HomeMy WebLinkAboutWillow Crossing 12/31/2018Commonwealth of Massachusetts
Town of Mansfield
Town of Mansfield 6 Park Row
Mansfield, MA 02048
Board of Health
Permit to Operate a Swimming Pool
PERMIT NUMBER: 17
PERMIT EXPIRES: December 31, 2018
Person Certified: PAUL J. MILLER
Pool/SPA Certification Date: May 15, 2015
Pool/SPA Certification Expires: May 15, 2020
Person Certified:
Pool/SPA Certification Date:
Pool/Spa Certification Expires:
In accordance with the provisions of Chapter 111. Section 127A of the Massachusetts
General Law, and Regulations established by the Massachusetts Department of Public
Health (105 CMR 435.00), permit is hereby issued to:
B-X MANSFIELD, LLC dbaTHE VILLAGE AT WILLOW CROSSINGS
for the operation of [_, Public Semi -Public ill Special Purpose Pool
located at:
25 COBB STREET
Method of water treatment is BROMINE
Bathing load not to exceed. 22 bathers
Number of Lifeguards required at all times the pool is open is: None
"NO LIFEGUARD ON DUTY" sign is required.
.filmy Donovan-PaCmer, Heaah .Agent /� J col �0/8
(i/// Date Issued
C
2 1 2017
1 Town of Mansfigjd
Town of Mansfield -Board of Health 6 Park Row
" — Mansfield, MA 02048
Swimming POOL Application PERMIT NUMBER 17
FEE: $125
NAME OF OWNER: B-X MANSFIELD, LLC dbaTHE VILLAGE AT
WILLOW CROSSINGS
ADDRESS: 25 COBB STREET
CITY: MANSFIELD
STATE: MA ZIP: 02048
TELEPHONE: (508) 261-1333
FAX: (5?8) 237-4663
iF" f'tl r'A C G
EMAIL: MSGHGLL-@BENCHMARKQUALITY.COM
FED ID/SS NO: 27-4452440
Certification Expires Every 5 Years.
Permit Expires December 31st Yearly.
PERSON CERTIFIED: PAUL J. MILLER
Pool/SPA Certification Date: 5/15/2015
Pool/SPA Certification Expires: 5/15/2020
PERSON CERTIFIED:
Pool/SPA Certification Date:
Pool/SPA Certification Expires:
certification remarks(if necessary):
REMARKS: "NO LIFEGUARD ON DUTY" sign is required.
I Public
POOL OPERATION:.' ' Semi -Public
ivl Special Purpose Pool
POOL LOCATION: 25 COBB STREET
TYPEIPOOL: GUNITE CONCRETE
LENGTH: 32' WIDTH: 14'
VOLUME: 12,544
MIN/MAX DEPTH: T 6" to TV'
SWIM AREA: 448 sf DIVE AREA: NONE
WATER SOURCE: TOWN
WAN DISPOSAL: TOWN SEWER
TYPE OF FINISH: BLUE MARBLEITE
SCUM GUTTER: NONE
DECK TYPE: CONCRETE
SKMMR WEIR LENGTH: 8.5"
TREATMENT SYSTEM: HAYWARD C-50OLF BROMINATOR
DISINFECT METHOD: BROMINE
CHEMICAL TREATMENT: BROMINE
NUMBER OF BATHERS: 22
SIGNATURE: DATE: 1j 7
� ` I 6 � Y1
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.
TAX CERTIFICATION FORM
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 By; Corporate Officer (Mandatory, if Applicable)
-u1(a�-v
"Social Security No. (Voluntary) or Federal
Identification Number
*This license will not be issued unless this 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 Massachusetts General Law
Chapter 62C, section 49A.
CAUsers\sleite\Desktop\Scott's Documents\Food Establishments- Temp\TAX CERTIFICATION FORM.doc
The Commonwealth ofAlassachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, A L4 02111
UqV www.mass.gov/dia
. Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information I C{(/566 '/ Please Print Legib
Aly
Business/OrganizationName:B-X /�1lgi LLC kbL t LV;110ge04 (01'116ld(0501 -s
Address: ;7_5 Nbb Weed
Phone #:
Are
1
ou an employer? Check�t�h�e� propriate box:
I am a employer with —1� employees (full and/
Business Type (required):
S. ❑ Retail
or part-time).*
6. ❑ Restaurant/Bar/Eating Establishment
2. ❑
I am a sole proprietor or partnership and have no
?, ❑ Office and/or Sales (incl, real estate, auto, etc.)
employees working for me in any capacity.
8. ❑ Non-profit
[No workers' comp. insurance required]
3. ❑
We are a corporation and its officers have exercised
9. ❑ Entertainment
their right of exemption per c. 152, § 1(4), and we have I
10.❑ Manufacturing
no employees. [No workers' comp. insurance required]*
11. Health Care
4. ❑
We are a non-profit organization, staffed by volunteers,
with no employees. [No workers',comp. insurance req.]
q� r
12. Other Senn 0Y �) U90WIPQ 14
*Any applicant that checks box ill must also fill out the section below showing their workers' compensation policy information.. V
**If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an
organization should check box Nl.
I am an employer that is providing workers' compensation insurancefibr my employees. Below is the policy information.
Insurance Company
Insurer's
City/State/Zip; 6
SS101
Policy # or Self -ins. Lie. # u% w o'T b /w3 Expiration Date: T I 1
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi717
y/�`nder the_paiins d enaltiespfperjury that the information provided above is true and correct
11 ,t n �Vl / (IAh A1'7
Phone
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Issuing Authority (circle one):
1, Board of Health 2. Building Department
6. Other
Contact
Permit/License
3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office
www.massZovidia
Phone
6ENCA55-02
ANE
3IV
OAT131/2017 YJ
/31/2017
A�RLT CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURE
, the pollcy(les) must have ADDITIONAL INSURED provisions or be endor ad,
If SUBROGATION IS WAIVED, subJect to the terms and conditio
this certificate does not confer rightsto the certificate holder In [IOU
s of the policy, certain policies may require an endorsement A statemen on
of such endorsement(s).
PRODUCER
NIAOT Willis Towers Watson Certificate Center
--
Willis of Illinois Inc.
c/o 26 Century §Ivd
P.O. Box 305191
PHONE FAX
�-I IAIc, Nm:(888) 467.2378
AIc, No, Exq: (877) 946-7378
E• m . Certificates@wlllis.com
Nashville, TN 37230.5191
-----`--
INSURERS AFFORDING COVERAGE
NAICp
INSURER A:Arch Insurance Company
11160
INSURED
INSURER B: Lloyd's
B7674
INSURER C;
Benchmark Senior Living LLC
201 Jones Road, Suite 300 West
Waltham, MA 02451
INSURER D:
INSURER E:
INSURERF: Y`�Y _
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .y
INSR JOUL
Type OF INSURANCE
ADOLSUOR INSD
MO
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑OCCUR
EACH OCCURRENCE
5
DAMAGE TO RENTEDES,
MED EXP (Any one non
5
PERSONAL B ADV INJURY
,�,-•_,
S
GEN'LAGGREGATE LIMIT APPLIES PER:
POLICY 11 TIT r I LOC
GENERAL AGGREGATE
5
PRODUCTS •COMP/OP AGG
S
$
OTHER:
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
AUTOSONLY SCHEDULED
AUTOS
AU SONLV AUTOSO V
Coil Dad $1,000 x Comp Dad slxo
x
41CAB4987704
04/0112017
04/0112018
COMBINED SINGLE UMIT
EaIKaMl
$ 1,000,000
BODILY INJURY IP.r anon
5
BODILY INJURY Par accident
S
P,,,aWUenl AMAGE
$
X
S
B
UMBRELLA LIAR
EXCESSLIAa
OCCUR
C AIMS•MADE
58•LTCAX-01413.17
04/01/2017
0410112010
EACH OCCURRENCE
5 20,000,000
X
x
AGGREGATE
$ 20,000,000
OEO RETENTIONS
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOMPARTNERIEXECUTIVE YIN
1W,FISsppary ingTfl cLU0ED9 El
Il yes, desuibe under
DE SCRIPTION OFOPERATIONS below
NIA
1WC14987904
04/01/2017
0410112018
-'
x PER OTH.
E.L. EACH ACCIDENT
1,000000
$ '
E.L. DISEASE EA EMPLOYEE5
1,000,000
E.L. DISEASE -POLICY LIMIT
5 1,000,000
A
BusinessAuto
1CA84887804
0410112017
0410112018
Any AUtoICSL
1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES/1ACORD 101Addlllonal Remarks 5chedolo, may be adadhad if more space is raqulmd) x
Included as an additional Named Insured: B•X frlansfleld LLC
Re: The Village at Willow Crossings .25 Cobb Street, Mansfield, MA 02048
Evidence of Insurance
Town of Mansfield - Board of Health
6 Park Row
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPI
l��"tbul_c -
HVUKU 40 txugolua) 91908-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
R
MCM Pool Service, Inc.
215 S. Worcester St.
Norton, MA 02766
(866) 626-7665
billing@mcmpoolservice.com
www.mcmpoolservice.com
BILL TO�
Robert Tirado
The Village at Willow Crossing
25 Cobb St.
Mansfield, MA 02048
INVOICE
2018-0022
DATE
r1, cr
rit3
TERMS
Net 30
DUE
DATE
05 06
2018
SDX High Flow Safety Drain _ _._ _ 2 ._ 70.00 140.00
Please make checks payable to:
MCM Pool Service
215 S. Worcester St.
Norton, MA 02766
Any amount due over $1,000 Is subject to a 3.5"/u credit card processing fee -
HIGH FLOW SAFETY DRAIN
HIGH FLOW SAFETY DRAIN
SDX/ SDX Retro
High Flow Salty Drain
aa000' colnPo
F9J1VlBegqam@@w®AAm��ppmm stir
c oEee�e
B r
9 q
a 112.19.8m°
wli usre2
AdZk
MADE IN USA
11I"f'h
�AHAMo�
QHOW CAN MY CURRENT POOL MEET THE LATEST SAFETY
DRAIN STANDARDS?
APARAMOUNT'S SOX AND SDX RETRO HIGH FLOW SAFETY DRAINS"', ARE
DESIGNED TO MEET THE INDUSTRY STANDARD ASME A112, 19.8-2007 ANTI -
ENTRAPMENT REQUIREMENTS, AND ARE TESTED AND LISTED BY IAPMO,
TO EARN THE PREMIER SWIMMING POOL SPA AND HOT -ruA CODE (USPC)
SHIELD. BOASTS A FLOW RATE OF 200 GPM ON FLOOR AND 192 GPM ON WALL
COMPATIBLE WITH PUMPS UP TO 3HP. IN MOST CASES THIS ELIMINATES THE
NEED TO CALCULATE l'HE SYSTEM TOTAL DYNAMIC HEAD. SOX HAS A 1.485
FEET PER SECOND VELOCITY AT THE OPENING AT A MAXIMUM LISTED 200
GPM, MUST BE INSTALLED WITH AT LEAST 2 SDX DRAINS TEED TOGETHER
TO COMPLY WITH SPLIT SUCTION CODES. SDX SERVES AS A WALL DRAIN
AND ALSO AS A FLOOR DRAIN IF DEBRIS REMOVAL IS NOT A CONCERN. SDX
RETRO CAN BE INSTALLED AS A SINGLE COVER WITH AN SVRS INSTALLED ON
THE LINE.
QWHAT OTHER BENEFITS DO SDX AND SDX RETRO PROVIDE?
AAPPROVED FOR USE ON FLOORS AND SIDE WALLS
APATENTED RIBS CREATE SIXTY SMALL DRAINS THAT DO NOT ALLOW FLOW
TO INCREASE IN ANY ONE CHANNEL WHEN BLOCKED. THIS MEANS HAIR WILL
NOT BE PULLED INTO THE OPENINGS AND EN ANGLED AROUND THE COVER.
ANTI -VORTEX SHIELD AND CHANNELS REDIRECT FLOW TO BLOCK CONTACT A
WITH DIRECT -SUCTION
ASDX IS APPROVED AS A BULKHEAD FITTING SO THERE IS NO NEED FOR THE
PIPE TO BE 11/? TIMES THE PIPE DIAMETER BACK FROM THE COVER, THE SDX
COVER PROVIDES UNIFORM SUCTION REGARDLESS OF PIPE LOCATION.
ASDX RETRO PITS EXISTING DRAIN COVERS IN CONCRETE AND VINYL POOLS
UP TO 1 O" DIAMETER
AHIGH -FLOW RATING FOR USE WITH LARGE HP OR MULTIPLE PUMPS
2 SDX DRAINS - 200 GPM FLOOR / 192 GPM WALL I 3 SDX DRAINS - 300 GPM
FLOOR / 288 GPM WALL 1 4 SDX DRAINS - 400 GPM FLOOR / 384 GPM WALL
AAVAILABLE IN EIGHT COLORS TO COMPLIMENT THE SURFACE OF ANY POOL
.1L1INQ', MO%' MID SOX MV ST.1 INSAI.LLD IN ACCORDANCE WITH C,RANOLNT 5 WRITTEN INSTRUCTION KINJVAL AVD IN
CONFORWY W H APPLICALL P fCD[RAI 5TATC, LOCAL AND 5WIMLIING POOL INDUSTRY CiUILDINO AI•ID SAFETY CODES
HIGH FLOW SHFE7Y DRAIN
SDX HIGH FLOW SAFETY
DRAIN COVER REPLACEMENT
OWNER'S MANUAL & INSTALLATION GUIDE
Read and follow these instructions. Give these instructions to
® the facility owner to keep for future reference. Follow all codes
and regulations that apply to the design, installation and use of
suction outlet fittings.
NaHANSI SO o0:+' Cat �y
/` ASME <s
USpC
nunEwusa
A,II.,9.B,
,n.o
®
'Ill�llr
�PARANO
KIOX' d SDX BRAINS ACE
Cg THE A
GRAWE BAKER ACT TWO.
US and Foreign patents and patents
pending see www.1
004-027-8747-00 REV010615
SUCTION ENTRAPMENT HAZARD:
DEATH or SERIOUS INJURY will result if
a drain cover or grate is not installed and
used correctly.
• Pool and spa pumps produce high levels of suction and move high volumes
of water, which can cause death or serious injury if a person comes in close
proximity to pool or spa drains.
• Keep clear of pool and spa drains to avoid death or serious injury from suction.
DEATH or SERIOUS INJURY will result from
hair entanglement or limb entrapment.
• Keep clear of pool and spa drains.
Hair sucked into pool or spa drains will tangle
and knot trapping the swimmer underwater.
Avoid placing your hair near a pool or spa
drain.
Avoid sitting on pool or spa drains because the
suction can cause severe intestinal damage,
evisceration, and/or disembowelment.
DEATH or SERIOUS INJURY will result from pool
or spa drain covers or grates that are improperly
installed, missing, clogged, or broken.
• Inspect pool and spa regularly to insure that drain covers and grates are
properly in place and secured.
• Ensure that drain covers are not damaged, cracked, broken, loose, clogged, not
properly secured, or missing because these conditions increase the chance of
death or serious injury from entrapment.
• If a drain cover is discovered damaged, cracked, broken, loose, clogged, not
properly secured, or missing, you should:
o Close the pool or spa immediately; and,
o Post a closure notice and keep the pool or spa closed until an appropriate
ANSI/APSP-16-2011 certified drain cover is properly installed.
DEATH or SERIOUS INJURY will result from
®+ contact with a damaged, loose, or missing drain
cover.
• Do not allow limbs to contact or be inserted
into a drain pipe with a damaged, loose,
• or missing drain cover. This could result
swelling of the limb and/or trapping a swimmer
underwater.
• Avoid mechanical entrapment of jewelry,
swimsuit, hair decorations, finger, toe, or
knuckle in a drain pipe with damaged, loose, or
missing drain cover. This may result in trapping
a swimmer underwater.
• Do not allow body to come into contact with
a drain pipe that has a damaged, loose, or
missing drain cover. This may result in trapping
a swimmer underwater.
MAINTENANCE INSTRUCTIONS & WARNINGS:
DEATH or SERIOUS INJURY can result from
pool or spa drain covers or grates that are clogged
by debris.
• All pool and spa drain covers may become obstructed by debris and should be
cleaned periodically due to clogging from debris, such as pieces of plastic, hair,
fabric, twigs, leaves, seeds, etc.
• The frequency of periodic cleaning will vary depending on the amount and type of
debris introduced into the pool or spa
• Clogging of the drain cover will increase the suction effect and increase the
likelihood of death or serious injury from those hazards listed above.
• A clogged drain can negatively affect the safety of the drain.
• It is advisable to have a qualified pool or spa professional perform this inspection
and debris removal from the pool an spa drain covers.
T25 Security Screwdriver
SLOT PLUGS
1k) oil
j
SDX trim pack
#005-252-2006-00 SDX Cover w/screws
(Not part of SDX replacement cover) #0052522084-XX.
Indicate color choice by placing the appropriate color code in place of the "XX" at the end of the part number.
white-01 Gray-02 Black-03 Taupe-04 Blue-05 Light Blue-06 Beige-07 Light Gray-08
The following steps may require a diver or draining
® the pool or spa. Draining a pool or spa may cause
structural damage. Before draining, contact your
local qualified pool or spa professional.
t . Using a T-25 security screw removal tool, unscrew the 3 screws on the cover and remove
the cover. Be careful not to allow any of the slot plugs fall out and float away
2. Examine the back plate. If it is a retro model make sure all slot plugs are in place. If any of
the slot plugs are missing they must be replaced (SDX trim pack part #005-252-2006-
00). Only SDX Retro pool installation will have slot plugs on the back plate.
3. Be sure to line up the grooves on top of the slot plug with the grooves in the back
plate. FAILURE TO PROPERLY REPLACE THE MISSING SLOT PLUGS WOULD
DISABLE THE SAFETY FEATURES OF THE SDX DRAIN. (Tip: Using a sticky
substance like thread sealant can help hold the slot plugs in place so they don't float
away.)
4. Replace the front cover using the new security screws that came with the new cover.
Check to be sure the SDX cover is secure by pulling on the cover and there are no gaps.
REGULATION
NO.
., , r -_
THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE
.vu'.V�'�OCLIS -
w�
34
Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF
105 CMR 435.29 THROUGH 435.31.
SIGNED b //''
1(/-
Operator
SIGN �iC•�LLLLLd
\Board of Health/Health Depa ment
Qa�Na Town of Mansfield
6 Park Row, Mansfield, Massachusetts 02048
508-261-7366
Health Department
Amy Donovan -Palmer, Health Agent
STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS,
105 CMR 435.000
SWIMMING
POOL INSPECTION
REPORT
TVPF. nF Pnnl:
PT rm.IC
F1
SFMI-PT TRT TC YY
SPFCTAT. PT WOOF PnnT. n
NAME OF POOL
V��\ft. � 2 G�� �n;,��(,'�;J LC-r, �S�v�c
ADDRESS
�[.7 Lib S}
OWNER
ADDRESS
DATE OF
POOL CAPACITY
INSPECTED BY
INSPECTION
y
# OF GALS
METHOD OF WATER
e� m"^z
BATHER
!�
# OF LIFEGUARDS
WATER SOURCE:
TREATMENT
LOAD
I k6_0y-\
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
.W Batnhouse and sanitary tacumes adequate lighting;
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 circulatiop & filtration systems. Filter Effluent flow
meter reading: � C� gpm. # of turnovers" k&t
.06 Suitable automatic equipment for disinfection of pool
0
water.
V
.06 Carbon dioxide (CO2) equipment for pH control
adequate. CO2 cylinders anchored. Inaccessible to
t
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 ❑ No
If lifeguards required. Proper credentials, roper 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
POOLSIDE READINGS
Cyanuric Acid
Water TemP.
* arts er 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
10.
^I9
i/
V
t� 0.
Total Chlorine
Comb.
Chlorine ,
PH level n P
�-\l` o Cie t�2c�S 5ci \