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1t�11V OF YR11�tTfH
t�ALTH OF.PAR11�I1P
POOI. I[�SPFx.TICN RHFORf
NAW� ��'_,(o�<�„t,.f�� DAT� �/o�
ADDRESS a C7 � TELEPHObIE IV[I�ER �"�' U�-�J( "t�i,�p�
OPERATOR "� i''C���;�: ``�`�' � � - pERMIT POSTED 1�
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� Regulations of the Massachusetta Sanitary Code: Article VI, Minimum Standards for Pools; and Tovun Amendments to Article VI.
1. All itans approved on the conatruction plan are of pernmnent nature and need not be checked at each inspection.
2, l�'A[�TH: Shower and health signs posted which state that bathera take showers; no ick or infected bathers;
T� no glass or dangerous objects; and children under the age of 16 must h/e acca�ppanied by a�adult swiRmer within.
3. CFItTIFlID POOL OPERATORS: Must staff at e,ast twq i(2�r�rtified operato�f in`First d, Water Safety, C.P.R., and
have one avail�b�eyon the praniaes dgr'r��o�l ope�a�ting hours.
�(�{� .."t �
- 4. SAFE'iY: One shepards crook anri one ring buoy with adequate rop�e for each 2,000 sq. ft. water surface. One pool
divider for shallow end w.ith fioatation buoys.
b K 5. FIRST AID: First aid kit (see back), e�r�ergency telephone numbers �osted, local police, state police, fire
departcnenC, and several available physicians. Telephone available or other means of ca�muiication {no+ pay
station). ���� � �' �f � ( pr,�� �
6. RDCORDS: Written records available of daily operation of the pooi, including attendance, water tests, chemicais t
used, hours of operation, backwashing and other information required. E
7. RpCIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every $ hours, �
maximum filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equipment fi�eky adjustable. Florov ,
meters and pressure gauges are required. `
_ 8. DEPTH MARKINGS: Must be clearly marked on deck and wall of pool, Markings muat be displayed fo� every foot down �
to a depth of 5 feet, and then at appropriate places of not more than 25 foot intervals aroucd the deep portion of �
the pooL
9. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sou� no spiinters or cracks,';
non slip surface. Not over l0 feet above water Ievel and at least 13 feet unobstru ted head roan.
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10. WATFR SqJRGE: Water used in any swiaming pool shall be fraan a source approved by the Heaith Depart�er_t. �
�11. $AGTERIOiAGTGAL SXIALITY: Health Department shall cause water s�les to be analyzed as considered necessary.`
Quality shall meet the USPHS drinking water standards. Untreated water not over 2,400 M'N Goliform.
12. CF�MICAL STA1�Il.lARD6: Treated with chlorine or other effective method. Tests tak��at lEas� 4 times a day
as required by Nealth Department. Free (�►lorine 1.0 - 3.0, pH 7.2 -<�'7.8, Brami�e 2.0 - 6.0,
Total Alkalix�ity 50 - 150 p.p.m. arad Canbined Chlorine less than 2 p.p.m. are requirc�i once a day. �
SWIbMIIVG PWL: Cl = pH = T.A. = Cari�ined Cl =
SWII�IING PQOL: Cl = pH = T.A. _` Car�iined Cl =
#
WHIRL�POC)L: C1 = pH = T.A. = ined CI =
�— �
WADING PQOL: C1 = pH = T..A. = Combined C1 = '
�
13. TF�TING �UIPAdENf: Testing eyuipnent provided, in good repair and canplete with fresh reagents. }�
�14. WATER CLARITY: A G inch black disc at bottam of deepest part of pool visable at 10 yards away. �
1
15. WADING POOLS: Quality of the water shall be the satne as awimning pools.` Turnover 4 hours or lesa. j
16. WHIRLPOOLS: Quality of the cvgter shall be the saaae as swirtming pools and shall be equipped with a thermonxter and
a time inatr�ment for t�e use of bathers.
17. IIV(,'LQSUEtE: A 6 foot high fence in accordance with M.G.L. c.140 with self-closing and self-latching gates or doors.
Indoor pool must aleo be reetricted in a siroilar manner. Pool entrances "arrd exits to be locked during
nqn-operating hours.
18. CtASUR�: Oper�tor to close pool when water does not meet the requirements of thie code. Operator understan�ls
their responsibilities in regarda to operating a public/sani-public swimning pool.
NO►TES: 0`1 C P�-+-t-,c C�-� �� c�C��2.:
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OPERt�,TOR Xif/ rn '� PERMIT PQSTID #
Regulations of the Massachusetta Sanitary Code: Article VI, Minim�m Standards for Pools; and Toan Amerxknents to Article VI.
1. All items approved on the construction plan are af pezmanent nature and need not be checked at each inspection�
--� 2, 1�'ALTH: Shower and health signs posted �vhich state that bathers take showers; no sick or infected bathers;
no glass or dangerous objects; and children under the age of 16 must be accunpanied by an aduit swimner within.
� 3. CIItTIFIID P00L OPFTtATORS: Must staff at least two (2) certified operators in First Aid, Water Safety, C.P.R., and
have one available on the premises during pool operating hours.
b� 4. SAFETY: One shepards crook and one riag buoy with adequate rope for each 2,000 sq. ft. water surface. One pool
divider for shallow end with floatation buoys.
Q,�. 5. FIRST AID: First aid kit (see back), emergency telephone nuribers �+osted, local police, state police, fire
department, and several aoailable �ysicians, Telephone available or other means of cormeuiication (no+ pay
station). C,�t�� f�f,ez,,,�E- Gyr
�b. RECORD5: Written records availabYe of daily operation of the pool, including attendance, water tests, chemicals
used, hours of operation, backwashing and other inforn�ation required.
�,7. AECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every $ hours,
maxim�m filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equignent finely adjustable. F2orov
me� arxl p�s�e g�� ar�quired. � st�•�- `•�...�(��C�..��
a
Q�8. D MAItKI Must be c early marked on deck and wall of pool. Markings must be displayed for every foot down
to a depth of 5 feet, and then at appropriate places of not more than 25 foot intervals around the deep portion of
the pool.
�9. DIVING BOARD6: Rigidly constructed, properly anchored, braced for heaviest load, sound no splinters or cracks, p
non slip surface. Not over 10 feet above water leve� and at least 13 feet unobstructed head roam.
/�. WATFR SqJRCE: Water useti in any snvinming pool shall be fran a source approved by the Health Departmer_t. i
�ll. BACI'�ItIOLOGTCAL SXIALITY: Health Department shall cause water samples to be analyzed as considered necessary.
Quality shall meet the USPHS drinking water standards. Untreated a✓ater not over 2,400 luPN Goliform.
' SEY`� �!1!D �/'1�
�2. Ct�MMICAL STMI�IARD6: Treated with chlorine or other effective method. Tests taken at least 4 times a day
as required by Health Department. Free Chlorine 1.0 - 3.0, pH 7.2 - 7,8, Bramine 2.0 - 6.0,
Total Alkalinity 50 - 150 p.p.m. and Canbined (�lorine less than 2 p.p.m, are required once a day.
9WIMulING POOL: C1 =�y$ �I = /� T.A. = 1�,� Combined C1 = Q
. 9WIMMING PQOL: C1 = pH = T.A. = Caribined C1 =
WHIRt,P00L: Cl = a�� t pH = /•(,p T.A. =�t � Caa�bined Cl =�
WADING POQL: C1 = pH = T.A. = C,orsbined C1 =
��-13. TFSTING IPI�Nf: Testing equi nt rov ded, in good repair and canplete with fresh reagents.
t�"- �� �-��/-�,.,�
�14. WAT�t CLARITY: A b inch black disc at bottan of deepest part of pool visable at 10 yards aavay.
�. WADING POOLS: Quality of the water shall be the same as swimning pools. Turnover 4 hours or less.
j",��b. WHIRLPO()LS: Quality of the water shall be the sa�pe as swinming pools ar�d shall be equipped with a thexmon�eter and
a time instnment for the use of bathers.
�F17. IIICLASURE: A 6 foot hi ence in accordance with M.G.L. c.140 with self-closing and self-latching gates or doors.
Indoor pool must also be restricted in a similar manner. Pool entrances and exits to be locked during
non-operating houre.
�18. QAStIRE: Uperator to close pool when water does not meet the requirements of this code. Operator understands
their responsibilities in regards to operating a pnblic/semi-public swi�ing pool.
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PERS0I�1 I IEWID �
10/96
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Tf� CI�lI�E'AL.1fi OF MhSSAQ�J�.T'I'S
1CxMi OF YAtiNDU1N
}lEAL1t1 DFPARII�F.IJf
POOI. II�PII.TIQ�1 REPORT �
� oaT� O 7 �_�t�.
anDx�ss T�t� �'$ '�71 6G�99
OPERATOR ��ryr�n i n�_�t�Cr` �"` � C� -��t S �„� �n/Y� PERMIT P(�STE� #
Regulations of the Massachusetta Sanitary Cade: Article VI, Minim�n Standards for Pools; and Town Amenc�nents to Article VI.
1. A1l items approved on the construction plan are of pern�anent nature and need not be checked at each inspection.
C�2. }tE'ALTH: Shower and health signs posted which state that bathers take showers; no sick or infected bathers;
� no glass or dangerous objects; and children under the age of 16 must be accanpanied by an adult swicmier within. �
��. 3. CF3iTIFIID POOL OPERATORS: Must staf� at least two (2) certified operators in First Aid, Water Safetq, C.P.R., and }
have ane available on the premises during pool operating hours.
� 4. SAFETY: One shepards crook arrl one ring buoy with adequate rope for each 2,000 sq. ft. water surface. One pool
divider #or shallow end w.ith floatation buoys.
a�•5. FIRST AID: First aid kit (see back), emergency telephone numbers posted. local police, state police, fire
department, and several available �ysicians. Telephone available or other means of carmruiication (no+ pay
station). �f� ���
� 6. RDCORDS: Written records available of daily operation of the pool, including attendance, water tests, chemicals
used, hours of o ration, b ckavashi and ther infornntion re ixed.
NeP d� -K� �eS+- �n� T��c�t �/ fi�S �A�/ �'Sle t�l�� dF'►�y�•t�'�
��..?. RE)CIRCULATION - FILTRATIoIV: Purification system capable of maintaining quality of wattr, turnove every $hours, �
maximum filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equignent finely adjustable. Flow �
meters and pressure auges are required. .,,,,,,.
�,,P +��� �f 0 �-- s (-� a�`,�5� jo O�r-- � �Z���°�+C�.t� �
Q�8. DEPTH MARKI Must be early marked on deck and wall of pool. rkings aust be di played for every foot down �
to a depth of 5 feet, and then at appropriate places of not more than 25 foot intervale around the deep portion of
the pool. �
hi� 9. DIVING HOARDS: Rigidly constructed, properly anchored, braced for heavaest load, soutxl no splinters ar cracks, �
non slip surface. Not over 10 feet above water level and at least 13 feet unobstructed head roan. - }
�CSU✓10. WATER SOI,IRGE: Water used in any swinming pool shall be fran a source approved by the Health Department. �
� 11. $AGTERIOLOGIGAL QJALITY: Health Department shall cause water sa�les to be analyzed as considered necessary. �
Quality sha����the��d�inQ_�te�s�ard��trea ed g�t�er/pot over 2,400 l�'N Goliform. �
. �1,/� r� „ -�, T- O� 't'
�1`2. CF�IICAL STAIVDARD6: Treated with chlorine or other effective method. Tests taken at least 4 times a day �
as required by Heaith Department. Free Chlorine 1.0 - 3.Q, pH 7.2 - 7.8, Bramine 2.0 - 6.0, �
� Total Alkalinity 50 - 150 p.p.m. and Caribined Chlorine less than�2 p.p.m. are required once a day.
,�;� f
!/9WIi�MING PUDL: Cl =� �I = 7•l T.A. = i !� Carl�fned Cl = � .Z• y
S1�VINMING PQOL: Cl = pH = T.A. = Canbined Cl - �
�j Q �] I
�WHIRL,P(�L: Cl - � � pH = /s (� T.A. _ �7� Cambined Cl �� `
�
, WADING POQL: C1 = pFl = T.A. = Canbined C1 = �
�k3. TF�TING FSIUIPI�Nf: Testing equignent provided, in good repair and canplete with fresh reagents. �
K— �Ob(c T�"..�T �-f �
_ (�14. WATEit CJ�RITY: A b inch black disc at bottan of deepest part of pool visable at 10 yards away. �
N 5. WADING POOLS: Quality of the water shall be the same as swimning pools. Turnover 4 hours or less. C
�
16. WHIRLPOOIS: Quality of the water shall lse the same as swimning pools and shali be equipped with a thermaneter and �
a time instrunent for the use of bathers.
�17. IIVCL,pSURE: A 6 foot high fence in accordance with M.G.G. c.140 with self-closing and self-latching gates or doors.
Indoor pool must also be reetricted in a similar manner. Pool entranees and exits to be locked during
non-operating hours.
�18. �: Operator to close pool when water does not meet the requirements of thie code. Operator understands y
their responsibilities in regards to operating a public/sgni-pubiic swi�nning pool. �
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