HomeMy WebLinkAboutMansfield Meadows 12/31/2005TOWN OF MANSFIELD
BOARD OF HEALTH
SIX PARK ROW, MANSFIELD 02048
PERMIT TO OPERATE A SWIMMING POOL
In accordance with the provisions of Chapter 111. Section 127,4 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 Meadows Assoc
for the operation of a ❑ Public �emi-Public ❑ Special Purpose Pool
at:
Bonney Lane
Method of water treatment is: calle and iron remover. Automatic chlori
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, 2005
Scott Le , 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:
Water Source:
W/W Disposal:
Type of Finish:
Scum Gutter:
Deck Type:
Skmmr weir length:
Mansfield Meadows Assoc
12 Bonney Lane 99
Mansfield
Zip:02048
508-339-3357
508-339-9761
04-3083384
Bonney Lane
Residential
Width: 22'
3.5' to 9'
40'x22'
None
Town
Town Sewer
Concrete
Cement Slab
Volume: 55,000
Treatment System: Heyward 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 3I't yearly
SIGNATURE: Z t� tl
DATE: E l
JAN y 200
Please make appropriate changes. Sign, date and enclose checkpayable to Town ofMansfield Mail to:
Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048.
RAHealthWats DocumentsTERi U APPLICATTONS\SWIMi IING POOLS APP.doc
NAME OF CITY OR TOWN
STATE SANITARY CODE : CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS,
105 CMR 435.000
SWIMMING POOL INSPECTION REPORT
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NAME OF POOL
ADDRESS
OWNER
f ADDRESS
DATE OF,POOL
CAPACITY
INSPECTED BY
INSPECTION
# OF GALS
METHOD OF WATER
BATHER `
L�
# OF LIFEGUARDS
WATER SOURCE;
TREATMENT
LOAD
Regulation 105 CMR 435.000 The items marked below with an "X" indicate the violated provisions of 105 C;MK 835.000.
Items marked with a "✓" are satisfactory.
ventilation; sanitary condition.
.Q3 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
.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
emergency shut off pump switch. Accessible and
prominently marked.
.09 Cross connections. Portable water supplied through air
Water Temp. 104°
r/
gap.
.10 Skimming facilities. 50% of recirculation drawn from
*parts per million
surface of pool.
.12 Line with floats separates non -swimmer area from
Other
.29 Pool water tested with appropriate frequency.
deeper water.
.30 Water testing equipment. DPD kit provided for
.12 Water depth markings on deck and walls. Properly
chlorine and bromine. Unbreakable thermometer for
spaced. Boundary line on pool floor and walls. Step
special purpose pools.
edges marked with contrasting color.
.31 Water clarity
.13 Walkway and decks 4 feet wide, safe condition.
V
.14 Ladders, steps - one per 75 feet. Not less than 2
Water Temp. 104°
r/
ladders.
*parts per million
.15 Diving equipment in safe condition.
Other
.29 Pool water tested with appropriate frequency.
.17 Pool supervision - Pool supervision provided.
.30 Water testing equipment. DPD kit provided for
Effective Jan. 1, 1999, pool supervisor certified as pool
chlorine and bromine. Unbreakable thermometer for
operator from YMCA or NSPF.
special purpose pools.
.21 Permit requirements - Permit issued. Adequate
.31 Water clarity
maintenance and testing records maintained. Records
V
initialed by person making tests.
.22 Health regulations: Signs posted. Health warning
continuously.
signs posted for special purpose pools.
.32 Special purpose pool drained, cleaned and every 14
.23 Lifeguards required: Yes ❑ No
days.
If lifeguards required. Proper credentials, proper suits
Maximum Operating Temperatures for Special Purpose
and garments worn. Whistle and bullhorn provided
Pools. (SPP).
.24 Safety equipment. Ring buoys and rescue hook
v
.33 a. Thermostatic control provided for each SPP.
provided. Rescue tube and backboard with straps at
b. Thermostatic control only accessible to the pool
pools attended by a lifeguard.
operator
.25 First Aid equipment provided.
.38 General sanitation
.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
V
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
Total Chlorine
Cyanuric AcidX30.100 pain) Comb. _(0 0 0 2ppm}
.. _ f1h1-- _-
Water Temp. 104°
pH level
*parts per million
Other
.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).
v
.33 a. Thermostatic control provided for each SPP.
b. Thermostatic control only accessible to the pool
operator
.38 General sanitation
NO. I THE SPACE BELOW DESCRI
.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/HeaRh Department