The URL can be used to link to this page

Home My WebLink AboutMansfield Depot II 12/31/2003TOWN OF MANSFIELD BOARD OF HEALTH SIX PARK ' 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: Keith Properties, Inc. .for the o .f a ❑ Public ❑ Semi -Public ❑ Special Purpose Pool operation o at: Mansfield Depot II Method of water treatment is: Hayward DE -3600 Earth Filter Bathing load not to exceed: 43 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. Permit No.: 6 Date of Expiration: December 31, 2003 Name of Owner Address: City: State: MA Telephone: Fax: Fed ID/SS No.: Pool Location: Type/pool: Length: 40' Min/Max. depth: Swim Area: Dive Area Water Source: W/W Disposal Type of Finish Scum Gutter: TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Keith Properties, Inc. 532 Page Street Stoughton Zip:02072 508-339-3583 0-'Aq'5-614 Mansfield Depot H Semi -Public Width: 20' 4'to5' 20x40' None Town Town Sewer Printed Vinyl N/A Deck Type: Cement Slab Skmmr weir length: 2 skimmers Volume: 9 , Treatment System: Hayward DE -3600 Earth Filter Disinfect Method: Chlorinating Sticks, Ph Minus and Plus, Chemical Treatment: Automatic Chlorinator No. of Bathers: 43 Remarks: Permit No.:6 Fee per pool: $75.00 Permit Expires December 31ST yearly SIGNAE: `� DATE:l1 O "z 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. RAHealthTat's Documents\PERMIT APPLICATIONSISWIMMUNG POOLS APP.doc C� ►�sF► a 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) , if applicable) ** Social Security Number (Voluntary) or Federal Identification Number Q q_ a! 7 Q * 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 - RA ni ioi it- L-1,—" RPFC`141 PI IRPORF POOL" I yFt VI' rVUL-. rUauL. NAME OF POOL LJ ��•- _ 5 YW ADDRESS 6 OWNER -------------------------------------------------------------------- .03 Adequate enclosure around pool. Gate self -latching w1latch 4 ft above ADDRESS � DATE OF INSPECTION.71 PACITY£ F GALS. --�METHOD INSPECTED BY ---------------------------------------------------------------------- OF WATERTHER_ 4OLCAAD ------------------------------------------------------------- .06 Water circulation & filtration systems. Filter effluent flow meter reading .06 # OF LIFEGUARDS WATER SOURCE:TREATMENT Pm#of turnovers�, ------------------------------------ - ------------------ _06 Suitable automatic equipment for disinfection of poolwater------------ --=' ------------------------------------------------------=-------------- .06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders d . - anchored. Inaccessible to ublic_ -- adequate ventilation ovi-ed --=........... -- --- ---- ------ - --------------------------- ----= ..f i nr, r`RAD A Ar% nnn Regulation 1U5 GMK 43b.000 I ne Berns nraincu uGIwr nriu1 an f% 111..I.,u... L..., r. ,. .-.._ -. • -- ----- - - 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 w1latch 4 ft above - - ---- ------------------------------------------- -__ground. -------------------------------------------------------------- ------ --------------------------------------------------------------------- 04 Sewage Disposal ------ ------------ --- ----------------- -- --------- - - ---------------------------------------------------------------------- 05 Location, structural stability, finish. ----------------------------------------- -----/ --------- ------------------------------------------------------------- .06 Water circulation & filtration systems. Filter effluent flow meter reading .06 i,. -% i Pm#of turnovers�, ------------------------------------ - ------------------ _06 Suitable automatic equipment for disinfection of poolwater------------ --=' ------------------------------------------------------=-------------- .06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders d . - anchored. Inaccessible to ublic_ -- adequate ventilation ovi-ed --=........... -- --- ---- ------ - --------------------------- ----= ----- --------------- -- ---- ---- -- ---- ------ - ------ Inlets and outlets- Inlets located to produce uniform circulation. Over rim .08 fill spout 6" above maximum water level_ Property 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 Minimum 2 suction outlets for each pump, or other means. of provided ... properlylocated 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 um switch Accessible and prominently marked``" 09 Crossconnections. Potable water suppliedthrouphairgap_____________ _______ _10 SkimminRfacilities_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 col floor and walls -S- -ed s marked with contra color. ---floor--=�sh-- -=---- --- ---- -- ----------- ------------- - --------------- ------ ----- -- _13 Walkway and decks 4 feet wide, safe condition _ q _14 Ladders, steps - one per 75 feet. Not less than 2 ladders.--- - - -'----------------------------------------------------------------------- _15 Diving equpment in safe condition. ------------------------------ ---------------------------------------------- -----=---------------------------------------- .17 Pool supervision — Pool supervision provided. Effective Jan 1, 1999, pool su ffy s certified as col erator from YMCA or NSPF .21 Permit requirements — Permit issued. Adequate maintenance and testing --- record ------ maintained. _-----sinitialedbypersonmakingtests._____________ --------------------------------------------------------------------- .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 provided. Rescue tube and backboard with straps atpools attended by_ a lifeguard_ _ _ _ 25 First aid equipmenterovided__Firstaidkitcomplete. ________________ .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 l earth filter backwash water. -- ------------------------------------------------------------------- - ---- --------- ------------------------------------------------------------ .i6 Chemical standards. Bromine Acid Chlorine .29 Pool water tested withappropriatefrequency--------------------------------------- _________________________ _ _ `-- - F--------------' $ y- -='_ -- -`--- .30 Water testing equipment. DPD kit provided for chlorine and bromine. --- Unbreakable -thermometer forspecialpurposepools---------------------------- __ .31- Water - clarity------------------------------------------------------ -------\_/ ------------------------------------------------------------------------ _32 Water clarity maintenance, Filtrationsystemoperatingcontinuously ------- �`°__I___________________________________________________________________ -.32s pecial purpose pool drained, cleaned and every 14 -days .---------------�ir` `----------------------------------------------------------- Maximum Operating Temperatures for Special Purpose Pools. (SPP). .33 a. Thermostatic control provided for each SPP. '�--- - poo p - T ..a F b. Thermostatic control on accessible to the I o erator - ------------------ .38 General sanitation. `P 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 C SIGNED Board of Health/Health