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Home My WebLink AboutHockomock YMCA 12/31/2009PERMIT NUMBER: PERMIT EXPIRES: Commonwealth of Massachusetts Town of Mansfield Board of Health Permit to Operate a Swimming Pool 12 December 31, 2009 Town of Mansfield 6 Park Row Mansfield, MA 02048 Pool/SPA Certification Date: October 10, 2007 Pool/SPA Certification Expires: October 10, 2012 Person Certified. WILLIAM DOHERTY Pool/SPA Certification Date: Pool/Spa Certification Expires: Person Certified: 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: HOCKOMOCK AREA YMCA-MANSFIELD for the operation of a C] Public ❑ Semi -Public ❑ Special Purpose Pool at: Method of water treatment is Bathing load not to exceed. 40 BALCOM STREET CHLORINE 30 bathers Number of Lifeguards required at all times the pool is open is: "NO LIFEGUARD ON DUTY" sign is required. ,--'f Scott LeL,kTealth Agent None I Town of Nkmwl o $PwkRew uen+ryfeiS. MAG" PERMIT NUMBER: P-�PUblc NAME OF OWNER: POOLOPERATION: "_1 Seml-Public I FJL �•��rv•eCk. &r'ca, ;tM 'c%i- �j SµroiE Pufoo" Pool 4WREEe: c{a ,belC•+�n $t-. POOLLOCATION:l C..�•.cA�1r`.. C..�•'Rwr CITY: tA.,naA4.1L t'-•tgrS�i.4�Z.. STATv MA rrP: OZ--Vf"' TrPEmouL: py.•.w Grt..-L TELaPFK1AS: �a�r-339'I�6s LA"7H., F SDK 33Z VOLUME: MINIMAKDEPT"! PRO IDM NO: FEE PER PER POOL' DIVE ARW: WATERSOURCE: FP,, k w. i sA1Rr.�1o�f EuenrSMae.Pi. W1W MPOMA j)A- R lu Fee r S1ld YMMv. TYPO GF PINsH; PERSONCERTIFIED: !`� SOUMOUTTER: $klhm,r PO VSPA i OrMCM0 Dete: jolm i T o 7 aw* iY4Et ! PDOtrSPA LaMd11CS1(pn ExplryE' �u� ;e+' z�12 %KMMR WEIR LENGTH: PERSON OERTIFIRD; TREATMENTSYSTEM: PooMA CartiAmdon Date: DISINFECT METHOD; L w\5-:1.4, PbOVSPA GerbAcation EXpkea; CHEMICU TREATMENT; a®rtRlaMbn tAmpkspl RiOMMYY); NUMBER OF aATTiERC NO LIFEGUARD ON DUTr sign IF npulred• I I SIGNATURE: „� �" „.__....,.. GAT'E: _, f✓ i `` C PANNO make appropttets glar1 w. Si data and wow Chock payable to Town Df AWPallatd. A400 to: 808fil of iaMIA Togo AfAAwvaB/dd SWP&*A0i; M*mNA0 Al "DO ZW•d to d.b8 L£E9As 9TitsW N'3Wr+ Ei3aa �t]G WO�IG GH Wd SS: 6S 6fW®'L-Z©•-•'lnt' 10 39Vd OWANOOH £099£79809 LT:80 6ZOZ/Z01LO Q�EyYNCr I,J'. ; Town of Mansfield - Board of Health d�gfFW x s x o�s'a,'� 1; Swimming Pool Application NAME OF OWNER: HOCKOMOCK AREA YMCA-MANSFIELD ADDRESS: 40 BALCOM STREET CITY: MANSFIELD STATE: MA ZIP: 02048 TELEPHONE: (508) 339-3066 FAX: (508)337-8479 FED ID/SS NO: 04-2131749 FEE PER POOL: $75.00 Certification Expires Certification Expires Every Years. Permit Expires December 31st Yearlv. PERSON CERTIFIED: DANIEL E. BRENNOCK Pool/SPA Certification Date: 5/19/2006 Pool/SPA Certification Expires: 5/19/2011 PERSON CERTIFIED: Pool/SPA Certification Date: Town of Mansfield 6 Park Row Mansfield, MA 02048 PERMIT NUMBER: 12 ❑ Public POOL OPERATION: ❑ Semi -Public ❑ Special Purpose Pool POOL LOCATION: 40 BALCOM STREET TYPEIPOOL: ABOVE GROUND LENGTH: 38' WIDTH: 18' VOLUME: 10,000 gal MINIMAX 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 WNINLY LINER SCUM GUTTER: NONE DECK TYPE: WOODEN SKMMR WEIR LENGTH: 1.5 to 2' TREATMENT SYSTEM: SAND FILTER DISINFECT METHOD: CHLORINE Pool/SPA Certification Expires: CHEMICAL TREATMENT: CHLORINE certification remarks(if necessary): NUMBER OF BATHERS: 40 REMARKS: ..NO LIFEGUARD ON DUTY" sign is required. SIGNATURE: DATE: 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. � \� \� ` \\� � ° .: .. / % m ¥� I i � / y: AUG-05-2009 04:39 AM HOCKOMOCK AREA YMCA MANS 5083378479 P.01 lw�NOCKOMOCK AREA, XMCA •North Attleboro •Franklin •Nlansfleld� ® •F4xboro FAX COVER SHEET DATE:--at NUM13E)I OF PACif'S (bicluding cover): SUIi]8CI':� DID YOU KNOW?? Reach Out For Youth & Families Provides confidential scholarship assistance to those who want to participate in Hockomock Area YMCA programs and services, but have the inability to pay. To make a contribution, call (508) 695-7001, ext, 225. Hockotiiock Area YMCA Manstcld I3tntich 4013alcom Street Mansfield, MA 02048 Tel; (508) 339-3066 Fax:(508)337-8479 We build strotrg Aids, Tfroulg fantllieV, strong eonuRunifiCs.