWNER r v( , Y� � -� ADDRESS ------ DATE OF INSPECTION `y POOL CAPACITY # OF GALS. ------------------------------------------- ------------------------ INSPECTED BY L t -j I �, METHOD OF WATER ,-, BATHER - # OF LIFEGUARDS WATER SOURCE: TREATMENTS Ct LOAD -------- -- ---------------------------------- -- -------- - ---------------------------------------------------------- _06 Suitable automatic equipment for disinfection of pool water_ .06- - - 41_1111\ 11 Regulation 105 CMR 435.000 I ne items marKeQ Delow witn an A InulGdte the Viviatcu Nlvvlawua vl 1 V11 VIYIR YJJ.VV V. 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 ------ --------------------------------------------------------------------- ground. -------------------------------------------------------------- ------ ------------------------------------------- ------------------------ .04 Sewage Disposal------- ------------------------------- -- -- - ------- - f ------ - ------------ ---- -- --- -- -- -- -------------------- 05 Location, structural- stability, finish. - --------------------------------------------------------------- ------ ---- ---- ---------------------------------------------- .06 Water ifculation & filtration systems. Filter effluent flow meter reading: p,f ` fpm_ # of turnovers ----- -------- -- ---------------------------------- -- -------- - ---------------------------------------------------------- _06 Suitable automatic equipment for disinfection of pool water_ .06- - - `"'` ------ ---------------------------------------------------------------------- .06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders -- ' anchored. Inaccessible to public,_ ade uate ventilation pEqyig9A .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 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, - _9perlylocatedandplumbed ------------------------------------------------------------------------------------------------------------- --------- .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 Skimming facre-circulation ilities. 50% of irculation drawn from surface of pool._ -.-12 Line with floats separates non -swimmer area from deeper water----------- .12 Water depth markings on deck and walls. Property spaced. Boundary line ... p n pool floor and walls. _ Step edges marked with contrasting color.......... .13 Wal and decks_4 feet wide, safe condition. _14 Ladders, steps — one per 75 feet. - Not less than 2 ladders. _15 Diving equipment in safe - condition. - -------------------------------------------- .17 Pool supervision — Pool supervision provided. Effective Jan 1, 1999, pool ... supervisor certified aspool operator from -YMCA -or NSPF--- ------------- .21 ___________.21 Permit requirements — Permit issued. Adequate maintenance and testing ... records maintained._ Records initialed byper cT making tests.............. .22 Health Regulations: Signs Posted. Health warning signs posted for special _ _ u ose ools. .23 Lifeguards required; Yes ❑ No El If Lifeguard required; proper credentials, proper suits and garments worn. Whistle andbuilhornprovided._______________________________________ .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 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. ---------------------------------------------------------------------I ---- A---------------------------------------------------------------------- I LI---11-1-------------------------------------------------------------------- ______________________________________________________________________I POOLSIDE READINGS Bromine F� ' Alkalinity S; - Total Chlorine' Free Chlorine Cyanuric, Acid Comb. Chlorine Q . Water Tem.0 =_ H Level *parts per million' Other .29 Pool watertested with ap-p_ropriatefreguency----------------------------` ------------------------ --- ---------------------------------------------------------------------- .30 Water testing equipment. DPD kit provided for chlorine and bromine. _ _ _ Unbreakable thermometer for special purpose pools ---------------------- L-_ - - _ _ ------------------------------------------------------------------- .31 Water clarity. -------------------------------------------------------------------- - ---- ---------------------------------------------------------------------- -.32- Water clarify maintenance. Filtration system operating continuously_ _ W -----------------------ration _ _ r -------------------------------------------------------------------------- ill" ;l Y° _32 specialpurpose pooldrained,cleaned and -every 14days._______________ ___ ______________________________________________________________________ Maximum Operating Temperatures for Special Purpose Pools. (SPP). .33 a. Thermostatic control provided for each SPP. . _ _ - _ b_ Thermostatic control only accessible tc the pool operator _ _ _ _ _ _ _ _ _ _ - - - ------------ _ _"' -'CA------------------------------------------------------------------ .38 General sanitation. REGULATION NO. THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE X/4 .34 Closure of the pool. POOL MUST BE CLOSED UNITL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. SIGNED a L Opgrator SIGNED" Boaro of Health/Health Department