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Home My WebLink AboutStation Pointe Apts. #1 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 EXPIRES: 12 December 31, 2018 Person Certified., SVETOSLAV A. KAZAKOV Pool/SPA Certification Date: March 10, 2017 Pool/SPA Certification Expires: March 10, 2022 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: BEACON COMMUNITIES, LLC for the operation of a 1 1 Public f 7 Semi -Public ❑ Special Purpose Pool located at: STATION POINTE APARTMENTS 1 Method of water treatment is CHLORINE Bathing load not to exceed: bathers Number of Lifeguards required at all times the pool is open is: None "NO LIFEGUARD ON DUTY" sign is required. .Amy Donovan -Palmer, Health .Agent Date Issued Town of Mansfield Towit of Mansfield - BOYIPfd Of Health 6 Park ROW Mansfield, MA 02048 Sftfantining Pool Application PERMIT NUMBER FEE: $125 QQ p Public NAME OF OWNER: J/QW�V�1wrn� "I�jPOOLOPERATION: N(Seml-PUbf(c ADDRESS, Q FYQ,, ttY,, 'rI.9 LLUemW CITY:M6h IeJd,) STATENA ZIP: Fill ✓" f TELEPHONE't,* - - 01 FAX: Din EMAIL: Sii3`LYc;,nry, tNN`n__O^^"-n"'1 FED IDI$S NO: Jc /lll(/",�q FEE PER POOL:'$'2,J Certification Explms Every 5 Years, Permit EXpires Decemher 31st Yearly. Uf' PERSON CERTIFIED. &etOgjb/ �Cl�kOv Pool/SPA Certification Date: 16l101 IT Pool/SPACertification Explres: _/ 10/2z PERSON CERTIFIED: Poot/SPA Certification Date: p special Purpose Pool U n POOL LOCATION:'st l on i'l YTi�/ ft ll TYPEIPOOL:: M64001 �{ LENGTH: J�p I/� n� pWIDTH:J* VOLUME: 31' AS41AI1 qY MINIMAX DEPTH: % - SWIM AREA, 6jj`ZL 1'ff- DIVEAREA: tU A WATER SOURCE' t A/ WAR DISPOSAL:�tWrl TYPE OF FINISH: VVIV SCUM GUTTER: NO, DECK TYPE: NY)l'i C,Lwr rl SKMMR W E4R LENGTH: Qj TREATMENT SYSTEM:b[ n1 DISINFECT METHOD: PeoDSPA Certification Expires., CHEMICAL TREATMENT. [wet codification remarks(I1 necessary): NUMBER OF BATHERS: I REMARKS: -NO LIFEGUARD ON DUTY" sign is required. SIGNATURE: . DATE: At ��lO Please make p 0 riate changes. Sign, date and enclose check payable to Town of Mansfield, Mail to: BOard of Health, Town o ansfield, Six Park Row, Mansfield, MA 02046. 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. P606 of In�vidual or Name (Mandatory) By, Corporate Officer (Mandatory, if applicable) �'2-�0�9r7gD ** Social Security Number (Voluntary) or Federal'ldentification 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 of Mansfield 6 Park Row, Mansfield, Massachusetts 02048 a 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 TYPFOFP00L- PUBLIC ❑ SEMI -PT iRLTC 0 SPFCIAT.PURP(_)SFP00l. ❑ NAME OF POOL C� ` \ \ \ ` i ADDRESS OWNER ADDRESS DATE OF INSPECTION II POOL CAPACITY # OF GALS 3� ��WQN INSPECTED BY A\r\ METHOD OF WATER TREATMENT pC BATHER LOAD # OF LIFEGUARDS 'A_ WATER SOURCE: A_.wr 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 it above ground. .04 Sewage Disposal .05 Location, structural stability, finish. .06 Water circulation & Oltration systems. Filter EfOugnt flow meter reading: gpm. # of turnovers G �a hf qJ \-0'•�n--bccv�5 .06 Suitable automatic equipment for disinfection of pool water. rvl- .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 `46� Ce n2C sec sir Cct\\ ve�.tn �3k Sc�L�ccc ch �'1� .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 A 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 POOLSIDE READINGS ,✓/ /\fin o``�.i2 I �{.i c�C.J R N ✓� `)C.��w.vy. Z�S, �. vv�c.�.w Vv c�..�v.5 Alkalini 50-i50 `m `ti :';, -1.0 Free Chlorine - 1:0=3 D m ,:~v~��. . o Cyanur c Acid (3000 pprfr) ` ;; Comb. (O.O,ro 2 pprn),=, ` Water .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 a H level 7.2� 8� Other \. \h USe- C REGULATION NO. THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE \g cc.-S- 1v-,� 2;-cx cCA\ > v. c- w,/ .34 Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31. SIGNED � y Operator '� ti Board of Health/Health Department