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Home My WebLink AboutCanoe River CG 12/31/2003TOWN OF MANSFIELD BOARD OF HEALTH SIX PARK ROW, 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: Canoe River Campground for the operation of a ❑ PublicEJemi-Public ❑ Special Purpose Pool at: 137 Mill St. Method of water treatment is: Sand Bathing load not to exceed. 94 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. Permit No Date of Expiration: December 31, 2003 v Date Is ued TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Name of Owner: Canoe River Campground Address: 137 Mill St. City: Mansfield State: MA Zip:02048 Telephone: 508-339-6462 Fax: 508-339-5237 Fed ID/SS No.: 04-2375571 Pool Location: 137 Mill St. Type/pool: Cement Length: 57' Width: 30' Volume: 60,000 Min/Max. depth: 3'-10' Swim Area: 57'x30' Dive Area: None Water Source: Town W/W Disposal: Private Leach Type of Finish: Cement Scum Gutter: Deck Type: Cement Skmmr weir length: 4 Treatment System: Sand Disinfect Method: Chlorine Chemical Treatment: Automatic No. of Bathers: 94 Remarks: Permit No.:1 Fee per pool: $75.00 Permit Expires December 31St yearly SIGNATURE: DATE: 0 a / O 1-)— 20 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\Paes Documents\PERMIT APPLICATIONS\S1Vn"ING 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) By: Corporate Officer (Mandatory, if applicable) **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. TOWN ON MANSFIELD BOARD OF HEALTH SIX PARK ROW MANSFIELD, MA 02048 STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 PMR 435.000 SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC C SPECIAL PURPOSE POOL NAME OF POOL- P ADDRESS OWNER ADDRESSLJ i ' DATE OF INSPECTION - POOL CAPACITY INSPECTED BY 2 -.. `° # OF GALS. METHOD OF WATER BATHER # OF LIFEGUARDS WATER SOURCE: TREATMENT LOAD -x Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of 105 CMR 435.000. Items marKea wim a 4 ale saLi,,mutu1. REGULATION XN VIOLATIONS/COMMENTS .03 Bathouse and sanitary facilities adequate lighting; ventilation; sanitary condition. ---------------------------------------------------------------------- 03Adequate enclosure around pool. Gate self -latching watch 4 ft above ----- ----------------------------- --- - - ----- round. ------------------------- - - - ----- - ------ -- ---------------------------------------------------------------------- _04 Sewage Disposal- ------- - ------------- -- ------------- - --- ---------------------------------------------------------------i 05 Location, structural stability, finish.------------------------------ ------------------------------ -------------------... ------------------------ --_ -, -------------------------- .06 Water circulation & filtration systems. Filter effluent flow meter reading: .,., gpm__# ------------------------------------- _#-of-turnovers ------ ------------------------------------- - -------------------- 06Suitableautomaticequipmentfordisinfectionofpool water -------------- ----------------------------------------------------------------------------- .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 fillspout6" above maximum -water level. Properlyshieldedandlocated_ ______________________________________________________________________. .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, ---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 ... mp switch_ Accessible and p Purominently marked-------------------- -- - - --- -- ----- - - -- - ------------- ---- 09 Cross - connections. Potable water supplied through- irg aap.----------------- r___________________________-_---------------------------------------- ----------------------------------- 10Skimminafacilities_50%ofre-circulationdrawnfrom-surface of pool_ --------------------------------------------------------------------- ------------ - -separa---------------------------------- .12Line with floats tesnon-swimmer area from deeper water. ______ _f--------------------------------------------------------------------- --------------------------------------------------------------------- .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 4feetwide, safe condition------------------------�_�"__--------------------------------------------------------------------- 14 Ladders, steps - oneper75feet. Not less than -2 ladders.-------------------------------------------------------- --------------- - --------------------------------- POOLSIDE READINGS --------------- ---- 15 Diving equpmentin safe condition----------------------------------- ,, -------------- ---- ---- - ---------------- -- -- --- --- - - - ------ .17 Pool supervision — Pool supervision provided. Effective Jan 1, 1999, pool Notal Chlorine supervisorcertifiedaspooloperatorfrom-YMCA orNSPF---------------- -------------------------------------------------------------------- ------- .21 Permit requirements — Permit issued. Adequate maintenance and testing Comb. Chlorine H Level 7,S records maintained._ Records initialed byperson making tests.______________�"______-_--------___---_--_________--_--------------------------------- Other .22 Health Regulations: Signs Posted. Health warning signs posted for special --- u ose ools. --------------------------------------------------------------------- .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 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 -------------------------------------------------- ---------------------------------------------------------------------------- .26 Waste and backwash water disposal properly discharged. No direct connection to sewer system. Separation tank provided for diatomaceous earthfilter backwash water.------------------------------------------------------------- --- .29 Chemical standards. 29 Pool water tested with app ropriatefrequency------------------------- ---------------------------------------------------------------------- --- .30 Water testing equipment. DPD kit provided for chlorine and bromine. k - Unbreakable -thermometer for special purpose pools.------------------------------------------------------------------------------------------ --- -- .31 Water clarity. -- - - ----- - - -- - -- ----------- --- --------------------- __32Waterclaritym-----ance_Fi-----n systemoperatingcontinuously-------- ___________________________________________________________________________ _32specialpurposepooldrained,cleanedandevery14days._----- _ _'---------------------------------------------------------------- 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. POOLSIDE READINGS Bromine Alkalinit Cyanuric Acid ` Water Temp. Notal Chlorine Free Chlorine Comb. Chlorine H Level 7,S * arts er million Other 29 Pool water tested with app ropriatefrequency------------------------- ---------------------------------------------------------------------- --- .30 Water testing equipment. DPD kit provided for chlorine and bromine. k - Unbreakable -thermometer for special purpose pools.------------------------------------------------------------------------------------------ --- -- .31 Water clarity. -- - - ----- - - -- - -- ----------- --- --------------------- __32Waterclaritym-----ance_Fi-----n systemoperatingcontinuously-------- ___________________________________________________________________________ _32specialpurposepooldrained,cleanedandevery14days._----- _ _'---------------------------------------------------------------- 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. 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. SIGNE1 r,o r..._,v.__ Operator tea.. SIGNED ` . B04 of Health/Health Department TOWN OF MANSFIELD BOARD OF HEALTH Six PARK ROW, MANSFIELD1 ' 1 1' •, 1 '' 1 1 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: Canoe River Campground f f a ❑ Public ` Semi -Public F1 Special Purpose Pool or the operation o at: 137 Mill St. Method of water treatment is: Sand Bathing load not to exceed: 94 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY"' sign is required. Permit No.: 2 Date of Expiration: December 31, 2003 Scor Health Agent Date issued 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 TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 SWIMMING POOL APPLICATION Canoe River Campground 137 Mill St. Mansfield Zip:02048 508-339-6462 508-339-5237 04-2375571 137 Mill St. Cement Width: 22' 3' 40'x22' None Water Source: Town W/W Disposal: Private Leach Type of Finish: Cement Scum Gutter: 94 Deck Type: Cement Skmmr weir length: 2 Treatment System: Sand Disinfect Method: Chlorine Chemical Treatment: Automatic No. of Bathers: 94 Remarks: Permit No.:2 Fee per pool: $75.00 Volume: 22,440 Permit Expires December 31sT yearly �---(-�L SIGNATURE: DATE: o /a Y /o 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 DOCumentsTFRMIT APPLICATIONS\SWP"ING POOLS APP.doe 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. s'i",-2L1A) ( - IA.) . *Signature of Individual or Corporate Name (Mandatory) By: Corporate Officer (Mandatory, if applicable) **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. 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 TYPE OF POOL: PUBLIC Regulation 105 CMR 435.000 t ne items marKeo oervw wiui till ' lit. ........ ►-•�- _.. __ ____ u n Items marked with a N are satisfacto REGULATION X14VIOLATIONS/COMMENTS .03 Bathouse and sanitary facilities adequate lighting; ventilation; sanitary condition. H °' --------------------------------------------------------- above -- .03 Adequate enclosure around pool. Gate self latching wAatch 4 ft above ---- ----------------------------- ground. -- - .04 Sewage Disposal-------------- ----------- --- ----- -- ------------------------------------------------------------------ .05 Location, structural stability, finish. 1 ------------------------------------------------------------------- .06 Water circulation & filtration systems. Filter effluent flow meter reading: m _#-of-turnovers _06 Suitable autcTatic equipment for disinfection of pool water______________ -------------------- _ - .06 Carbon dioxide (CO2) equipment for pH control adequate. (CO2) cylinders r anchored. Inaccessible topublic, adequateventilation pr y ed----------- -------------------------- -------------------------------------------------------- - .08 Inlets and outlets- Inlets located to produce uniform circulation. Over rim 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 --- rovtded. ---------------- ------------------------------------------------------- --------------------------------------------------------------------- .08 Each system outlet protected against user entrapment by antivortex cover or other means. Minimum of 2 suction outlets provided for each pump, -- pro erl located and lumbed------------------------------'- p --y----- -----p ----- --- ------ ----- ---------- -- ----------------- ----- ------------ ----- - .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 Skimminafacilities_50% of -re -circulation drawn from surface of pool. 12 Line with floats separates non -swimmer area from deeper water. ------- with ------ - .12 Water depth markings on deck and walls. Properly spaced. Boundary line on pool floor and walls. Step edgesmarked with contrasting color--------- _13 Walkway_ _ and decks 4 feet wide, safe condition _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . -.14 Ladders, steps --one per75feet._Not less than -2 ladders ---------------- _.15 Divinq e9u!neTjt in safe -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 POOLSIDE READINGS --records maintained. Records initialedbypersonmakingtests. _____________ --------------------------------------------------------------------- .22 Health Regulations: Signs Posted. Health warning signs posted for special Chlorine p u e - --- -- ----- ------ p'os-- poolools. -------------------------------- -- ------------------- --------------------------------------------- --- Cyanuric Acid Water Tem ryF .23 Lifeguards required; Yes ❑ No If Lifeguard required; proper credentials, proper suits and garments worn. Comb. Chlorine M H Level $ Whistle and bullhorn pjqyiqeq arts per million - .24 Safety equipment Ring buoys and rescue hook provided. Rescue tube Z and backboard with straps atpools attended by alifeguard_______________ _------------------------------------------- ____________________________ .25 First aid ui ent rovided. First aid kit complete.-------- ----- ---- ----------- �"-- 1--- - --------------------------------------------------------------------- .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. .29 Pool water tested withappropriatefrequency_ ________________ __ - - - - -I------------------------------------------------------------------ .30 Water testing equipment. DPD kit provided for chlorine and bromine. --Unbreakable thermometer for special purpose pools.-------------------------------------------------------------------------------------------------- .31-Waterclarity.------------------------------------ -`� -------------------------------------------------------------------- -------------- .32 Water claritymaintenance.Filtration systemoperati-9 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 ony accessible to the pool operator _ _ _ _ _ _ _ _ _ _ _ 38 General sanitation. POOLSIDE READINGS y Bromine {rEMSTotal Chlorine Alkalinity` Free Chlorine Cyanuric Acid Water Tem ryF Comb. Chlorine M H Level $ arts per million Other .29 Pool water tested withappropriatefrequency_ ________________ __ - - - - -I------------------------------------------------------------------ .30 Water testing equipment. DPD kit provided for chlorine and bromine. --Unbreakable thermometer for special purpose pools.-------------------------------------------------------------------------------------------------- .31-Waterclarity.------------------------------------ -`� -------------------------------------------------------------------- -------------- .32 Water claritymaintenance.Filtration systemoperati-9 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 ony accessible to the pool operator _ _ _ _ _ _ _ _ _ _ _ 38 General sanitation. REGULATION NO. THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE XIII .34 Closure of the pool. POOL MUST BE CLOSED UNITL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. ' Operator m ..a SIGNEDr Board o Health/Health Department