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HomeMy WebLinkAboutApp-License-Certifications-Inspections The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-23-1995 Issue Date: 01/03/2023 Mailing Address: Location Address: EOS HOSPITALITY 39 TODD RD BLUE ROCK CLUB SOUTH YARMOUTH. MA 02664 39 TODD ROAD SOUTH YARMOUTH, MA 02664 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. Board Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman Of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston Bruce G. Murp , MPH, R.S. CHO/J s G. Gardiner Health Director/Assistant alth Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Lodging License Number: BOHL-23-1997 Issue Date: 01/03/2023 Mailing Address: Location Address: EOS HOSPITALITY 39 TODD RD BLUE ROCK CLUB SOUTH YARMOUTH. MA 02664 39 TODD ROAD SOUTH YARMOUTH, MA 02664 IS HEREBY GRANTED A 2023 LICENSE TO OPERATE: Motel This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2023 unless sooner suspended or revoked and is not transferable. Board Hillard Boskey, M.D.,Chairman Mary Craig,Vice Chairman Of Charles T. Holway,Clerk Debra Bruinooge Health Eric Weston ruse G. Murphy, MPH, R.S., C O/Ja G. Gardiner .00) Health Director/Assistant Hea th Director TOWN OF YARMOUTH BOARD OF HEALTH APPLICATION FOR LICENSE/PERMIT-2023 OEC 5 2022 Please complete form and attach all necessary documents by December 18,2022. Failure to do so will result in the return of your application packet. ESTABLISHMENT NAME: Olt �.� AA•AY TAX ID: 7- 2 i I `�`,69,Co LOCATION ADDRESS: .V i d "-1( S MO ijTh TEL.#: ,$OS 31 oZ9 MAILING ADDRESS: E-MAIL ADDRESS: t'cicc�yh y1, j�sick,y *r€soct5'Gor� Item OWNER NAME: IOS ." 1# F CORPORATION NAMER APPLICABLE): MANAGER'S NAME: av, Q'Lou h{,r► TEL.#: SD Fr .2.17 q`i 1 1 MAILING ADDRESS: POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Onnro*...- - ------ `ly State law. Please list the designated Pool Operator? c� f1-, Soo za_ Pool operators I in standard First Aid and Community Cardiopulmonai • premises at all times. Please list the employees beloi Health Department will not use past years records. ur place of business. 1. 1.4 rn be L LA 3. FOOD PROTEC All food service employee who is certified as a Food Protection Manai Establishments, 105 CMR 590.000. Please attach cop tent will not use past years'records. You must provit 1. PERSON IN CHARGE: Each food establishment must have at least one Person In Charge(PIC)on site during hours of operation. 1. 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 provide new copies and maintain a file at your establishment. 1. 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 new copies and maintain a file at your place of business. 1. 2. 3. 4. RESTAURANT SEATING: TOTAL# OFFICE USE ONLY LODGING: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# INN $55 CAMP $55 / MOTEL $110 z S WINNING POOL$l l0ea. —LODGE $55 _TRAILER PARK $105 *WHIRLPOOL $110ea. FOOD SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# .41_0-100 SEATS $125 CONTINENTAL $35 NON-PROFIT $30_ >I00 SEATS $20000MMON 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= $ /j i) rte. *****PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** ADMINISTRATION 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 ATTACHED Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES l.7 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.yarmouth.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:l't Violation a fine of$1,000.00 shall be imposed,2°d Violation within 36 months of 1't 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 pool(i.e.,painting,new equipment,ect.),Must be reported to and approved b the oard of Health to commencement. Renovations may require a MA engineer site plan. DATE: I ), /S a,D— SIGNATURE: i PRINT NAM &TITLE:/ZA t CI L c' c,l-t `i .1 IA inn?,,� Rev.10/11/2022 Form s_ I Print C -.% 7'hP Cnmmonwea!th of Massachusetts , , Department of Industrial Accidents Office of Investigations 1_ 1 Congress Street, Suite 100 471 Boston, MA 02114-2017 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: .1101 cD cK R e.scc \--- Address: 3°'‘ Toll 1\01 itCity/State/Zip: 5 yac,tr, vJ Phone #: Are you an employer? Check the appropriate box: Business Type(required): 1.❑ I am a employer with I 'ram employees (full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. n Office and/or Sales(incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] $• El 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]** 4.ElWe are a non-profit organization, staffed by volunteers, 11.❑ Health Care with no employees. [No workers' comp. insurance req.] 12.0 Other *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'compensation insurance for my employees. Below is the policy information. Insurance Company Name: L..)c i L h 111s i.,C C a Co 1 part 1/41 Insurer's Address: i'a`'I9 z`;c, t_ r1 •s. al City/State/Zip: S L \ a u M b u ; : I L Go I '1 (e, Policy#or Self-ins. Lic. # W e- I $5 $OO (') t Expiration Date: 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 certify, under the ains and penalties of perjury that the information provided above is tru and correct. Signature: O Date: t a I i S a. Phone#: 5'0 ') * C QI(o e 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 •• Qa..1, :n`z, F\l' 00', • (---7., 1 .L - -• ,,... r•-11 f , ( JI i .' II, i- A 1\ (L...: 1 1*-,-, i / li--1,..-.f,N7 !\ , ..x k ---% N11T I' 1 1-4 k...., . 1. la...., ......1 ( j , i_, .1! 1 ' \ rin, ) ‘, r,:\ ‘ 71 -.,v •110\ , c. ru , ,, ,,,, , , , . , , ,, ,, im g, ,. ..,,, 7 .-- 4.."' EM,P L„‘k.) f 14E! :::).' '..: 1.'"'...- Vf EN1P t ( i TY I-4 F S ___..._ _,,,, ,,....,„ :„....., , ... my, , „ ki. l'IL if 9 c --1 — i,m1,,, 7 - I1 ett s 4 i A.., L.,,corin.w11 vki La.b...n. ol. Ivic,.2i,sat.„,i1„.1,t5 ,.., , ,, ....4.. T I r '•,' ) , -DEP A.RINIENT OF -11''',1JilL S I tdAt.., ACCIDENT S LAFP',YETTE CITY CENTER, 2 AVE NIL E DE LAFAYETTE, BOSTON,, MA 02111 (6 1 3c) 727-490C: -- VinVW.rnass.govidta As required by v..assa.chusets General. Law. Chapter 152, Sections 21, 22 & 30,:this will give you notice that I ohm have provided for payment to our irjued employees ander the above-mentioned chapter by it:mar:11g with: .. . , ,,i•T'!al, 17,4.11i Zug' :!.11 ,Ils u ranc la ttL ohm pari! NAME OF INSUl;LANCE COMPANY 12 OS) 'aid c h 1,AI'av, :ff challnriburcl IL 60/96-587o . ADDRESS OF liNSURANCE COMPANY IN C 11&-a53Q.!110,-;.ri 13(1J2(11122 to6i1/2023 - — ------------ POLICY NI..1.113ER EFFECTIVE DAZES 'I7Ipee A'Illi F,'i If 1 ce Center. :355f.. Aon Riiiik. :'A !AfF'D(!7:5, irK; •!!iht,iirl'ta, E RI 2E 4044421007 NAME OF IlsESCR.ANCE AGENT ADDRESS . PHONE# S. SHORE i:Vit casis LIU:: IP DS '14lISPITA JT'if LILL. 3C. ..6T1.1, '1'AR ildOUTli, MA u2664 — -- EMPLCYER ADDRESS Oasis ...P:1:1:1F I:1-.1'111C; '.1-110SPrf.A1,..11977 i...LC 111712021 _ . EMPLOYER'S WORKERS' COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above::v riled insurer is requared in casv., 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 provisicns yl•the Workers Compensation Act. A copy of the Fist Report of Injury must be given to the injured emphyee. The en:ployee may select [1d3 or her,own.physician. The reasonable cost of the ser- vices ptovld,xl by the treatang physician will be paid by the insurer, if the treatment is necessary and reasonably c3: nected to tie work related injury. In cases requiring hospital attention, employees are hereby notifies :hat the insurer has aiTanged for E;uch attention at the irt a ro 1,:l'ilalig!,17WV., diEV 91"! _ _ ___ _______ NAME, OF 710:3P1TAL ,OSTIN3 LOCA 1.10h:rEOS 1-103P ITAL.TY] S SHO''1E D .SCUM YARMOUTH.MA 02,i6:, ADDRESS ___ :Inc,- Ar•V't 7-9-1 rit EmERGENcyCARE SAFETYINSTITUTE & Certificate of Completion The Education Center, below, verifies that Ryan O'Loughlin has successfully completed the knowledge and skill evaluations for the Emergency Care & Safety Institute Course. Adult,Child,Infant CPR&AED/Standard April 10.2023 April 10.2025 D3CRJ6F9EPT3 First Aid Course Name Course Completion Date Recommended Renewal Date Student Authorization Number Cape Cod CPR&First Aid Training 508-364-4750 Pamela Ciborowski WBU7HO03WW0 Education Center Education Center Phone Number Instructor Name Instructor ID Number info@CapeCPR.com This certificate does not guarantee any future performance or suggest any form of licensure. Skills deteriorate rapidly when not Education Center Email used. Periodic retraining is strongly recommended. �s Student Authorization#: D3CRJ6F9EPT3 Cut along the dotted line at the bottom of V at" tr.4. ° � awl Education Center: Cape Cod CPR&First Aid Training the certificate and along the dotted lines around 4• .r .:. x • ' Education Center Email: info@CapeCPR.com the course completion card. Fold the card in half. Course: Adult,Child,Infant CPR&AED/Standard First Aid Education Center Phone#: 508-364-4750 Instructor Name: Pamela Ciborowski Name: Ryan O'Loughlin Instructor ID#: WBU7H003WW0 The Education Center verifies that the above has successfully The ECSI course meets the most current international consensus guidelines on completed the knowledge and skill evaluations for the cardiopulmonary resuscitation(CPR)and emergency cardiac care(ECC) Emergency Care&Safety Institute Course. To verify course completion.visit www.ECSlnstitute.org April 10,2023 April 10,2025 and enter the above student authorization number. Course Completion Date Recommended Renewal Date ECSI Phone Number:(800)71-ORANGE www.ECSlnstitute.org American College of AAOS } Emergency Physicians EMERGENCY CARE P.SAiETY INSTITUTE JANCNG 6WHG61,CY CAGE .__ - .. ",.. EMERGENCY CARE & SAFETY INSTITUTE Certificate of Completion The Education Center, below, verifies that Gina Piscillo has successfully completed the knowledge and skill evaluations for the Emergency Care & Safety Institute Course. Adult,Child,Infant CPR&AED/Standard April 10,2023 April 10,2025 JDXUVC4ALDZV First Aid Course Name Course Completion Date Recommended Renewal Date Student Authorization Number Cape Cod CPR&First Aid Training 508-364-4750 Pamela Ciborowski WBU7H003WVV0 Education Center Education Center Phone Number Instructor Name Instructor ID Number info@CapeCPR.com This certificate does not guarantee any future performance or suggest any form of licensure Skills deteriorate rapidly when not Education Center Email used. Periodic retraining is strongly recommended. SCSI 1( Student Authorization#: JDXUVC4ALDZV Cut along the dotted line at the bottom of ' 1� ! Education Center: Cape Cod CPR&First Aid Training the certificate and along the dotted lines around Education Center Email: info@CapeCPR.com the course completion card Fold the card in half. Course: Adult.Child,Infant CPR&AED I Standard First Aid Education Center Phone#: 508-364-4750 Name: Gina Piscillo Instructor Name: Pamela Ciborowski Instructor ID#: WBU7H003WVV0 The Education Center verifies that the above has successfully SCSI course meets the most current international consensus guidelines on completed the knowledge and skill evaluations for the Emergency Care&Safety Institute Course. cardiopulmonary resuscitation(CPR)and emergency cardiac care(ECC). April 10,2023 April 10,2025 To verily course completion,visit AWN ECSlnstitute.oro and enter he above student authorization number. Course Completion Date Recommended Renewal Date ECSI Phone Number:(800)71-ORANGE • • ServSafe National Restaurant Association T« { CE Rh FI CATICJ N JANICE COPLEY for successfully completing the standards set forth for the ServSafee Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute(ANSI)-Conference for Food Protection (CFP). 19097250 5473 CERTIFICATE NUMBER EXAM FORM NUMBER 3/9/2020 3/9/2025 DATE OF EXAMINATION DATE OF EXPIRATION I ` Local laws apply. Check with your local regulatory agency for recertification requirements11,51 ACCREDITED PROGRAM American National Stimulants trOtlhAe „and.Dl0Cisofim ite for Food Protection ® =`0655 Sherman Brown Executive Vice President, National Restaurant Association Solutions .ri;4:13 01 In accordance-nth Mantime Labour Convention 2006,Reguution ADM N 068-2013(Regulation 3.2,Standard A3.21 8)2017 National Restaurant Association Educational Foundation(NRAEF)All rights reserved,ServSafe©and the ServSafe logo are trademarks d the NRAEF National Restaurant Association®and the arc design are trademarks of the National Restaurant Association This document oamot be reproduced or altered. 17110811 171 1 Contact us with questions at 233 S Wacker Drive Suite 3600,Chicago It 60606-6383 a ServSafe@restaurant org • )) ServSafe National Restaurant Association ServSofe® CERTIFICATION GINA PISCILLO for successfully completing the standards set forth for the ServSafe®Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute(ANSI)—Conference for Food Protection (CFP). • 19836343 5481 CERTIFICATE NUMBER EXAM FORM NUMBER 9/24/2020 9/24/2025 DATE OF EXAMINATION DATE OF EXPIRATION /� Local laws apply.Check with your local regulatory agency for recertification requirements. ANSI I iii r ACCREDITED.PROGRAM American National Standards Institute and the Conference for Food Protection-",,, #0555 Sherman Brown Executive Vice President, National Restaurant Association Solutions p .- p In occordancc with Maritime Labour Convention 2006.Resolution ADM N 068-2013(Regulation 3.2,Standard A3 2) (02017 National Restaurant Association Educational Foundation(NRAEF).All rights reserved.ServSafe®and thr ServSafe logo ore trademarks of the NRAEF National Restaurant Association®and the arc design are trademarks of the National Restaurant Association This document cannot be reproduced or altered. 17110811 v 1711 Contact us with questions at 233 S Wacker Drive,Suite 3600,Chicago,IL 60606-6383 or ServSafe@restaurant.org OSHA 34-702045532 I�raH G GALLAGHER a T and Nest.pCmlMaLnlu� This card kn ied^aSI ethe It.lilt 1 :ces>tull....-�',.ta - 10-hour General Industry Safety and Health DIRECT RESPONSES TO: This card issued to GINA PISCILLO Rick Grobart 02/23/2021 Gallagher Bassett RICHARD GROBART 737 W. Washington, Ste. 2207 Date of Issue Trainer Name Chicago IL 60661 Direct: 847/250-6887 Ms. Gina Piscillo Red Jacket Resorts/Davenport Realty 39 Todd Rd. South Yarmouth MA 02664 RE: OSHA 10-Hour General Industry Training Online Class Dear Ms. Piscillo: Enclosed you will find your OSHA 10 Hour card, for your attendance and completion of the above- mentioned class. This course was designed for managers, supervisors, and employees who are responsible for on- the-job safety and health and work practices that comply with OSHA regulations. Topics included: ➢ OSHA-The OSH Act; General Duty clause; OSHA's most frequently cited violations. penalties and appeals ➢ Walking and working surfaces ➢ Fire safety and means of egress ➢ Occupational noise exposure ➢ Personal protective equipment ➢ Risk Management/Pandemic Response ➢ Lockout/Tagout ➢ Machinery and machine guarding ➢ Electrical safety ➢ Hazard communication It was a pleasure providing this loss control service. If you have any questions relating to this service, or any safety related issue I can assist with, please feel free to contact me at your convenience. Sincerely, " '1 Rick Grobart Loss Control Consultant The information contained in this report was obtained from sources which to the best of the writers knowledge are authentic and reliable.Gallagher Bassett makes no guarantee of results,and assumes no liability in connection with either the information herein contained.or the safety suggestions herein made.Moreover,rt cannot be assumed that every acceptable safety procedure is contained herein,or that abnormal or unusual circumstances may not warrant or require further or additional procedures. 2850 GOLF ROAD ROLLING MEADOWS, IL 60008-4050 0 630.773.3800 F 630.285.4000 www.gallagherbassett.com a EMERGENCY CARE & SAFETY INSTITUTE Certificate of Completion The Education Center, below, verifies that Robert Curley has successfully completed the knowledge and skill evaluations for the Emergency Care & Safety Institute Course. Adult,Child,Infant CPR&AED/Standard April 10,2023 Apr l 10,2025 OSOV5E52ODDD First Aid Course Name Course Completion Date Recommended Renewal Date Student Authorization Number Cape Cod CPR&First Aid Training 508-364 4750 Pamela Ciborowski WBU7H003WW0 Education Center Education Center Phone Number Instructor Name Instructor ID Number info@capecpr.com This certificate does not guarantee any future performance or suggest any form of licensure.Skills deteriorate rapidly when not Education Center Email used. Periodic retraining is strongly recommended. f Student Authorization#: OSOV5E52ODDD Cut along the dotted line at the bottom of Education Center: Cape Cod CPR&First Aid Training the certificate and along the dotted lines around Education Center Email: info@capecpr.com the course completion card. Fold the card in half. Course: Adult,Child,Infant CPR&AED/Standard First Aid Education Center Phone#: 508-364-4750 Instructor Name: Pamela Ciborowski Name: Robert Curley 1 '..-,:or;,,,,i` tyk g sa. S i'Pk4§r,, A n T;. tom; ri N BFY `4 ,'i 2 ID .bs b' `T 1' O T MP Cit. (D O . o a)3 0rt O co N () X rt o N r2r � 02 11 o- O n O0rii : g.� . = (v-r rrt. Ry O "� i C O s' `� 2 ;11111P_I D CT 0 rt lD ((D N !. N 0 ➢°° O o 7 cn c) cow -11 C rt• c CI) .,,„:,,, ..,?; Q E.0o0 N)Nao, 3liii m e _ C to W Q= 0 � In 5 m Ir 0 b m ID 0 NaS cn MIC fei _. _• Q0Ti (1) 2 - � a rt (p 2 r-t- c- Qo m = O () n D re, m . ` ,, -ok /174`1-7 r3 I IqGC-vc 1\AL:t Mc-r LIPI/P.5 /0,)-Y\T". //414 LA:1 Lit) ,frAM-- ge) /7(. pCcce / 6felca 1-015. r ?,1404 4--m1 '36° F.- 67:1-7 /1/1e- / Fr /O`i •, -if a I /ip # 11 0 _ ( THE CU,ft&INVFALTH OF MASSACHUSETTS TOWN OF YARMOU H HEALTH DEPARTMENT POOL INSPECTION RAT / NAME ' • Y'o cj DATE �/ 1/// o � ADDRESS 39 �� � i 7 / TELEPHONE UNUMER OPERATOR RC/23 Ci PERMIT POSTED # 1 J 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. 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. 4' 3. CERTIFIED POOL OPERATORS: 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. 5- -(- � Gk� fu/ ( 60 4. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2,000 sq. ft. water surface. One pool divider for shallow end with floatation buoys. O c 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 comrunication (no+ pay station). t r re .E- Si' /'/-) to 'Le s 1-0-o+ (.c- ,751^ $ CS CS<Th 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. • L 5-19 f'"7 /5 sr. S (Joe:8• DEPTH MARKINGS: Must be clearly m rked 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. N/A9. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound no splinters or cracks, non slip surface. Not over 10 feet above water level and at least 13 feet unobstructed head room. 7Z54.0. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. 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. 6,/10/,✓ 12. 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 42.0me-s a6.00, Total Alkalinity50 - 150 - p.p.m. and Carbined Chlorine less than 2p.p.m. are required once a day. SWIMMING POOL: Cl = '. (,j PH = --/ T.A. _ 00 Combined Cl = SWIMMING POOL: CI = pH = T.A. _ Combined CI = WHIRLPOOL: CI = pH = T.A. = Combined CI = WADING POOL: Cl = pH = T.A. = Combined Cl = 0413. TESTING EQUIPMENT: Testingequipment provided, in good repair and complete with fresh reagents. A-cs. 1r c ,ti{ 644. WATER CLARITY: A 6 inch black disc at bottan of deepest part of 001 visable at 10 yards away. 4415. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. 716. 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. (K17. 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 II!! non-operating hours. OK18. 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: 1 7 PERSON INTERVIIINID F(lOL i' 10/96