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HomeMy WebLinkAbout2023 Licensing The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Lodging License Number: BOHL-16-10458-05 Issue Date: 1/1/2023 Mailing Address: Location Address: HARI HOSPITALITY INC. 135 ROUTE 28 TIDEWATER INN WEST YARMOUTH. MA 02673 135 ROUTE 28 WEST YARMOUTH, MA 02673 IS HEREBY GRANTED A 2023 LICENSE TO OPERATE: Motel This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2023 unless sooner suspended or revoked and is not transferable. Conditions *101 UNITS; 101 BEDROOMS. INCLUDES 2 MANAGER UNITS. Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston Bruce G. Murphy,MPH, .S., C /James G.Gardiner Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-16-10460-06 Issue Date: 1/1/2023 Mailing Address: Location Address: HARI HOSPITALITY INC. 135 ROUTE 28 TIDEWATER INN WEST YARMOUTH. MA 02673 135 ROUTE 28 WEST YARMOUTH, MA 02673 IS HEREBY GRANTED A 2023 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2023 unless sooner suspended or revoked and is not transferable. Conditions INDOOR SWIMMING POOL Board Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman of Charles T. Holway,Clerk Debra Bruinooge Health Eric Weston Bruce G. Murphy,MPH, R.S., HO/J es G.Gardiner Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $185.00 Food Establishment License Number: BOHF-16-10464-06 Issue Date: 1/1/2023 Mailing Address: Location Address: HAM HOSPITALITY INC. 135 ROUTE 28 TIDEWATER INN WEST YARMOUTH. MA 02673 135 ROUTE 28 WEST YARMOUTH, MA 02673 IS HEREBY GRANTED A 2023 LICENSE TO OPERATE: Food Service; Common Victualler This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2023 unless sooner suspended or revoked and is not transferable. Conditions SEATING: 90 Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston Murphy' .Gardiner Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth siio.00 Swimming Pool Operations License Number: BOHSP-16-10462-06 Issue Date: 1/1/2023 Mailing Address: Location Address: HARI HOSPITALITY INC. 135 ROUTE 28 TIDEWATER INN WEST YARMOUTH. MA 02673 135 ROUTE 28 WEST YARMOUTH, MA 02673 IS HEREBY GRANTED A 2023 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2023 unless sooner suspended or revoked and is not transferable. Conditions OUTDOOR SWIMMING POOL Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman Of Charles T. Holway,Clerk Debra Bruinooge Health Eric Weston Bruce G. Murphy, MP , R.S., O/James G. Gardiner Health Director/Assistant Health Director TOWN OF YARMOUTH BOARD OF HEALTH M APPLICATION FOR LICENSE/PERMIT -2023 S * Please complete form and attach all necessary documents by December 18, 2022. Failure to do so will result in the return of your application packet. ESTABLISHMENT NAME: .-e(7 _n), ) TAX ID: n i S Cko LOCATION ADDRESS: TEL.#:, MAILING ADDRESS: f2�,,( 9 C� . .(1t'}(V A r4P- A2 -7 3 E-MAIL ADDRESS- Q r s' y) P, 3 ,eD/Yl4 OWNER NAME: pa, -�, ft.,kr • CORPORATION NAME OF APPLICABLE): y ( &iC- 4 MANAGER'S NAME: ' TEL.#: MAILING ADDRESS: 5-plykir % 1°, / am1 u*) t - Z 2( 73 POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated Pool Operator(s) and attach a copy of the certification to this form. 1. CI' aiIes bd ains 2. Pool operators must list a minimum of two employees currently certified in standard First Aid and Community Cardiopulmonary Resuscitation (CPR), having one certified employee on premises at all times. Please list the employees below and attach copies of their certifications to this form. The Health Department will not use past years' records. You must provide new copies and maintain a file at your place of business. 1. L 5 Qco3 h 2. jcnc e)y) 1 /7171 tA-nj 0,1,0..cay)FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments are required to have at least one full-time employee who is certified as a Food Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. Please attach copies of certification to this application. The Health Department will not use past years'records. You must provide new opies and maintain a file at your establishment. 1. � f9Q_7/rJ 2. PERSON IN CHARGE: Each food establishment ust have at least one Person In Charge (PIC) on site during hours of operation. 1. ap r l R1kJ 2. ALLERGEN CERTIFICATIONS: All food service establishments are required to have at least one full-time employee who has Allergen certification, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.009(G)(3)(a). Please attach copies of certification to this application. The Health Department will not use past years' records. You must provid new copies and maintain a file at your establishment. 1. mi PoAeJ 2. HEIMLICH CERTIFICATIONS: All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich Maneuver on the premises at all times. Please list your employees trained in anti-choking procedures below and attach copies of employee certifications to this form. The Health Department will not use past years' records. You must provide newPa-10 copies and maintain a file at your place of business. 1. egt)Prl A-otay-Y\S 2. � 6� -qtfA,„,,,_,,,, _ _ _ _ — RESTAURANT SEATING: TOTAL # OFFICE USE ONLY LODGING: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# B&B $55 CABIN $55 OTEL $110 INN $55 —CAMP $55 41SWIMMING POOL$110ea. BADGE $55 —TRAILER PARK $105 WHIRLPOOL $110ea. FOOD SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# /6-100 SEATS $125 _CONTINENTAL $35 NON-PROFIT $30 —>100 SEATS $200 COMMON VIC. $60 —WHOLESALE $80 —RESID.KITCHEN $80 RETAIL SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# <50 sq.ft. $50 >25,000 sq.ft. $285 VENDING-FOOD $25 —<25,000 sq.ft. $150 -FROZEN DESSERT $40 —TOBACCO $110 NAME CHANGE: $15 Amount Due= $ V-D *****PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** ADMINISTRATION c � , Under Chapter 152,Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal of any license or permit to operate a business if a person or company does not have a Certificate of Worker's Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR CERT. OF INSURANCE ATTACHED OR WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHE' Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES NO MOTELS AND OTHER LODGING ESTABLISHMENTS TRANSIENT OCCUPANCY: For purposes of the limitations of Motel or Hotel use,Transient occupancy shall be limited to the temporary and short term occupancy,ordinarily and customarily associated with motel and hotel use. Transient occupants must have and be able to demonstrate that they maintain a principal place of residence elsewhere.Transient occupancy shall generally refer to continuous occupancy of not more than thirty(30)days,and an aggregate of not more than ninety(90)days within any six (6) month period. Use of a guest unit as a residence or dwelling unit shall not be considered transient. Occupancy that is subject to the collection of Room Occupancy Excise, as defined in M.G.L. c. 64G or 830 CMR 64G, as amended, shall generally be considered Transient. POOLS POOL OPENING: All swimming,wading and whirlpools which have been closed for the season must be inspected by the Health Department prior to opening. Contact the Health Department to schedule the inspection three (3) days prior to opening. PLEASE NOTE: People are NOT allowed to sit in the pool area until the pool has been inspected and opened. POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count by a State certified lab, and submitted to the Health Department three(3)days prior to opening, and quarterly thereafter. POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of closing. FOOD SERVICE SEASONAL FOOD SERVICE OPENING: All food service establishments must be inspected by the Health Department prior to opening. Please contact the Health Department to schedule the inspection three(3)days prior to opening. CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the required Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtained at the Health Department,or from the Town's website at www.varmouth.ma.us under Health Department,Downloadable Forms. FROZEN DESSERTS: Frozen desserts must be tested by a State certified lab prior to opening and monthly thereafter,with sample results submitted to the Health Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFÉS: Outside cafes(i.e., outdoor seating with waiter/waitress service), must have prior approval from the Board of Health. OUTDOOR COOKING: Outdoor cooking,preparation, or display of any food product by a retail or food service establishment is prohibited. TOBACCO PRODUCT PERMIT CAP & VIOLATION ASSESSMENT A tobacco permit holder who has failed to renew his or her permit within thirty (30) days of the previous year's permit expiration date is considered an expired license, and the tobacco license cap is reduced. Violations of 105 CMR 665.000, State minimum standards for retail sale tobacco,shall be assessed as follows: lst Violation a fine of$1,000.00 shall be imposed,2°d Violation within 36 months of 1st violation,a fine of$2,000.00 shall be imposed and a prohibition on sale of tobacco products may be imposed for at least 1 day and up to 7 days, 3rd Violation within 36 months of 1st violation or additional violations during that time period,a fine of$5,000.00 shall be imposed, and a prohibition on the sale of tobacco products may be imposed for at least 7 consecutive business days and up to 30 consecutive business days. NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED RENEWAL APPLICATION(S) AND REQUIRED FEE(S)BY DECEMBER 18, 2022. All renovations to any food establishment,motel or 24 .e.,pain new equipment,ect.), Must be reported to and approved by the Board of Health to commence rig. Renovations m require a MA engineer site plan. DATE: 09, 1ST 3 SIGNATURE: Ali, PRINT NAME&TITLE: Vs . \)0Q s v NI Rev. 10/11/2022 The Commonwealth of Massachusetts Print Form I Department of Industrial Accidents _ (l Office of Investigations �x�.. : 1 Congress Street, Suite 100 !l!' j Boston, MA 02114-2017 '` _ www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: d&ik I j�j , LJ4 �' Hcq)clot-dzi Address: 1 %j ee 4e -- City/State/Zip: A.)1.Irk Ntedth * O2J7'3Phone #: Are you an employer? Check the appropriate box: Business Type(required): 1.❑ I am a employer with employees(full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.0 I am a sole proprietor or partnership and have no 7. ❑ Office and/or Sales(incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] o. ❑ Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4), and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]** 1 4.❑ We are a non-profit organization, staffed by volunteers, 11.0Health Car with no employees. [No workers' comp. insurance req.] 12.N Other g( 1 • ( K. *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **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#1. I am an employer that is providing workers"comp satin insurance for my em i oyees. Below is the pot' information. Insurance Company Name: Ho j�f ( 1�,6 t- J • .;; ; Insurer's Address: P LAU .‘' C SD/C1r)J _ 9i— J City/State/Zip:SLJ COCIE O,. j 1 ;�pl 3 f Policy#or Self-ins. Lic.# t �/\cce 1,v_e_ )V., Expiration Date: , 3( 12...)23 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 o DIA for insurance coverage verification. I do hereby , - enalties of perjury that the information provided above is true and correct. Signature Date: a 1 S// Phone#: J O fr1 .5 1v�j� `2 l Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Licensing Board 5. Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia NOTICE NOTICE TO TO EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS LAFAYETTE CITY CENTER, 2 AVENUE DE LAFAYETTE, BOSTON, MA 02111 (617) 727-4900 — http://www.ma.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22, & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: Hartford Casualty Insurance Company NAME OF INSURANCE COMPANY One Park Place, 300 South State St, 7th Floor Syracuse NY 13202 ADDRESS OF INSURANCE COMPANY 08 WEC AK8XPJ 03/12/22 -03/12/23 POLICY NUMBER EFFECTIVE DATES PO BOX 9011 CORCORAN & HAVLIN INSURANCE GROUP WELLESLEY MA 02482 (800)-304-8242 NAME OF INSURANCE AGENT ADDRESS PHONE Hari Hospitality Inc 135 ROUTE 28 WEST YARMOUTH MA 02673-4653 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER Form WC 88 20 01 E Printed in U.S.A. 4/29/2021 vmau-Iry Letter Charles Odams <charlescdams@gmail.com> CPO Letter 1 message nac4h2o@aol.com <nac4h2o@aol.com> Thu, Dec 12, 2019 at 8:03 AM To: charlesodams@gmail.com 12-12-19 Charles Odams Jr. Tidewater/HGM W. Yarmouth, MA :02673 Dear Charles, Congratulations on your successful completion of the CERTIFIED POOL/SPA OPERATORS course. I hope your experience was a positive one. You will be listed in the National Swimming Pool Foundation's Certified Pool/Spa Operator National Registry. Within 4-6 weeks, you will receive an official CPO Wall Certificate and Wallet Card. These will list your registration number. Thank you for your participation. If you have any questions, or if I or my company can be of any assistance to you now or in the future, please don't hesitate to contact me at 1-888-833-5770. Sincerely, SCORE:100 Robert R. Freligh, CPO INSTR. Pres. NAC, Inc. hops://mail.google.corn/mail/u/0?ik=6de2940c15&view=pt&search=all&penrithid=thread-f%3A1652719163301417009&simpl=msg-f%3A16527191633... 1/1 `P'.. fT 1,fil -1- HEART1 ,1,%1„: „ 11.11 • Violet Ronch has successfully completed the cogr-iitive in accordance with the curriculum of 1, American r irk Heartsaver First Aid c;prt AED Prs)grarri. Optional modules completed: Child CPR AED. Infant CPR Training Ito,' Name Survival u . L.i Marjori lntruiJ Trainitici Ceritet. ID r1150'-4 Training C;iiy., State North vri, CT Training Center phone NuaTtber Tr • (203)`,.•..4-6326 To view or verifyauthentic .t it rtployers should scan this co th their mat,' ,`,,neitcan Heart Association.All t t 7 `-I, v ue I .�,+,.„� r aA r Ti "hR shy ,b ' 9 mi a, h ' - • -� t,.._ #• �sew y =rican of — l 1 � i�r1 Parth Patel has siu t c i fiaiily completed the e.o nitive and skills ev in accor ,dt;.r.o.. with the curriculum of the American Heart if ti.nr� io:°a Hei r'tsaver First Aid CPR AED Program. Optional modulo , completed: Child CPR AE.D, Infant CPR IssUta Renew !: i 05/20 .. Traininj 1411ame lnstruc it Survival Group, L.i_C.' Marjorie rlrr, •{V Instruct..'r ID Trairtit,y C'en•i'arrtl � 07150�^•rr eCarz Training Ccntr City, State 216012^t North Haven, CT QR Training =dey`r:or Phone ''Lgr`ober chi, , To view or verify Qum.,a :i:: c...u•.,r ,,r,ployers si,o:dc,scan v,i,.iafi cocie with tnalr motAle device or go tc r • t:,.:-<:nr/nlycards. 2vi21 A:nerican Heart Association.AU rights reserved. 20-3002 1/21 ; American ift-ftrt Atsciation. Mark Huitchinson has sup completed the cognitive and skills evale..j.;ons in accordance. with the curriculum coi the American Heart Af.::..cciation • Actsaver Fist Aid CPR AED Program. Optional modules completed: Child CPR AED, Infant CPR hie Date Renew 1.3y 5,'912321 05/2022 Trainincl Canter Flame instructor ie su, Ali Group, Ll..c Marjorie Arliciid Instructor ID Trait ihg Center ID 071503490'32 CI 05943 eCard Cede) Training Cr Citl,/, State 2160122C7 7:5 North 11aN.'ell, CT OR ric-7_. Trainirq:j t..7(,?.?:1tOr Phone 'g.b.4rflalor (203) 2.3,i-6326 • To vow or verify at sthe otici, 3 I.sdcots C. omployers shou1 en th OH code with their mobile device or go to w.v •c,,Lorg/cpr/mycards. American Newt itii.XI sights reservsd. 20-3002 1/21 HEART:-.IV.' J I-ie r® ; rlicrt n ,• "•,,of- '17:d R Timothy Hutchinson has completed the cu,orlitive and skill:; in accorda..c:?, with the curriculum at tile American Hea, Heartsaver First Aid Cril AED Program. Optional modules completed: Child CPR AED, Infant CPR Issue Date Renc- 6•'_, 2021 Training ce.lter Name Instr; sup/iv., (3ii)up, t.LC Marjori$ Trainint Center ID eCr Training Cecitc,r City, State 2irr, Nord CT Traininc3 ,23-1-6i26 To view or verify aJthentier StUd011tS and employers should scan this(11-1 cod.,with their moryle device or ' • - nrus. 12021 American Heart Association.All no: recerved. 20-:::c102 rAmerican 1, He rt Association", Devon Adams has successfully completed the cognitive and skills evaltr tions in accordance with the curriculum of the American Heart Ac yociation Heartsaver First Aid CPR AED Prograrn. Optional modules completed: Child CPR AED, Infant CPR Issue Date renew By 5/9/2021 05/2023 Training Center Name Instructor Mame Survival Group, LLC Marjorie Arnold Instructor ID Training Center ID 0715034902,2 CT05948 eCard Code Training Center City, State 21601228072,0 North Haven, CT • OR Codn Training Center Phone dumber c,20:3j 234-6:326 • •��•-�•iEa To view or verify ra.11.?nticity students arc'wnployers scan this OH code with their notrii0 device or go to www,heert.org/cpr/mycards. r;O 2021 American Heart Association.Alrights reserved. 20-3002 1/21 qt1t. ID1 ' ' ---- - rt-arf, - He Fi, •-rt. A.-: ;cciatiorL Lisa Washington has successfully completed the cognitive and skills evaluations in accordance with the curriculum of the American Heart Association Heartsaver First Aid CPR AED Program. Optional modules completed: Child CPR AED, Infant CPR ic,fle Date Renew ro:' 5,T;v2021 05/2023 Training Center Name Instructet Survival Group. LLC Marjorie Anil Instructor l0 Tra9 Center ID 0715034P032 FOSO4 8 eCard Cc Training C<,,,riter City, State 216012287:"-iS North Haven, CT OR Cod Training Center Phone 1-4timber (203';234-6326 d; ,v or verify a ithialki.6t.tael s Ltno o Apioyers .0.lid thin QFl Uthje,with their mobile devico or go tr;w.v—: 'rt.orgicpr/mycards. 2021 A,orioan ha..Associatio; Al fights reservad. 20-3002 /2 u a THE (XIMM NW ALTH OF P.MSSACHUSETTS TOW OF YARM XTDI HEATH DEPARII&NT POOL IMPELTIM REPORT NAME .%' C Gr/C--/ '-i ,.--7 DATE 61Q /-21----3 ADDRESS / 3 s---- ,7.04c, , s)/ -(..¢' TELEPHONE NUMBER OPERATOR ,LOCP, 7, /`'/ - , ') Cite, PERMIT POSTED # Regulations of the Massachusetts Sanitary Code: Article VI, Mininun Standards for Pools; and Town Amendments to Article VI. [�J 1. All items approved on the construction plan are of permanent nature and need not be checked at each inspection. _1- 2• HEALTH: 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 accompanied by an adult swimner within. elz 3. CERTIFIED POOL OPERATORS: Must staff at least two (2) certified operators in First Aid Water Safet , C.P.R., and have one available on the premises during. .: .perating hours. _STAFF ems—i Aid, Water 4=< 4. SAFETY: One shepards crook and one ring th adequate rope for each 2,000 sq. ft. water surface. One pool divideor shallow end with floatation bu 5. FIRST AID: First aid kit (see back), t`r enc telephone y e phone numbers posted, local police, state police, fire department, and several available physicians. Tele one available or other means of cormunication (not pay station). Re,'..0 'I cc.1 .gi l l le',�..,,:p e-G Lt•67/S et' 6. RECORDS: Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. 414<-7. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, maximun filtration rate 2-3 gal. per min. per sq. ft. filter., Disinfection equipment finely adjustable. Flow meters and pressure gauges are required. C�/ 7� I 3 p c j p. .—. ,¢Gait, , , ��5 8. DEPTH MARKINGS: Must be `clearly 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. f� 9. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load,non slip surface. Not over 10 feet above water level and at least 13 feet unobstructed head roan :nters or cracks, i0. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. 4( 11. BACTERIOLOGICAL QUALITY: Health Department shall cause water samples to be analyzed as considered necessary. ' Quality shall meet the USPHS drinking water standards. Untreated water'not over 2,400 MPN Coliform. CJ12. CHEMICAL STANDARDS; 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, Branine 2.0 - 6.0, Total Alkalinity 50 - 150 p.p.m. and Cathined Chlorine less than 2 p.p.m. are required once a day. WINNING POOL: CI = a pH = —7, 6. T.A. _ / Combined Cl = Z-- SWIMAING POOL: CI = PH = T.A. = Combined CI = ,' WHIRLPOOL: CI = = T.A. = Combined CI = WADING POOL: Cl = pH = T.A. = Combined Cl = _13. TESTING EQIIIRAENT: Testing egtlipnent provided, in ood epair and complete with fresh reagents. . K14. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. 447415• WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. i/A16. WHIRLPOOLS: Quality of the water shall be the same as swimming pools and shall be equipped with a thermometer a time instrument for the use of bathers. and U'="'17. ENCLOSURE: 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 also be restricted in a similar manner. Pool entrances and exits to be locked during non-operating hours. u,,� 1e F)/ / L o'G1G„ 2."�18• CLOSURE: Operator to close pool when water does not F,t the requirements of this code. Operator understands their responsibilities in regards to operating a public/'�. - ,blic swimming pool. NOTES: Lo 6G►S G e.S(7>`. `-._ PERSON INTERVIEWED d'"�INSPECT ITV 10/96 SAFELY SIGNS AND HQUIP4rN1 1. Signs to be posted at the pool include: * All persons are required to take a cleansing shower before entering the pool. * No person with a communicable disease is allowed to use the pool. * No bather shall wear a bathing suit that is unclean. * No person suffering from a cough, cold, inflammation of the eyes. nasal or ear a scharges, ,0 :mny t ' communicable disease shall be allowed to use the pool. * No person with sores or other evidence of skin disease, or who is wearing a bandage or medical covering of any kind, shall be allowed use of the pool. * No person shall spit or in any other way contaminate the pool. or its floors, walkways, aisles. or dressing rooms. * No glass containers shall be permitted in the pool or on walkways within 8 feet of the pool. * No person shall bring or throw into the pool any object that may in any way carry contamination or endanger the safety of the bathers. 2. Lifeguards and operators crust enforce the rules noted on the above-signs. 3. A shepherds crook or reaching pole with a minimum handle length that extends greater than la feet. ,,.ast be piovrded tor each 2,000 sq. ft. of water surface area (MGL, c140, s206). i 4. One Ring Buoy or Rescue Tulle with a }" polyeth+ne. rope attached, no less in length than 1} the width of the pun . If the pool has lifeguards, a rescue tube mist be ;located at each station., 5. Emergency communication equipment mist be available for reaching anergenc response persons. Appropriate telephoee nurbers and directions for the use of the equipment must be posted. 6. There must be an appropriately equipped first aid kit. Public pools ma have a roan designed and equipper: io emergency care of sick and injured bathers. 7. Whirlpool - Must be drained every 30 days and scrubbed and disinfected. FIRST AID KI'1' ` 35 1' Band-Aids 10 3" x 3" sterile gauze pads 2 5" x 5" surgipads 1 8" x 10° surgipad 1 2" soft roller bandage 2 3' soot roller bandages I roll 1/2" hypoallergenic tape 1 triangular bandage 1 scissors 1 rescue blanket 12 antiseptic wipes 2 disposable instant ice pack. 1 sterile isotonic buffered eye wash 2 pair one size-fits--ail latex gloves 1 microshield or pocket mask with a one way valve POOL LOGS Logs must be kept each day the pool is in operation. Test for: Free Chior,ne 4X/day Cathined Chlorine 1X/day oil 4X/day Total Alkalinity 1X/day Also note on the log: Clarity Good/Average/Poor Chlorinator On/Off Chlorinator Setting Low/Medium/High or 1/2/3, etc. Weather Sunny/Cloudy, etc. Air Temperature Bather Load Chemicals Added Any Other Actions Taken 1 Initial. of Tester ADMINISTRATION P(X)L CLOSURE ' IS THE RESPONSIBILITY OM ER REASON THAT S'ULD MAKE POOL USE UNSAFE. U t( 1 . N ICAL PHYSICAL THE 17E OF SAFET WETY Y DARDS ARE NOT MET, OR FOR ANY in canplia.*ice with MGL 1140.205, when closing your outdoor inground swimming pool for the season. pools must be drained a:' remain dry throughout closure time, or covered within seven (7) days of closing. POOL OPENING In the event that your pools have been closed for the season, all swimming, wading and whirlpools are to be inspected by the Health Department prior to opening. Prior to calling for an inspection appointment, a water sample from each pool and i irlhcol Tust be submtted far testinF for coliform and pseudomoras by an independent lab. Lab results crust be submitted prior to inspection and op a ng. THE OCMAJNWEALIN OF MASSACHUSETTS TOWN OF YARMXTH HEALTH DEPARTMENT POOL INSPECTION REPORT .y 1 NAME ! 1 GIPGUC-1 n /1 DATE 5/ ADDRESS ./ S /6?G .z fo le// TELEPHONE NUMBER OPERATOR ---- �����? d 4-171 Cf�� PERMIT POSTED M - Regulations of the Massachusetts Sanitary Code: Article VI, Minimum Standards for Pools; and Town Amendments to Article VI. 1. All items approved on the construction plan are of permanent nature and need not be checked at each inspection. 0<2. HEALTH: 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 accompanied by an adult swimmer within. Cam`` 3. CERTIFIED POOL OPERATORS: Must staff at least two (2) certified operators in First /did, Water Safety, C.P.R., and have one available on the premises during pool operating hours. $1�-^-t,ev C:v1 O L< 4. S One shepards crook and one rilVuoy with adequate rope for each 2,000 sq. ft. water surface. One pool dividerap shallow end with floatation buoys. J 5. FIRST AID: First aid kit (see back), emergency telephone numbers posted, local police, state police, fire department, and several available physicians. Telephone available or other_means of communication (not pay station). OK 6. RECORDS: Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. 7. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, maximum filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equipment finely adjustable. Flow meters and pressure gauges are required. =N ,, cam_ 154,'8. DEPTH MA Must be dearly marked on deck and wall of pool. Markings must be displayed for every foot down 1 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. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound no splinters or cracks, 1 non slip surface. Not over 10 feet above water level and at least 13 feet unobstructed head room. I.-P"10• WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. ik 11. BACTERIOLOGICAL QUALITY: Health Department shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2,400 MPN Coliform. ‹ V 2. CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken at least day as required by Health Department. Free Chlorine 1.0 - 3.0, pH 7.2 - 7.8, Bromine 42.0 -times a6.0, Total Alkalinity 50 - 150 p.p.m. and Combined Chlorine less than 2 p.p.m. are required once a day. ,^ SKIMMING POOL: Cl = pH c� T.A. _ /Q Q 0 Combined Cl = SWIMMING POOL: Cl = pH = T.A. = Combined Cl WHIRLPOOL: Cl = pH = T.A. = Combined Cl = WADING POOL: CI = pH = T.A. = Combined Cl = 6403. TESTING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. 01<14. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. A1T715• WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. Af46. WHIRLPOOLS: Quality of the water shall be the same as swimming pools and shall be equipped with a thermometer and a time instrument for the use of bathers. 6(17, ENCLOSURE: 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 also be restricted in a similar manner. Pool entrances and exits to be locked during non-operating hours. 18. CLOSURE: Operator to close pool when water does not meet the requirements of this code. Operator understands their responsibilities in regards to operating a public/semi-public swimming pool. NOTES: /11 J 7C2.46—X' r (- PERSON INTERVIEWED~ 1 P(IOL 10/96 SAF 2iY SIGNS AND EQUIPMENT Signs to be posted at the pool include: * All persons are required to take a cleansing shower before entering the pool. ' No person with a communicable disease is allowed to use the pool. * No bather shall wear a bathing suit that is unclean. * NO person suffering fran a cough, cold, inflammation of the eyes. nasal or ear d=scharges, o: any •:tro! communicable disease shall be allowed to use the pool. * No person with sores or other evidence of skin disease, or who is wearing a bandage or n idicai covering 01 any kind, shall be allowed use of the pool. * No person shall spit or in any other way contaminate the pool, or its floors, walkways, aisles, or dressing rooms. * No glass containers shall be permitted in the pool or on walkways within 8 feet of the pool. ' No person shall bring or throw into the pool any object that may in any way carry contamination or endanger the safety of the bathers. 2. Lifeguards and operators must enforce the rules noted on the above-signs. 3. A shephards crook or reaching pole with a minimum handle length that extends greater than 15 feet „ast be orot ided for each 2,000 sq. ft. of water surface area (MGL, c140, s206). 4. One Ring Buoy or Rescue Tube with a }" polyethelene ropy attached, no less in length than 14 the width of the pow . If the pool has lifeguards, a rescue tube must be located at each station. 5. Emergency communication equipment must be available for reaching amergency response persons. Appropriate teleph r:c numbers and directions for the use of the equipment must be posted. 6. There ,nest be an appropriately equipped first aid kit. Public pools oust have a room designed and equipper for emergency care of sick and injured bathers. 7. Whirlpool - Must be drained every 30 days and scrubbed and disinfected. FIRST AID KIT 35 1" Band-Aids 10 3" x 3" sterile gauze pads 2 5" x 5' surgipads 1 8" x 10' surgipad 1 2" soft roller bandage 2 3' so.it roller bandages 1 roll 1/2' hypoallergenic tape 1 triangular bandage 1 scissors rescue blanket 12 antiseptic wipes 2 disposable instant ice packs sterile isotonic buffered eye wash 2 pair one size-fits-ail latex gloves 1 microshield or pocket mask with a one way valve FOOL. Inns hogs mist be kept each day the pool is in operation. Test for: Free Chlorine 4X/day Combined Chlorine 1X/day lei 4Xlday Total Alkalinity 1X/day Also note on the log: Clarity Good/Average/Poor Chlorinator On/Off Chlorinator Setting Low/Medium/High or 1/2/3. etc. Weather Sunny/Cloudy, etc. Air Temperature Bather Load Chemicals Added Any Other Actions Taken Initials of Tester ADdIN IS1RAT 1U4 POOL CLOSURE IT IS THE RESPONSIBILITY OF THE FOOL., OPE1lAT(R TO CLOSE THE POOL WHEN ANY OF T1IE CHEMICAL, PHYSICAL OR SAFETY SCANDiUd` ARE NUT MET, OR FOR ANY OTHER REASON THAT WOULD MAKE POOL USE UNSAFE. USE (XXI) JUDGEMENT!!! ERR ON THE SIDE OF SAW in compliance with WI 140.246, when closing your outdoor inground swimming pool fur the season, pools oust be drained and remain dry throughout closure time, or covered within seven (7) days of closing. POOL OPENING In the event that your pools have been closed for the season, all swimming, wading and whirlpools are to be inspected by the Health Department prior to opening. Prior to calling for an inspection appointment, a water sample from each pool and whirlpool ;mast tie. -',u)n tied fir testr tor coliforrn and pseudemooas by an independent lab. Lab results oust be submitted prior to inspection and opening.