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Bell @ Salem Station Pool Inspection 5-20-2019 JIL CITY OF SALEM, M.kSSACHUSETTS BOARD OF Fl uTH 120 W ASHINGTON STREET 4""FLOOR Nbl1CHedth Prevent.Promote.Protect. TEL. (978) 741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL lramdin@salem.com LARItI' N!h iN,RS/It1;I IS,CL-[O,C'I'-FS MAYOR HIa.um-I AGI?,N,r SWIMMING POOL INSPECTION REPORT NAME: 9 a+%''bn DATE: 5 TIME IN: ADDRESS: `� PHONE: TIME OUT: CERTIFIED POOL OPERATOR: ctl Regulations 105 CMR 435.000 :Minimum andards for Swimming Pools, State Sanitary Code, Chapter V Regulation Compliance , Number Yes IN,p 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 recc,tacle 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 } 5 a C • Wading Pools—Once every four hours C • Special Purpose Pools (Spas)—Once every half hour �°v ' Maximum design filtration for filters: • High rate sand filter— 15 gpm/ft2 - 20 gpm/ftz(NSF filters) • DE filters—2 gpm/ft2 N �+ • Cartridge filters—0.375 gpm/ ftzp�� ate' I 5 Automatic hypochlorinators required feed-rate capacity: lrx� 3? • 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 dividin 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 2urification 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 104°F— 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 CompHance Number Yes I 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 V inch letters. Clothing—Lifeguards shall wear red or bright orange bathing suits, shirts or jackets with guard printed in 4-inch letterin . Lifeguards shall direct their attention to area assigned ' 435.24 Safety Equipment—'One ring Buoy for each 2000 f t2,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 L/ 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 PPM Combined Chlor a 0.0—0.2 PPM • Bromine 2.0—6.0 PP 3 0 C _G • pH 7.2—7.8 PPM M� - • Alkalinity 50— 150 PPM�( ' a'C�• 7's 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' minimum of once every 14 days 435.33 Maximum Operating Temperature for Special Purpose Pools—Water temperature not more than 104°F—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 throuuh 435.31 standards 435.38 General Sanitation—All pools, bathhouses and grounds shall be maintained in good repair, safe and sanitary 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 Alkalin" Alkaliniy Alkalinity Alkalinity Alkalinity Calcium CalciumL:J Calcium Calcium Calcium Hardness 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: Type: Type: Ty e: Free Free Free Chlorine Chlorine Chlorine Combined Combined Combined Chlorine Chlorine Chlorine Bromine Bromine Bromine H PH PH Alkalinity Alkalinity Alkalinity Calcium Calcium Calcium Type: Type Type: Hardness Hardness Hardness yP Pool Pool Pool Volume Volume g Volume g Sand Sand Sand DE Filter Type DE Filter Type DE Filter Type Cartridge Cartridge Cartridge Filter Size ft2 Filter Size ft2 Filter Size ftz Minimum Minimum Minimum Flow Rate gpm Flow Rate g pm Flow Rate gpm Maximum Maximum Maximum Flow Rate gpm Flow Rate g[)m Flow Rate gpm Actual Actual Actual Flow Rate aum 1 Flow Rate g in Flow Rate g m (1v )_ a j c4f 3y,(::P,,l 3 A�3 c-1Q,LLz_k oud'� alid icz'D'E� -4� wd W C ;? T r , b fc 66 :� Ct Passed Inspection: Yes V ❑No ❑ Re-Inspection Date: Inspector's Signature: '' Person In Charge: !( CITY OF SALEM MASSACHUSETTS Public Health P r J BOARD OF HEALTH Prevent.Promote.Protect. �8 WASHINGToN STREET,3RD FLOOR TEL.(978)741-1800 KIMSERLEY DRISCOLL health@salem.com DAVID GREENBAUM MAYOR HEALTH AGENT APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL 0\0 �IN al 1 n AAA A NAME OF APPLICANT U N� TEL# 5 � -S'-7 4`T - -T tY L�6 MAILING ADDRESS 11 0 1 N N` l q_� (J EMAILADDRESS Sof�Cm s�rAA-1or) hefi trS1r1L , (-Or^, CERTIFIED POOL OPERATOR Name: � 11-'� Cert M S$S TEL# 401 -3 2-3 - Z.oS 0' DATES OF OPERATION(if not annual): S 2_6 l°1 DAYS&HOURS OF OPERATION: M h^ TYPE OF POOL Public _ Semi-Public X-- - Special Purpose Surface Area $� sf Volume 33, (,W gallons Bather Load FEE: $210.00 for year-round pools $140.00 for seasonal $40.00 Non-Profit (Please pay total with one check payable to the City of Salem) This permit is not transferable and must be reissued upon change of ownership. In accordance 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. Pursuant to MGL Chapter 63C,Section 49a,I certify under the pains and penalties of perjury that I,to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature T Date' SS#or Federal Identification Number 46 This section for office use only Check# 06 HDate Amount