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PICKMAN PARK POOL INSPECTION 5-23-2017 .} CITY OF SALEM, MASSACHUSETTS 10 BOARD OF HE:ILTH 120 W ASHINGTON STREET,4"i FLOOR PublicHealth Prevent.Promote.Protect. TEL. (978) 741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL IramdinCa salem.com Lt\RRY ILIMDIN,RS/R1I-IS,CHO,CP-FS NLkYOR HEALTI I AGr,NT SWIMMING POOL INSPECTION REPORT i` NAME: 1 DATE: a 7 TIME IN: ADDRESS: PHONE: TIME OUT: CERTIFIED POOL OPERATOR: Regulations 105 CMR 435.000 :Minimum Standards for Swimming Pools, State Sanitary Code, Chapter V Regulation Compliance Number Yes No Title and Description 435.03 Bathhouse: Separate sanitary dressing facilities and water closet for each sex which are well lighted, drained and ventilated- Showers with hot and cold water— Sanitary drinking water— toilet paper, soap at sink and in showers (shatter proof containers), paper towels and waste receptacle 435.06 Water Circulation and Filtration: Over-all recirculation and purification system designed recirculates and filters the entire volume as follows: • Swimming Pools—Once every eight hours 3 L • Wading Pools—Once every four hours lbpllv- • Special Purpose Pools (Spas)—Once every half hour C � �� Maximum design filtration for filters: J • High rate sand filter— 15 gpm/ftz -20 gpm/ftz (NSF filters) • DE filters—2 gpm/ftZ • Cartridge filters—0.375 gpm/ftz Automatic hypochlorinators required feed-rate capacity: • Outdoor Pools—Three pounds of chlorine per 24 hours per 10,000 gallons • Indoor Pools—One pound of chlorine per 24 hour per 15,000 gallons 435.08 Inlets and Outlets—All special purpose and wading pools shall install an emergency shut off switch which is accessible, working and prominently marked 435.12 Water Depth Markings—Marked on pool deck and on vertical pool wall. Four-inch contrasting color stripe dividing shallow and deep ends including ledges and steps 435.21 Permit Requirements and Pool Records—Permit posted in conspicuous location. Maintain initialed records including daily attendance, amounts and types of chemicals used daily, chemical and bacteriological tests, dates and times of emptying, cleaning, and back-washing and hours of operation of purification equipment 435.22 Health Regulations, Signs—No employee working at swimming, wading or special purpose pool shall have a communicable disease. Operator shall enforce the following for bathers:All bathers shower before entering pool-Clean bathing suits—No communicable diseases (fever, cough, cold, inflamed eyes, nasal/ear discharge)—No open sores, skin diseases or bandages—No glass • Signage at entrance of pool enclosure or in dressing room—"All persons are required to take a cleansing shower bath before entering the pool. No person with a communicable disease is allowed to use the pool". • Additional signage for special purpose pools—"Do not use under these conditions: Alone- Under the influence of alcohol, anticoagulants, antihistamines,vasoconstrictors, vasodilators, stimulants, hypnotics or tranquilizers—Consult physician if person is elderly, pregnant, suffers from heart disease, diabetes, high/low blood pressure—Water temperature above 1040F—Observe reasonable time limits—No oils and body lotions" Easily readable large dial clock SWIMMING POOL INSPECTION REPORT Regulations 105 CMR 435.000 Minimum Standards for Swimming Pools, State Sanitary Code, Chapter V NAME: DATE: Regulation Compliance Number Yes No Title and Description 435.23 Lifeguards—Lifeguard certifications—Warning sign stating(if no lifeguard is required by Board of Health)"Warning—No lifeguard on Duty"and"Children under age 16 should not use swimming pool without an adult in attendance and "Adults should not swim alone"in four inch letters. Clothing—Lifeguards shall wear red or bright orange bathing suits, shirts or jackets with guard printed in 4-inch lettering. Lifeguards shall direct their attention to area assigned 435.24 Safety Equipment—One ring Buoy for each 2000 ft2,One rescue tube and rescue hook Lifeguard staffed pools shall have readily available a backboard with straps 435.25 First Aid Equipment and Emergency Communication—Provide a standard Red Cross first aid / kit—Working, convenient, immediate, toll-free communication system with emergency medical services, local/state police, fire department available to staff and public at all times with _ instructions for use 435.29 Chemical Standards—Test for residual disinfectant and pH conducted four times a day(once during peak load), Alkalinity and calcium test conducted weekly. Ranges are: • Residual Chlorine 1.0—3.0 PPMokJ Combined Chlorine 0.0—0.2 PPM • Bromine 2.0—6.0 PPM • pH 7.2—7.8 PPM 7-q • Alkalinity 50—150 PPM lM- 435.30 Water Testing Equipment—Provide a DPD test kit for measuring chlorine/bromine and appropriate kit for measuring pH, alkalinity and cyanuric acid—Reagents shall not be more than one year old—Provide accurate, unbreakable thermometer forspecial purpose pools 435.31 Water Clarity—Water shall be clear(black disc on bottom of pool, clearly visible from sidewalks of pool at all distance up to tenyards) 435.32 Water Quality Maintenance— Special purpose pools shall be drained, cleaned and refilled a r' minimum of once every 14 days 435.33 Maximum Operating Temperature for Special Purpose Pools—Water temperature not more than 1040F—Water temperature shall be tested when residual disinfectant and pH are tested 435.34 Closure of Pool—Operator shall immediately close pool until pool water conforms to 105 CMR 435.28 throw h 435.31 standards P"::A General Sanitation—All pools, bathhouses and grounds shall be maintained in good repair, safe and sanit2g manner. Remarks, Results and Action Taken: Swimming Pool Wading/Kiddie Pool Spa Type: Type: Free Free Free Free Free Chlorine Chlorine Chlorine Chlorine Chlorine Combined Combined Combined Combined Combined Chlorine Chlorine Chlorine Chlorine Chlorine Bromine Bromine Bromine Bromine Bromine H PH pH pH PH Alkalinity Alkalinity Alkalinity Alkalinity Alkalinity_ Calcium Calcium Calcium Calcium Calcium Hardness I Hardness Hardness Hardness Hardness SWIMMING POOL INSPECTION REPORT Regulations 105 CMR 435.000 Minimum Standards for Swimming Pools, State Sanitary Code, Chapter V NAME: DATE: Remarks,Results and Actions: T e: Type: Type: Free Free Free Chlorine Chlorine Chlorine Combined Combined Combined Chlorine Chlorine Chlorine Bromine Bromine Bromine H PH pH Alkalinity Alkalinity Alkalinity Calcium Calcium Calcium T e. Type: Hardness Hardness Hardness yp Type Pool Pool Pool Volume g Volume g Volume Sand Sand Sand DE Filter Type DE Filter Type DE Filter Type Cartridge Cartridge Cartridge Filter Size ftZ Filter Size ftZ Filter Size ftz Minimum Minimum Minimum Flow Rate gpm Flow Rate gpm Flow Rate gpm Maximum Maximum Maximum Flow Rate-,,pm Flow Rate gpm Flow Rate gpm Actual Actual Actual Flow Rate 2m Flow Rategpm Flow Rate gpm Passed Inspection: Yes ❑No ❑ Re-Inspection Date: Inspector's Signature: Person In Charge: 1Nky.01.2017 11:56 AM RECEIVED PAGE. 2/ 2 • MAY 0 82017 CITY OF SALEM BOARD OF HEALTH C TTY OF SALEM, MASSAC.:,HUSETTS li[)ARD OilEN.,AIX111 12Q WAAIIN(TON 5'i'lil'f.:l,4""V1,0.H 'I m'.(978)7414800 KINIB ERL.EY I)It1.tiCOLT. FA-X(973)745,•0341 MAWR iLiISr1 7s LARRY 1W41)TN,16/1 E17TS.UTO.C24"$ P IC TI N F R PERM T'TO.OEERAIgA B IMM RO — l _. - ,S ' LOCATION OF PO(]Ya NAME OI~APPLICANT T�EjIa# MAI LING ADDRESS grV !� CERTIFIU OOI.OFE TOR 1�` �� '� / 7 Name: _.�—�._._Corr#; ---TEL 1 (� Q La _ —� � ?l�6l�� rOPERATION if nut anneal};_ ' — DAYS&HOURS OF OPERATION--J "0 Public Semi-Public Special Purpose FUt $210,00 for year round poo, $140. or seasonal$40.00 Non-Profit (Please pay total with one check pays a to the laity of Salem) This permit is not transferable and must be.reisxued upon oha<liic Of ownership, In accor#once with the State Sanitary Code,before any renovations,Improvements,or Equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. JR ant to MOO Cha 63C,Section 49a,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have 1 state tax retu s nd paid all state tarns required under the law. LJA--, � Date SS#or Federal Identification Number t re 512311 uolappll.doc Chock#pates