Loading...
HomeMy WebLinkAboutHockomock Y 12/31/2005TOWN OF 1 :'i•'1 OF SIX PARK ROW, ; 1 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: Hockomock Area YMCA -Mansfield X .for the operation of a E]Public n Semi -Public F-1Special Purpose Pool at: 40 Balcom Street Method of water treatment is: Chlorine Bathing load not to exceed: 40 bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. Permit No.: 12 Date of Expiration: December 31, 2005 Scott Leite, HeVgh Agent U� to ssued TOWN OF MANSFIELD,BOARD 1, HEALTH X PARK ROW, 1 1" 02048 SWIMMING POOL APPLICATION Name of Owner: Hockomock Area YMCA -Mansfield Address: 40 Balcom Street City: Mansfield State: MA Zip:02048 Telephone: 508-339-3066 SIGNA DATE: t Volume: r 1 -fro i h mber 31St yearly Please make appropriate changes. Sign, date and enclose checkpayable to Town ofMansfield Mail to: Board of Health, Town ofMansfield, Six Park Row, Mansfield, MA 02048. RAHeallh\PaPs Documents\PERMH APPLICATIONS\SWINIMMG POOLS APP.doc Fax: Fed ID/SS No.: 04-2131749 Pool Location: 40 Balcom Street Type/pool: Above -ground Length: 38' Width: 18' Min/Max. depth: 3' to 4'6" Swim Area: 38'x 18' Dive Area: None Water Source: Town W/W Disposal: Septic System Type of Finish: Steel w/vinly liner Scum Gutter: None Deck Type: Wooden Sknunr weir length: 1.5 to 2' Treatment System: Sand Filter Disinfect Method: Chlorine Chemical Treatment: Chlorine No. of Bathers: 40 Permit No.: 12 Fee per pool: $75.00 SIGNA DATE: t Volume: r 1 -fro i h mber 31St yearly Please make appropriate changes. Sign, date and enclose checkpayable to Town ofMansfield Mail to: Board of Health, Town ofMansfield, Six Park Row, Mansfield, MA 02048. RAHeallh\PaPs Documents\PERMH APPLICATIONS\SWINIMMG POOLS APP.doc /'YAP^/�SGiZL-0 NAME OF CITY OR TOWN STATE SANITARY CODE : CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 CMR 435.000 SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC ❑ SPECIAL PURPOSE POOL ❑ NAME OF POOL ADDRESS OWNER ADDRESS DATE OF INSPECTION /,POOL CAPACITY # OF GALS 1 INSPECTED BY METHOD OF WATERBATHER TREATMENT LOAD i % ` 6 # OF LIFEGUARDS WATER SOURCE; Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of 105 CMR 435.000. Items marked with a" v"' are satisfactory. REGULATION X/✓ VIOLATIONS/COMMENTS ventilation; sanitary condition. 03 Adequate enclosure around pool. Gate self -latching w/ latch 4 ft above ground. .04 Sewage Disposal .05 Location, structural stability, finish. .06 Water circulation & filtration systems. Filter Effluen flow meter reading: pm. # of tumovers .06 Suitable automatic equipment for disinfection of pool 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 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 the use of tools. Open area does not provide entrapment of fingers, toes, etc, At least one antivortex drain provided. 08 Each system outlet protected against user entrapment by antivortex cover or other means. Minimum of 2 suction outlets provided for each pump, properly located 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 .08 Special purpose pool and wading pools equipped with emergency shut off pump switch. Accessible and A`1 prominently marked. VV .09 Cross connections. Portable 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 Walkway 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 as pool operator from YMCA or NSPF. .21 Permit requirements - Permit issued. Adequate maintenance and testing records maintained. Records initialed by person making tests. .22 Health regulations: Signs posted. Health warning signs posted for special purpose pools. .23 Lifeguards required: Yes ❑ No If lifeguards 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. .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 Bromine 2.0-6.0 m*; Total Chlorine Alkalinity 11450450 m Free Chlorine 1,0;3.0 ' m _ Cyanuric Acid (30-100 pp fty. Comb. 1 Water Tema. 1 104-V.'.-, 1 I uH level 1 (7-2-7.8) *parts per million 1 .29 Pool water tested with appropriate frequency. .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. Maximum Operating Temperatures for Special Purpose Pools. (SPP). .33 a. Thennostatic control provided for each SPP. b. Thermostatic control only accessible to the pool operator .38 General sanitation 12EG NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE .34 Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. SIGNED SIGNED Operator Board of Health/Health Department NAME OF CITY OR TOWN STATE SANITARY CODE : CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS, 105 CMR 435.000 SWIMMING POOL INSPECTION REPORT ■111•/aWei 2 Mal Mali1.10C61M0 MRS ULVAIMU1]1.10rISMNMill 9»[4lI11INWIN USNIaMe] I1111■11111111 NAME OF POOL a ADDRESS OWNER ADDRESS DATE OF POOL CAPACITY INSPECTED BY INSPECTION # OF GALS METHOD OF WATER BATHER # OF LIFEGUARDS WATER SOURCE: TREATMENT LOAD Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of 105 CMR 435.000. Items marked with a "✓' are satisfactory. I REGULATION X/✓ VIOLATIONS/COMMENTS I ventilation; sanitary condition. .03 Adequate enclosure around pool. Gate self -latching w/ latch 4 ft above ground. .04 Sewage Disposal .05 Location, structural stability, finish. .06 Water circulation & filtration systems. Filter Effluent flow meter reading: gpm. # of turnovers r .06 Suitable automatic equipment for disinfection of pool 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 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 the use of tools. Open area does not provide entrapment of fingers, toes, etc. At least one antivortex drain provided. .08 Each system outlet protected against user entrapment by antivortex cover or other means. Minimum of 2 suction outlets provided for each pump, properly located 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 .08' Special purpose pool and wading pools equipped with emergency shut off pump switch. Accessible and prominently marked. .09 Cross connections. Portable 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 Walkway 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 as pool operator from YMCA or NSPF. 21 Permit requirements - Permit issued. Adequate maintenance and testing records maintained. Records initialed by person making tests. .22 Health regulations: Signs posted. Health warning signs posted for special purpose pools. .23 Lifeguards required: Yes Q No ❑ If lifeguards required. Proper credentials, proper suits and garments wom. 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. .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 Alkalinity 50-150 m Free Chlorine 1.0-3:0 m Cyanuric Acid (30400 ppm) Comb. ((?.0-0.2 pphi) Water Temp. * narts Der million .29 Pool water tested with appropriate frequency. .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. 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 .__...... . f�EGULATION NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE .34( I Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. SIGNED (SIGNED Operator Board of Health/Health Department Department of Public Health Division of Community Sanitation STATE SANITARY CODE: CHAPTER IV, MINIMUM SANITATION AND SAFETY STANDARDS FOR RECREATIONAL CAMPS FOR CHILDREN, 105 CMR 430.000 NAME OF CAMP: ( ADDRESS: q' ,NLev--°^- 5 C ZWER/OPERATOR:- OFF SEASON [�v� c � ✓ i r. I ADDRESS: CAMP DIRECTOR: INSPECTED BY: ipo E OF CAMP: (Circle) WATER DATE OF INSPECTION: Residential SOURCE:rt/NoSport) CAMPER Trip Primitive Travel CAPACITY: "No" column = `�' marked below indicates a violation of 430.000. "Yes" column = `�' marked below indicates compliance with provision of 430.000. "N/A' column = 'I' markedbelow indicates that the _pr vision of 430.000 _tia io Permits is not ucaoie _ to this earn . m .451 Current Certificate(s) of Occupancy from local building inspector for sleeping/assembly areas. .215 Written compliance from local fire dept. .300(A)(2)(a) Private water supply - DEP approval (>25 people, >60 days/yr) .300(A)(2)(b) Private water supply - BOH approval and chemical and bacterial analyses (<25 people, <60da s/ r Plans and Policies- Written .090(A) Procedures for background. review of staff and volunteers. .090(C) CORI and SORT , previous work history, 3 references, out of state/international criminal background checks for staff and volunteers Staff and volunteer orientation Oan and review. .091 .093 Abuse and neglect prevention/reporting procedures. / .191(B)(C) Discipline Policy with: appropriate discipline methods and prohibitions. A Fire evacuation plan and drills �✓ .210 B Disaster Plan �✓ .210 C Lost Camper Plan .210 .210 C Lost Swimmer Plan D Traffic Control Plan ✓ .210 Contin enc lans - Da Cam .211 A B Camper doesn't show up for da Camper doesn't show up at point of pickup✓ Child not registered arrives Contingency plans - Primitive, Travel and Trip: ✓ C A Itinera daily- copy to parents .212 B Source of emergency care .190 Camper released only to parents or parent - designated individual in writing. Other plan approved in writing by BOH. e uaio _ .N Promotional literature/packet contains: .159(B)(2) Copy of policy re: care of mildly ill campers, administration of meds and emergency health care provision. 1;90(C) ; Statement re: regulatory compliance and licensing. .190(D) Inform parents of right to review background check, health care, discipline policies and grievance procedures upon request. Transportation .250 Vehicle must comply with MGLc.90 s7B&7D: <14 passengers AND driver is camp coach, director,etc. private vehicles may be used. >14 passengers, vehicle must be school bus All vehicles must be RMV compliant .253 Proper automobile insurance .251 Seatbelts must be worn and special needs of campers communicated to driver .251 Camper <7yrs not transported longer than 1 hr to cam Staff Qualifications Camp Director .102(A) Residential Camp: 25 yrs, completed course in camp administration or at least 2 seasons experience. .102(B) Day Camp: 21 yrs, completed camp administration course or 2 seasons experience. .102(C) Primitive, Travel, Trip: 21 yrs and proof of experience. .102(D) Designated substitute when director off-site >12 hrs. (Sub must meet criteria above Counselors/Junior Counselors .100 Day Camp, non -sport: Counselor= 16 yrs. Junior Counselo­15 yrs. .100 Other camps: Counselors= 18 yrs or graduated from high school. Junior Counselors= 16 yrs .100 All counselors 3 yrs older than campers Required Counselor Ratios .101(A) Residential and Day Camps: 1 staff per 10 kids over 6 yrs 1 staff per 5 campers 6 yrs and under .101(8) Primitive,Travel, Trip: 1 counselor per 10 campers. 2 counselor min. .101(C) Special Needs: 1 counselor per 4 mildly disabled campers 1 counselor per 2 severely disabled campers i107 Aquatics Director• y�,�I �'"� Ione Name: American Red Cross Lifeguard Trng cert., CPR for Professional Rescuer and First Aid Cert. or their equivalents. If supervise 2 staff, 21yrs,and experience w/mans ement .103 Lifeguard: American Red Cross Lifeguard Trng cert., CPR for Professional Rescuer cert. and First Aid Cert. or their equivalents. List names. .103 Certifications for other high-risk activities, eg: NRA instructor certification for firearms. List Names and Certifications: .252 Camp vehicle drivers: 18yrs, 2yrs driving experience, current license for type of vehicle First Aid certified if no other trained staff aboard. Medical Personnel/Records/Facilities .159(A) Health Care Consultant e* MD NP PA(w/pediatric training) eck for Health Care Consultant Agreement .159(C) Health Supervisor (on site at all times) 18 rst Aid Cified OR, MD PA NP RN LPN .1 59 B Health Care Policy .1 60 A Medication stored in original containers. ✓ .160(B) Meds stored in secured cabinet and if t/ necessary refrigerated in affixed box. .1 60 C Medication administered by Health Supervisor ✓ .154 Injury Reports completed for fatality or serious injury. Copy sent to MDPH. .155 Medical log book- bound, pre -numbered pages, ink entries, no skipped lines. .161(A) Infirmary provided- day and resident.camps Exterior light - resident. camps .453 Lighting rovided in infirmary .161 B Area for isolation of ill child .161(C) First Aid Kit: non -perfumed soap, sterile gauze squares, compresses, adhesive tape, bandage scissors, triangular and rolled bandages, CPR mask, tweezers, coldgloves. .150 .pack, Health record for each camper and staff: -emergency contact info -camper <18 yrs must have written parental permission for meds and emergency care. Residential, Sport,Travel/Trip: Health History, Physical Exam(< 2yrs) Record of Immunizations (noted below) Day Camp Non -Sport: Health History, Record of Immunizations (noted below) .204(A) Swimming areas clean and safe, no swimming at undesignated sites or at night without lighting. .204E Piers and floats in good repair. .204(G) Watercraft : equipped with US Coast Guard approved flotation devices and wom by all campers and staff participating in watercraft activities. Immunizations: .152(A) Campers and staff under 18yrs: Number of records checked: MMR: 1 sc dose = 12 mos or older, / Measles: 2nd dose = grades K-12 ' or age equiv �l .163 Polio: 3 doses IPV or OPV, or 4 doses mix IPV/ OPV .430 Diphtheria and Tetanus Toxoids and Pertussis*: .204(B) 4 doses DTaP/DTP/DT or, 3 doses of Td .103 (persons 7 yrs or older needing additional vaccines to comply with above, Td is to be used) *Booster dose of Td: .204(C) -grades 7-10 need booster if >5yrs since last dose of DTaP/DTP/DT -grades 11-12 need booster if more than 10 yrs since last dose of DTaP/DTP/DT/rd Hep B: 3 doses if born on or after 1/1/92 .152(B) Campers and staff 18 yrs.or older: Number of repords Measles: 2 doses (exempt if born before 1957) checked:_ Mumps: 1 dose (exempt if born before 1957) Rubella: 1 dose (exempt if born before 1957) Diphtheria and Tetanus Toxoids*: 3 doses DTaP/DTP/DT/Td *Booster dose of Td required if more than 10 yrs since last dose. .204(A) Swimming areas clean and safe, no swimming at undesignated sites or at night without lighting. .204E Piers and floats in good repair. .204(G) Watercraft : equipped with US Coast Guard approved flotation devices and wom by all campers and staff participating in watercraft activities. Activities .190 Activities and physical environment meet the needs of campers; do not pose hazard to / health/safety. �l .163 Operator encourages sun protection for all. Aquatics .430 Swimming Pool: in compliance with 105 CMR 435.00 - permit posted. .204(B) Bathing Beach: in compliance with 105 CMR 445.00 - weekly water sampling conducted. .103 Proper supervision at swimming venue: 1 lifeguard per 25 campers 1 counselor per 10 campers Plan to check swimmers- "buddy system" .204(C) Swim test to classify swimmers by ability. .204(A) Swimming areas clean and safe, no swimming at undesignated sites or at night without lighting. .204E Piers and floats in good repair. .204(G) Watercraft : equipped with US Coast Guard approved flotation devices and wom by all campers and staff participating in watercraft activities. WA III uaoINN Aquatics cont'd MEN= .204(H) Campers must be certified by American Red Cross or equivalent for white water, hazardous salt or fresh water activities. .103(C) Minimum 2 counselors in separate watercraft supervising white water, hazardous salt or fresh / 1� water activities. Crafts .205 Equipment in good repair, safety precautions / taken. Playground/Athletic Equipment .206 Equipment properly maintained, fields/surfaces free of holes/accident hazards .206 Playground equipment secure, no concrete under/around it, pliable swing seats. Firearms .201 Single shot rifles only. .201 Shooting range away from other activity areas .201 Firearms in good condition, stored in locked cabinet. Ammunition locked in separate cabinet. Archery .202 Equipment in good condition, stored in locked / area. ✓ .202 Range away from other activity areas, clearly marked as danger area. Must have common firing line and 25 yards clearance behind each , / target. V .203 No personal weapons, bows, rifles allowed. Horseback Riding .208(A) 1 certified instructor per 10 campers (Min.2 counselors .208(A) Riders must wear hard hat .208(B) Licensed stable Cabins/Structures: .457 Day Camp provide shelter for on-going camp activities. .216 Smoke detectors provided. .455/.456 Egresses comply with Bldg.Code and are free from obstruction .453 Lighting rovided for stairways .454 Floors maintained. Residential Camps/Sleeping Areas: .458 Provide adequate space: 40sgft /person in single bed 35sgft/person in bunk bed 50sgfVperson in sleeping area requiring special equip ment .470 Provide bed/cot per person with 6 feet between sleeper's heads and: 3 feet between single beds/ 41/2 feet between bunks ula, o jo Residential Cam s/Slee in Areas: .459 Campers and staff with limited mobility housed on ground level; egresses leading to grade or ramp provided. .452 Screens provided. Screen door self-closing. .454 Floors maintained. Tents: .217 Fire -retardant and non-toxic. No open flame nearby. .458 35 s ft/ erson in bunk bed Toilets/Showers ..360 Proper sewage disposal. .301 Plumbing in good working order .370 Adequate # of toilets: All camps: 2 toilets/privy seats for each sex Day Camp: >60 of one sex, provide 1 additional toilet per every 30 people of that sex. Non -Day Camp: >20 of one sex, provide 1 additional toilet per every 10 people of that sex. .372 Toilet less than 200 feet from sleeping rooms.Toilet paper provided. Windows/ / openings screened. Screen doors self-closing. .373 Adequate # of sinks: Day Camp: 1 per every 30 people / Residential Camp: 1 per every 30 .374 Adequate # of showers (residential camp): / 1 shower/tub per 20 people V/ .378/.380 Special needs campers provided facilities that meet their needs .453 Lighting rovided. .375 Toilets and shower rooms ventilated to outdoors IZ .376 Hot water at sinks, showers/tubs not more than 112°F. ✓ .377 Sanitary facilities maintained in clean condition. / Shower room floors washed daily. Laundry .162 Residential Camp: laundry facilities provided .472 Bedding and towels laundered; no common towels Grounds: .300 Potable water provided. .300/.304 Adequate and centralized drinking water facilities. No common drinking cups. .209 Telephone readily available with #s of HCC, EMS, police, fire. Da and Residential Camps only)�/ .213 Emergenqy Emergencycommunications stem. .165 Tobacco use restricted to designated areas not accessible to campers. .350/.355 Proper storage and disposal of solid waste I REGULATION NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE .207 Proper storage and operation of power equipment. ..214 Flammable and hazardous materials labeled and stored in locked unoccupied building. .400 Rodent and insect control. .401 Weed and noxious plant control. .450 Site location does not cause undue traffic hazards and is accessible at all times. Food Service .320 Food service in compliance with 105 CMR 590.000, Minimum Standards for Food Establishments. Permit posted in food service facility. .330 Nutritious meals that include a variety of foods served. Menus posted. .331 Residential camps — Provide at least three nutritious meals. Foods must meet Recommended Dietary Allowances RDA .332 Day camps — Each meal provided must meet 1/3 of the RDA requirements. .334 Adequately trained staff and equipment provided to ensure handicapped campers are eating nutritious meals. .335 Proper methods for storing meals brought from home. Meals provided to campers who arrive without a bag lunch. .452 Screening provided for food preparation and food service areas. Screen doors must be self- closing. .453 Lighting rovided in kitchen and dining area. .471 Sleeping rohibited in food areas. I REGULATION NO. I THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE