HomeMy WebLinkAboutMansfield Meadows 12/31/2003TOWN OF 1
BOARD OF
UY PVaV, R! 1 i''I•
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:emi-Public"
adosoc
for the operation of a E] Public ❑ Special Purpose Pool
at.
Bonney Lane
Method of water treatment is: Heyward Earth Filter 4800
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.: 7
Date of Expiration: December 31, 2003
r
ScjLeita hAgent Date Is ued
TOWN OF MANSFIELD, BOARD OF HEALTH
SIX PARK ROW, MANSFIELD 02048
SWIMMING POOL APPLICATION
Name of Owner: Mansfield Meadows Assoc
Address:
12 Bonney Lane #9
City:
Mansfield
State: MA
Zip:02048
Telephone:
508-339-3357
Fax:
508-339-9761
Fed ID/SS No.:
04-3083384 '
Pool Location:
Bonney Lane
Type/pool:
Residential
Length: 40'
Width: 22' Volume: 55,000 gal.
Min/Max. depth:
35' x 9'
Swim Area:
40'x22'
Dive Area:
None
Water Source:
Town
W/W Disposal:
Town Sewer
Type of Finish:
Concrete
Scum Gutter:
--------
Deck Type:
Cement Slab
Skmmr weir length:
---------
Treatment System:
H6,yward Earth Filter 4800
Disinfect Method:
Chlorinating sticks, plus to increase ph
Chemical Treatment:
calle and iron remover. Automatic chlori
No. of Bathers:
43
Remarks:
Permit No.:7
Fee per pool:
$75.00
Permit Expires December 31St yearly
SIGNATURE: tt r �,- �
DATE:
OV 1 8 2102
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.
RAHeaith\Pat's DocumentsTERNUT APPLICATIONS\SWIMMING 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.
L L
,r
* Sign e of Individual or
Corporate Name (Mandatory)
** Social Security Number (Voluntary) or
Federal Identification Number 04-3083384
* 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
.. n SDGf`IAI PI 1PPCl.5`F P001 n
I T rG \Jr rv\JL. rv�Lav
NAME OF POOL
LJ
�..
P
—
ADDRESS_
condition.
OWNER
ADDRESS
-
DATE OF INSPECTION
c . a:
POOL CAPACITY
# OF GALS.
-------------------------------------------------------------------
INSPECTED BY
_
METHOD OF WATER
.05 Location, structural stability, finish.
-----------------------------------------
BATHER
- -- ----- -- -- -----------------------------
-
# OF LIFEGUARDS
-;t--ir.
WATER SOURCE:
TREATMENT
0A I -C4
LOAD
=-=-----------------------------------------
fpm_
----.--------
- -- - --
_06 Suitable automaticequipmentfor disinfection ofpoo!water_------- -
~`j_
______________________________________________________________________
.06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders
A9C fVV1
Regulation 105 CMR 435.UUU I ne items marKea Ueww wnn all n niuwa►c uic V u OLrlu p1wv " '" �. .�� �•-•• - •- ---•
Items marked with a "4" are satisfactory.
REGULATION X14 VIOLATIONS/COMMENTS
.03 Bathouse and sanitary facilities adequate lighting; ventilation; sanitary
condition.
--------------------------------------------------------------------
03Adequate enclosure around pool. Gate self -latching w1latch 4 ft above
-
... ound. r
----------------------------------------------------------------
-
-------------------------------------------------------------------
- Sewage Disposal------------ --------------------------- ---- --
- - 71
---------------------------------------------------------------------
.05 Location, structural stability, finish.
-----------------------------------------
"{
- -----
- -- ----- -- -- -----------------------------
-
-----------------------
.06 Water circulation & filtration systems. Filter effluent flow meter reading:
# of turnovers
=-=-----------------------------------------
fpm_
----.--------
- -- - --
_06 Suitable automaticequipmentfor disinfection ofpoo!water_------- -
~`j_
______________________________________________________________________
.06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders
anchored_ Inaccessible to public, adequatevenfilationprovided.
_______________________________________________________________
.08 Inlets and outlets- Inlets located to produce uniform circulation. Over rim
-fill spout 6" above maximum water level_ Properly shielded and located_
'f- -
----------- ---- ------ ---------------------------------------------
.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
f
or other means. Minimum of 2 suction outlets provided for each pump,
... proper!ylocatedand plumbed._______________________________________
_----------------------------------------------
--
.08 Suction outlet covers in place, unbroken and secure and cannot be
r `
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 Skimmingfacilities_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 pool floor and walls. Step edges marked with contrasting color_
13 Walkway and decks -4 feet wide, safe condition ------------------------
1--.-14
_______________________14 Ladders, steps – oneper ?5 -feet. -Not less than -2 ladders._ _ _ _ _ _ _ _ _ _ _ _ _ _ _
__15 Diving equpment- safe condition----------------------------------- �-z-1-----------------------------------------------------------------------
.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----------------- >
----------_--> ----------- --------------------------------------------------------------
.22 Health Regulations: Signs Posted. Health warning signs posted for special r
---purp.--- ----- ---------------------------------------------
------------------------
ose pools
------------------------------------------------- -
.23 Lifeguards required; Yes ❑ No Elr-'
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 equipmenrovided_ First aid kit Complete.----------- ----------� __= J ._' =={- - --------------------------------------------
4
.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 - sted ,,y
------- --- - -- -----l --- ---- -- --- --- --- -------------- ----------- --------- ----
.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 liar Total Chlorine
Alkalinity Free Chlorine ?rt
Cyanuric Acid: _ Comb. Chlorine
Water Tem _ - x uw_ H Level: 7 $
arts per million Other
_.29 Pool water tested with appropriate frequency--------------------------------- ---- _..="'---------- -- ----- --------------------
.30 Water testing equipment. DPD kit provided for chlorine and bromine.
--Unbreakableth_ermometerforspecialpurposepools.---------------------- ---------------------------------------------------------------- ---- --
.31 - Water - clarity.
-----------------------------------------------------------------
.32 Water clarity maintenance. Filtration system operating continuously_ ......
------------------------------------
_32 specialpurpose 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 ony accessible to the pool operator
38 General sanitation._
REGULATION
NO.I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE I
.34I I Closure of the pool. POOL MUST BE CLOSED UNITL IT MEETS THE STANDARDS
OF 105 CMR 435.29 THROUGH 435.31.
SIGNED
rR
SIGNED
Board of Health/Health