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HomeMy WebLinkAbout2023 Inspections (2) The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-1015-08 Issue Date: 1/1/2023 Mailing Address: Location Address: HOLLY TREE CONDOMINIUM TRUST 412 ROUTE 28 HOLLY TREE RESORT WEST YARMOUTH.MA 02673 31 FLINTLOCK WAY YARMOUTHPORT,MA 02675 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 WHIRLPOOL/VAPOR BATH Board Hillard Boskey,M.D.,Chairman Mary Craig, Vice Chairman of Charles T. Holway,Clerk Debra Bruinooge Health Eric Weston Bru .Murphy,MPH, S.,CH James G.Gardiner Health Director/Assistant ealth Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Lodging License Number: BOHL-15-1012-08 Issue Date: 1/1/2023 Mailing Address: Location Address: HOLLY TREE CONDOMINIUM TRUST 412 ROUTE 28 HOLLY TREE RESORT WEST YARMOUTH.MA 02673 31 FLINTLOCK WAY YARMOUTHPORT, MA 02675 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 BUILDING A - 76 UNITS BUILDING B- 8 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,R.S ,CH ames G.Gardiner Health Director/Ass stant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-1013-08 Issue Date: 1/1/2023 Mailing Address: Location Address: HOLLY TREE CONDOMINIUM TRUST 412 ROUTE 28 HOLLY TREE RESORT WEST YARMOUTH.MA 02673 31 FLINTLOCK WAY YARMOUTHPORT, MA 02675 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,MP R.S., /James G.Gardiner Now Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-1014-08 Issue Date: 1/1/2023 Mailing Address: Location Address: HOLLY TREE CONDOMINIUM TRUST 412 ROUTE 28 HOLLY TREE RESORT WEST YARMOUTH. MA 02673 31 FLINTLOCK WAY YARMOUTHPORT, MA 02675 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 (s)--)ai - Bruce G. Murphy,MPH,R. , CH / ames G.Gardiner Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-23-3538 Issue Date: Mailing Address: Location Address: HOLLY TREE 412 ROUTE 28 412 ROUTE 28 WEST YARMOUTH. MA 02673 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 KIDDIE 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 .,CHO amen G. Gardiner Health Director/Assistant Health Director •` TOWN OF YARMOUTH BOARD OF HEALTH :F(1517607oDi23 �`' 1"i APPLICATION FOR LICENSE/PERMIT -2023�1�1 _ � * Please complete form and attach all necessary documents by December Failure to do so will result in the return of your application packet. HEALTH DEPT. ESTABLISHMENT NAME: :Nvl. L- .t -' i_- TAX ID: LOCATION ADDRESS: 4-1 Z v J r S T \AD TEL.#: -7 i Co ce - -1 MAILING ADDRESS: •i &NIL E-MAIL ADDRESS: 13 c - ' M O c oxD ' (_-0 c/`----- OWNER NAME: \_v-\__ T 1 5 t CORPORATION NAME (IF APPLICABLE): St- MANAGER'S NAME: \ (L= 1 Ol t�k-4_,JI�c„OV TEL.#: `1 [ \ CoC���-- MAILING ADDRESS: 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. 1 mo ouz_ 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 1. (A n(-5 I_ ,�if f— � 2. C-Ql- c..— tM V c Q v1 1,_ 3. iM-- TZ L.)1c(Anil \ 4. FOOD PROTECTION MANAGE S - CERTIFICATIONS: All food service establishments eq ' -d to have at least one full-time employee who is certified as a Food Protection Manager, as de v • i t S Sanitary Code for Food Service Establishments, 105 CMR 590.000. Please attach copies of certi c. '•, t' . s ation. The Health Department will not use past years'records. You must provide new co• •s a 1 d a . • a file at your establishment. — -- PERSON IN CHARGE: Each food establishment must have I st • k er •n In Charge (PIC) on site during hours of operation. 1. 2. ALLERGEN CERTIFICATIONS: All food service establishments are required t ave . -ast • • full-time employee who has Allergen certification, as defined in the State Sanitary Code for Food rvi - , • ishments, 105 CMR 590.009(G)(3)(a). Please attach copies of certification to this applicati e. • 1 artment will not use past years' records. You must provide new copies and maintain aiNk o e ,bh hment. 1. 2. HEIMLICH CERTIFICATIONS: All food service establishments with 25 seats or re must have at least one employee trained in the Heimlich Maneuver on the premises at all times. Please 1 loyees trained in anti-choking procedures below and attach copies of employee certifications to is fo Department will not use past years' records. You must provide new copies and main a e t ace 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# B&B $55 CABIN $55 MOTEL $110 —INN $55 —CAMP $55 SWIMMING POOL$110ea. —LODGE $55 TRAILER PARK $105 WHIRLPOOL $110ea. FOOD SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# 0-100 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 /1� NAME CHANGE: $15 Amount Due = $ V *****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 COMP ATION 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 t newal 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 col orm and standard plate count by a State certified lab, and submitted to the Health Department three(3)days prior to opening, and quarterly thereafter. 0 POOL CLOSING: Every outdoor in ground swimming pool must be draiu,e or covered within seven(7)days of closing. FOOD SERVICE SEASONAL FOOD SERVICE OPENING: All food service establishments must be inspected by the Health Departmenteprior to opening. Please contact the Health Department to schedule the inspection three(3)days prior to opening." e. CATERING POLICY: . Anyone who caters within the Town of Yarmouth must notify the \ mouth Health Department by filing the required "1 Temporary Food Service Application form 72 hours prior to the catered event.''Thew 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 o enfig and monthly thereafter,with sample results submitted to the Health Department. Failure to do so will result in the suspel1ion or revocdrion of your Frozen Dessert Permit until the above terms have been met. t: 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: 1st 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 pool painting,new equipment,ect.), Must be reported to and approved by the Board of Health to commencement Re ` ati. I s " r u1ke a ►�i A engineer site plan. DATE: 2i t ( \ �j SIGNATURE: :��� n'", PRINT NAME& TITLE: � � ' '` Rev. 10/11/2022 A ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/01/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Diane Carmain NAME: The Armstrong Company Insurance Consultants PHONE (310)530-0099 FAX (310)530-0098 (A/C,No,Ext): (A/C,No): 2780 Skypark Dr,Ste 440 E-MAIL dcarmain@armstronginsco.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC ft Torrance CA 90505 INSURER A: Employers Preferred Insurance Company 10346 INSURED INSURER B: Holly Tree Condominium Trust INSURER C: 412 Main Street,Route 28 INSURER D: INSURER E: West Yarmouth MA 02673 INSURER F COVERAGES CERTIFICATE NUMBER: 22/23 WC Only REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY RE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ID SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X MUTE EMPLOYERS'LIABILITY STATUTE ER Y(N 1 A ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA EIG494051400 04/01/2022 04/01/2023 E.L.EACH ACCIDENT $ , , OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. Health Department-Hazmat Ren AUTHORIZED REPRESENTATIVE 1146 Route 28 South Yarmouth MA 02664 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r 1 'Ark\ CPO CERTIFIED POOL &SPA OPERATOR" Pool&Hot Tub Professionals ASSOC. Certified Pool & Spa Operator Certification for ,Jacob T. Mourhess as an Operator of Aquatic Facilities issued by the Pool & Hot Tub Alliance on Certification Date: May 14,2020 Expiration Date: May 14,2025 Certification Number: pntn42y Instructor Name(s) i „(] I Tracy Phoenix Blakely • • Sabeena Hickman,CAE President&CEO POOL411116 Pool&Hot Tub Alliance. HOT TUB ALLIANCE .. t dr . . .. . ..awaecrudi4tl aa`. n"- - For verification,telephone PHTA at 719-540-9119 or email servicei vphta.org HEARTSAVER Heartsaver® American First Aid CPR AED Heart Association. Chris Leavell 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: Exam, Child CPR AED, Infant CPR Issue Date Renew By 2/9/2021 02/2023 Training Center Name Instructor Name Sylvester Consultants, Inc. Andrew Kleamenakis Training Center ID Instructor ID 11070600905 MA20132 Training Center City, State eCard Code 206003945674 Hyannis, MA Training Center Phone QR Code Number o: (508)7/1-8700 , 0 To view or verify authenticity,students and employers should scan this QR code with their mobile device or go to www.heart.org/cpr/mycards. ©2020 American Heart Association.All rights reserved. 15-3002 R3/20 HEARTSAVER 011% Heartsaver® American First Aid CPR AED Heart Association. Jacob Mourhess 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: Exam, Child CPR AED, Infant CPR Issue Date Renew By 2/9/2021 02/2023 Training Center Name Instructor Name Sylvester Consultants, Inc. Andrew Kleamenakis Instructor ID Training Center ID 11070600905 MA20132 eCard Code Training Center City, State 206003945675 Hyannis, MA Training Center Phone OR Code Number (508)771-8700 � n +'i i To view or verify authenticity,students and employers should scan this QR code with their mobile device or go to www.heart.org/cpr/mycards. ©2020 American Heart Association.All rights reserved. 15-3002 R3/20 www.capecodsatetytraining.com �.o Sq, NSC First Aid Course a .r 2 < Na0°°cw"`‘ OSHA 1910.151 °.me: Chris Leavell Security Control No. Address: Holly Tree 21 3 49 Ci Address: 412 MA-28 City, State, Zip: West Yarmouth, MA 02673 Course Completion Date: 02/08/2023 Training Center: Cape Cod Safety Training Expiration Date: 02/0812025 Instructor Name: Rick Todd Instructor Number: 1040918 Chris Leavell has successfully completed the NSC First Aid Course. The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining THIS DOCUMENT IS VOID IF REPRODUCED i- .Lt 1 / ?0?3 HEALTH DEPT. ,�,,,... Security Control No. o��+. .101 213 Q. 5 9 M Chris Leavell =oi has completed the uuuNe, NSC First Aid Coursi9SHA 1910.15f We want your feedback! Training Center: Cape Cod Safety Training Please visit nsc.org/firstaidevaluation to Completion Date: 0210812023 take a brief survey and share your opinions Expires: 02108/2025 Instructional Hours: about the NSC course you completed. __ #1040918 Instructor Signature Instructor No. ,NSC-in it for life' nsc.org/fatrainin) Keep this card for your records.Void if reproduced. 30M04012020 1015 900008129©2016 National Satety Council 79173-0000 i www.capecodsafetytraining.com gip` s9Cr 1ph, � NSC First Aid Course Z 1,,,, coo"c,�:11: OSHA 1910.151 Name: Craig Murphy Security Control No. Address: Holly Tree 213458 Address: 412 MA-28 City, State, Zip: West Yarmouth, MA 02673 Course Completion Date: 0210812023 Training Center: Cape Cod Safety Training Expiration Date: 0210812025 Instructor Name: Rick Todd Instructor Number: 1040918 Craig Murphy has successfully completed the NSC First Aid Course. The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining THIS DOCUMENT IS VOID IF REPRODUCED e."sL Security Control No. • i < 2 1? 4 5 9 �s Craig Murphy s has completed the Ewe NSC First Aid C.oursSHA 1910.151 want your feedback! Training Center: Cape Cod SafetyTraining Please visit nsc.org/firstaidevaluation to Completion Date: 0210812023 take a brief survey and share your opinons Expires: 0210812025 Instructional Hours: about the NSC course you completed #1040918�+ Instructor Signature Instructor No. SC NSC-in it for life: nsc.org/fatraining� Keep this card for your records.Void if reproduced. - 30M04012020 1015 900008129 ©2016 National Safety Council 79173-0000 , www.capecodsafetytraining.com i•°gyp` s9� NSC First Aid Course ai 1::: .4 2 v c0— ° OSHA 1910.151 Name: Jacob Mourhess Security Control No. Address: Holly Tree 213457 Address: 412 MA-28 City, State, Zip: West Yarmouth, MA 02673 Course Completion Date: 02108/2023 Training Center: Cape Cod Safety Training Expiration Date: 0210812025 Instructor Name: Rick Todd Instructor Number: 1040918 Jacob Mourhess has successfully completed the NSC First Aid Course. The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining THIS DOCUMENT IS VOID IF REPRODUCED Ea 1 7 2023 HEALTH DEPT. r °or"J, Security Control No, 0 213457 0,..,a. or" Jacob Mourhess "° ll has completed the °""`� NSC First Aid CoursOSHA 1910.151 We want your feedback! Training Center: Cape Cod Safety Training Please visit nsc.org/firstaidevaluation to Completion Date: 0210812023 take a brief survey and share your opinions Expires: 0210812025 Instructional Hours: about the NSC course you completed. ,---:-, #1040918 t-- ja--'7 Instructor Signature Instructor No. NSC-in it for life. nsc.org/fatrainin9} Keep this card for your records.Void if reproduced. 30M04012020 1015 900008129®2015 National Safety Council 79173-0000 www.capecodsafetytraining.com °gyp` Sloe NSC First Aid Course a .4 < coo"c‘® OSHA 1910.151 Name: Mitzy Burchell Security Control No. Address: Holly Tree 213456 Address: 412 MA-28 City, State, Zip: West Yarmouth, MA 02673 Course Completion Date: 02108/2023 Training Center: Cape Cod Safety Training Expiration Date: 02/08/2025 Instructor Name: Rick Todd Instructor Number: 1040918 Mitzy Burchell has successfully completed the NSC First Aid Course. The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining G©GDMCD THIS DOCUMENT IS VOID IF REPRODUCED FEB 1 7 2023 HEALTH DEPT. Security Control No. 456 i "" °°" Mi Burchell 1 �< has completed the NSC First Aid Cours SHA 1910.151 We want your feedback! Training Center: Cape Cod Safety Training Please visit nsc.org/firstaidevaluation to Completion Date: 0210812023 take a brief survey and share your opinions Expires: 0210812025 Instructional Hours: about the NSC course you completed_ #1040918 Instructor Signature Instructor No. \_NSC-in it for life. nsc.org/fatrainin, Keep this card for your records.Void if reproduce,;' 30M04012020 1015 900008129©2016 National Safety Council 79173-0000 i www.capecodsafetytraining.com ® ■ ■ Esc NSC CPR Course National Safety Council Adult, Child, Infant, FBAO & AED Name: Chris Leavell Security Control No. Address: Holly Tree - 9 6 4 9 0 8 Address: 412 MA-28 City, State,Zip: West Yarmouth,MA 02673 Course Completion Date: 0210812023 Training Center: Cape Cod Safety Training Expiration Date: 02/0812025 Instructor Name: Rick Todd Instructor Number: 1040918 Chris Leavell has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECC. ( The National Safety Council is America's leading nonprofit safety advocate.We focus on eliminating the leading causes of preventable injuries and deaths so people can live their fullest lives.We create a culture of safety to not only make people safer at work but also to make people safer beyond the workplace.For more life-saving courses from NSC please visit nsc.org/fatraining THIS DOCUMENT IS VOID IF REPRODUCED FEB 1 7 1023 HEALTH DEPT. ::nsc Security Control No. `��� nsc Chris Leavell 964908 National Safety Council has completed the We want your feedback! NSC CPR Course Adult,Child,Infant FBAO&AED Training Center: Cape Cod Safety Training Please visit nsc.org/firstaidevaluation to Completion Date: 0210812023 take a brief survey and share your opinions Expires: 02108/2025 nstructional Hours: about the NSC course you completed. • �0 #1040918 Instructor Signature Instructor No. Keep this card for your records.Void if reproduced. 79t 7a 0000 50M11092021 ©2020 National Safety Council www.capecodsa.fetytraining.com : nsc NSC CPR Course National Safety Council Adult, Child, Infant, FBAO & AED Name: Jacob Mourhess Security Contra No. Address: Holly Tree 9649 6 4 9 09 Address: 412 MA-28 City, State,Zip: West Yarmouth,MA 02673 Course Completion Date: 02/08/2023 Training Center: Cape Cod Safety Training Expiration Date: 02/08/2025 Instructor Name: Rick Todd Instructor Number: 1040918 Jacob Mourhess has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECC. r 1 The National Safety Council is America's leading nonprofit safety advocate.We focus on eliminating the leading causes of preventable injuries and deaths so people can live their fullest lives.We create a culture of safety to not only make people safer at work but also to make people safer beyond the workplace.For more life-saving courses from NSC please visit nsc.org/fatraining THIS DOCUMENT IS VOID IF REPRODUCED ti 1 7 2023 HEALTH DEPT. ::n sc security contra No. National Sally Cann 964 909 fSc Jacob Mourhess National Safety Council has completed the We want your feedback! NSC CPR Course Adult,Child,Infant FBAO&AED Training Center: Cape Cod Safety Training Please visit nsc.org/firstaidevaluation to Completion Date: 02/08/2023 take a brief survey and share your opinions Expires: 02/0812025 nstructional Hours: about the NSC course you completed. )e..20, #1040918 Instructor Signature Instructor No. Keep this card for your records.Void if reproduced. 50M11092021 ©2020 National Safety Council 79174-0000 4% vww.capecodsafetytraining.com ® ■ nsc NSC CPR Course National Safety Council Adult, Child, Infant, FBAO & AED Name: Craig Murphy Security Control No. Address: Holly Tree 964910 Address: 412 MA-28 City, State,Zip: West Yarmouth,MA 02673 Course Completion Date: 02/08/2023 Training Center: Cape Cod Safety Training Expiration Date: 02/08/2025 Instructor Name: Rick Todd Instructor Number: 1040918 Craig Murphy has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECC. The National Safety Council is America's leading nonprofit safety advocate.We focus on eliminating the leading causes of preventable injuries and deaths so people can live their fullest lives.We create a culture of safety to not only make people safer at work but also to make people safer beyond the workplace.For more life-saving courses from NSC please visit nsc.org/fatraining THIS DOCUMENT IS VOID IF REPRODUCED FEB 1 Z 2023 HEALTH DEPT. ■fa▪ nSC Security Control No. National sn.ty Own. ® :nsC Craig Murphy " 0 4 J 1 Li National Safety Council has completed the We want your feedback! • NSC CPR Course Adult,Child,Infant FBAO&AED Training Center: Cape Cod Safety Training Please visit nsc.org/firstaidevaluation to Completion Date: 02/08/2023 take a brief survey and share your opinionsExPi 02108l2025 Instructional Hours: about the NSC course you completed. £.-r '-'1;-10 eiil #1040918 . Instructor Signature Instructor No. I Keep this card for your records.Void if reproduced. • 50M11092021 ©2020 National Safety Council 79174-0000 r www.capecodsafetytraining.com a . nsc NSC CPR Course National Safety Council Adult, Child, Infant, FBAO & AED Name: Mitzy Burchell Security Control No. Address: Holly Tree _ 964911 Address: 412 MA-281 City, State, Zip: West Yarmouth, MA 02673 Course Completion Date: 02/0812023 Training Center: Cape Cod Safety Training Expiration Date: 02/08/2025 Instructor Name: Rick Todd Instructor Number: 1040918 Mitzy Burchell has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECG. The National Safety Council is America's leading nonprofit safety advocate.We focus on eliminating the leading causes of preventable injuries and deaths so people can live their fullest lives.We create a culture of safety to not only make people safer at work but also to make people safer beyond the workplace. For more life-saving courses from NSC please visit nsc.org/fatraining J THIS DOCUMENT IS VOID IF REPRODUCED • U:nsc Security Controlnt No. wn�r s.rry cw�cx �,✓ •"1' `.J 1 ® �n$�+ Mitzy Burchell National Safety Council has completed the We want your feedback! I NSC CPR Course Adult,Child,Infant FBAO&AED Training Center: Cape Cod Safety Training Please visit nsc.org/firstaidevaluation to Completion Date: 02/08/2023 take a brief survey and share your opinions Expires: 02J08/2025 nstructional Hours: about the NSC course you completed. #1040918 Instructor Signature Instructor No. ,\,, _ ) Keep this card for your records.Void if reproduced. 79174-0000 50M11092021 ©2020 National Safety Council THE OOMAtNYFAL.TH OF P.MSSACHETIS TOWN OF YARNOUTH HEALTH DEPARTMENT C POOL INSPECTION REPORT NAME }�J 1 1 J 1�-Q �j., �"�C.JS C. \' " . DATE F.Ja?5/2_----) ADDRESS '//2- se r 2 ,--. Fl �� TELEPHONE NUMBER OPERATOR -.,) Q /Ya r.,1- Cp;`.71--iD ucXC_. PERMIT POSTED # 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. : '.- '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. "7'+ - (7- 4(4. SAFETY: One she's crook and one risdatitoy with adequate rope for each 2,000 sq. ft. water surface. One pool divider f9r hallow end with floatation buoys. 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 communication (no+ pay station). ( 1�Pr )1G l i i 4e.s _o r- ,(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 met s and pressure ,gauges are requir - 8. DEPTH MARKINGS: Must be learly 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. 14. 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 roam. ` 10. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. (C]r/.1'i. 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. 00( 12. 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, Bromine 2.0 6.0, Total Alkalinity 50 - 150 p.p.m. and Combined Chlorine less than 2 p.p.m. are required once a day. SWIMMING POOL: Cl = I , 41 pH = If T.A. _ /1/49 Combined Cl = C SWIMMING POOL: CI = pH = T.A. = Combined Cl WHIRLPOOL: Cl = pH = T.A. = Combined Cl = WADING POOL: Cl = pH = T.A. = Combined Cl = Cj"113. TESTING EQUIPMENT: Test equipment provided, in good repair and complete with fresh reagents. I CYQ 4. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. , ` el�l5• WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. /`y'//`�6. WHIRLPOOLS: Quality of the water shall be the same as swimming pools and shall be equipped with a thermometer and /T' a time instrument for the use of bathers. i (Y<.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. . 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. N01 : 44e-61000-g4 S Goc ' LX � 'ALIT /-s=� .Q�RM�/�C�t, i�j PER / p l I jcav/ -e 10/96 SAFE IN 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 from a cough, cold, inflarnnation of the eyes. nasal or ear discharges, or an,: 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 B 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 Ili safety of the bathers. 2. Lifeguards and operators must enforce the rules noted on the above-signs. { 3. A shepherds crook or reaching pole with a minimum handle length that extends greater than 15 feet ,oust be provided tor each 2,000 sq. ft. of water surface area (MCL, c140, s20b). { 4. One Ring Buoy or Rescue Tube with a i" polyethelene ropy attached, no less in length than 14 the width of the pool If the pool has lifeguards, a rescue tube mist be located at each station. 5. Emergency communication equipment must be available for reaching urgency response persons. Appropriate t.lethcr:c numbers and directions for the use of the equipment must be posted. b. There rust be an appropriately equipped first aid kit. Public pools must have a roan designed and equipped for emergency care of sick and injured bathers. 7. Whirlpool - Must be drained every 30 days and scrubbed and disinfected. E1RSr AID KIT 35 1" Band-Aids 10 3" x 3' sterile gauze pads 2 5" x 5" surgipads 1 8" x 10' surgipad 2" soft roller bandage 2 3" soft roller bandages 1 roll 1/2' hypoallergenic tape triangular bandage scissors rescue blanket 12 antiseptic wipes 1, disposable instant ice packs 1 sterile isotonic buffered eye wash 2 pair one size-fits--ail latex gloves 1 microshield or pocket mask with a one way vave POOL LAGS Logs must be kept eacn day the pool is in operation. Test for: Free Chlorine 4X/day Combined Chlorine 1X/day uti 4X!day Total Alkalinity 1X/day Also note on the log: Clarity Good/Average/Poor Chlorinator OntOff Chlorinator Setting Low/MediuniHigh or 1/2/3. etc. Weather Sunny/Cloudy, etc. Air Temperature Bather Load Chemicals Added Any Other Actions Taken initials of Tester ADMINISINATION P(X)L CLOSURE 1T IS THE RFS ONSIBILITY Oh' 171E POOL OPERATOR TO CUISF Tlx: POOL WHEN ANY OF WE CHEMICAL, PHYSICAL OR SAFETY STN'O%EI ; ARE N7r MET, OR FOR ANY GIUf]t REASON THAT WOULD MAKE POOL USE UNSAFE. USE ('iI) JLIX*Nfl?1 FR (N THE SIDE OF SAFETY in compliance with 140.206, when closing your outdoor inground swutrn irg pool for the season, pools must be drained a:.d remain dry throughout closure time, or covered within seven (7) days of closing. P(X:L 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 mist he submitted for testing for colitorm and pseudomr,nas by an independent lab. Lab results trust be submitted prior to inspection and opening. THE (XIM&NNFALTH OF ANSSAQIJSEI S TOWN OF YARI,OUIH HEALTH DEpARSID T POOL INSPECTION REPORT r NAME �"fG/ // -tree C- f DATE ✓J 4' / - ADDRESS 7/" �c-• �+�P_ / f TELEPHONE NUMBER / OPERATOR �j,I. e /�jj{ yJG -t�,�l� r Q�-/� PERMIT POSTED # Regulations of the Massachusetts Sanitary Code: Article VI, Minimum Standards for Pools; and Town Amendments to Article VI. I. All items approved on the construction plan are of permanent nature and need not be checked at each inspection. a.A(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. ,��y (/'�' 3. CERTIFIED POOL OPERATORS: Must staff at least two (2) certified operators in First A011, Water Safety, C.P.R., and have one available on the premises during pool operating hours. S-ncit,:q ce- de 4. SAFETY: One shepard crook and one ring buoy with adequate rope for each 2,000 sq. ft. water surface. One/pool dividaor shallow end with floatation buoys. 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 (nos pay station). / F���� Cr ( /" � T C G 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 cater, turnover every 8 hours, maximum filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equipment f 1 padju ble. Flw meters and pressure gauges are re uired. =5- 96c1 -tc./5 S25 w p 6S � �-' `.•+ �' 8. DEPTH MARKINGS: Must-be clearly marked on deck and wall of '��pool. Markings Must be disp aybd for every:Pbot 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. iVp- 9. 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 roam. 1'3110. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. (*CM. BACTERIOLOGICAL iUALITY: 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. (2102. 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, Bromine 2.0 6.0, Total Alkalinity 50 - 150 p.p.m. and Combined Chlorine less than 2 p.p.m. are required once a day.SWIMMING POOL: _ 0 pH = 7. T.A. _ / )a CcmbffFt!-Cl `r'T"�/ SWIMMING POOL: Cl = pH = T.A. = Combined Cl = WHIRLPOOL: = 3. v pH = ' CC7 T.A. = Z�7 Cambi..,,J Cl - /v1:1( ���,,�� WADING POOL: ab = 5-, 0 pH = 7 CO T.A. _ 9!) CorhtneQ"L't = fv �- '�-13. TESTING EQUIPMENT: Testing equipment proIlde0, in good repair and complete with fresh reagents. ( .14. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. <:1 5. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. . 16. WHIRLPOOLS: Quality of the water shall be the same as swimming pools and shall be equipped with a thermometer and a time inatrTent for the use of bathers. az. . S /eI. + G O F'' C lr cry c; '17. ENCLOSURE: A 6 foot high fence accordance with M.G.L. c.140 with sel 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. C ; 0 8. 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: O 60(,f PFRSCN ;01/76-c.Ae5?-1 b-.."- 10/96 SAFELY SIGNS AND HQUIPMENT 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 connunicable disease is allowed to use the pool. * No bather shall wear a bathing suit that is unclean. * No person suffering from a cough, cold, inflamnation of the eyes. nasal or ear discharges, or any .;ti-e cannunicable 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 cover;ne 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, c dimssing 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 eneanger tee 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 ,c.tst be provided tar each 2,000 sq. ft. of water surface area (MGL, c140, e20b). 4. One Ring Buoy or Rescue Tube with a }" polyethelene raps attached, no less in length than 1} the width of the leeo . If the pool has lifeguards, a rescue tube crust be located at each station. 5. Emergency canristication equipment must be available for reaching emergency response persons. Appropriate t.elephoee numbers and directions for the use of the equipment must be posted. 6. There must be an appropriately equipped first aid kit. Public pools must have a room designed and equipped for emergency care of sick and injured bathers. 7. Whirlpool - MAtst be drained every 30 days and scrubbed and disinfected. F1RS1' 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" sort roller bandages I 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 Trask with a one way vale POOL LOGS Logs Host be kept each dal the pool is in operation. Test for: Free chlorine 4Xfday Canbined Chlorine 1X/day pH 4Xlday Total Alkalinity 1X/day Also note on the log: Clarity Good/Average/Poor Chlorinator On/Off Chlorinator Setting Low/Medium/High or 112/3, etc. Weather Sunny/Cloudy, etc. Air Temperature Bather Load Chemicals Added Any Other Actions Taken Initials of Tester A1MINIS1EATIiN POOL CLOSURE IT IS THE RESPONSIBILITY OF 11EE POOL OMIATOR TO 0.115E THE POOL, MEN ANY OF THE CHOMICAL, PHYSICAL OR SAFETY 1flI 1 MLE ARE NOT MET, OR ECM ANY OTHER REASON THAT MILD MAKE FOOL USE UNSAFE. USE (111) JUDGE ENT!!t ERR CH THE SIDE: OF SAFE 7 in compliance with Ma 140.206, rrhen closing your outdoor inground swarming pool for the season, pools must be drained and remain dry throughout closure time, or covered within seven (7) days of closing. POOL OPE? INC 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 Ai-,iripool :mast be sutxnitted for testing for coliform and pseudatr,ras b, an independent lab. Lab results 'wst be suurnitted prior to inspection and opening.