CHILDREN'S ISLAND - COMMENT RESPONSE LETTER - PROPOSED COMPOSTING TOILET FACILITIES APPLICATION MERIDIAN
ASSOCIATES
140,G'S -rPloyea owner,
VIA EMAIL:dgreenbaumtDsalem.com and dano@millriverconsultine.com
April 3, 2024
City of Salem Health Department
Attention: David Greenbaum, RS, CHO
Salem City Hall
93 Washington Street
Salem, Massachusetts 01970
Re: Children's Island—Comment Response Letter
Proposed Self-Contained Composting Toilet Facilities
Permit Application
Dear Mr. Greenbaum:
The YMCA of the North Shore,the (Client) and Meridian Associates, Inc(MAI) are in receipt of an email
from the City of Salem Board of Health's Peer Review Consultant, Mill River Consulting, dated March 19,
2024, in regard to the proposed Self-Contained Composting Toilet Facilities that are being proposed at
Children's Island.The Consultant has offered the comments listed below to the original submittal and
MAI has provided the following responses in blue.
For the proposed compost toilet use:
• Provide a DSCP application for each building;
• MAI has provided two (2) Disposal System Construction Permit(DSCP) applications, one (1)
for each facility/building. Each of the applications are attached as a part of this
resubmission.
• Provide information to explain how the liquid by-product will be transferred from the composter to
the storage tank,and how the owner is to monitor the liquid storage tank for contacting a septage
hauling company if needed;
• As shown on the system plans, each composter is equipped with a liquid removal pump.
When the level in the composter reaches the high point,the pump is engaged and transfers
the liquid to the storage tank. Each composter and the storage tank are also equipped with
a float alarm to alert staff and personnel if a high level has been reached.
• The liquid will be removed by the Clients licensed contractor,as needed, and as outlined in
the maintenance agreement,via a pump truck or other similar pumping device,that will
pump the liquid product from the facilities into a proper container that will be shipped back
to the mainland for disposal in accordance with applicable Local,State and Federal
requirements;
• The liquid storage tanks are translucent with a high-level alarm that will have an audible and
visual alarm that will sound and flash when the liquid levels exceed the specified level in the
container.The translucent tan will allow for the Client to visually see the liquid level within
the container.A description of the high-level alarm and the associated audible and visual
500 Cummings Center, Suite 5950, Beverly, Massachusetts 01915 P 978-299-0447 F 978-872-1157
www.meridianassoc.com
P:\651 1_Childrens Island Salem,Ma\ADMIN\Letters-Memos\2024-04-03-Board of Health Response Letter.docx Pagel of 2
warning alarms are provided in the facility system plans that were provided by Clivus in the
initial submittal.
• Provide a drawing which has been endorsed by a professional engineer;
MAI has provided a stamp and signature of a professional engineer to the Toilet Facility
Plans. It should be noted that the facilities certified by NSF 41 as per DEP requirements.
For the nrol)osed hand sanitizer use:
• Provide a rendering depicting the location of proposed had sanitizer dispensing units as well as any
signage or other features which would be relevant;
The Self-Contained Composting Toilet Facility Plans have been revised to specify the hand
sanitizer dispensers that are to be used as well as to show the locations of the hand sanitizer
dispensers within the facilities.These plans are attached as a part of this resubmission.
• Provide a checklist for YMCA staff to use to examine the sanitizer dispensers for proper operation
and needed refill;
• A checklist for YMCA staff to use to examine the sanitizer dispensers for proper operation
and needed refill, has been prepared and is attached as a part of this resubmission.A copy
of this checklist will be posted in each of the facility buildings, in a location that is visible to
staff.
Please do not hesitate to contact me at��-IlevCcDmeridianassoc.com or(978) 265-5402 if you have any
questions,comments or concerns regarding this submittal and any of the attachments.
Sincerely,
MERIDIAN ASSOCIATES, INC.
David S. Kelley, PE
Vice President
500 Cummings Center, Suite 5950, Beverly, Massachusetts 01915 P 978-299-0447 F 978-872-1157
www.meridianassoc.com
PA6511_Childrens Island Salem,Ma\ADMIN\Letters_Memos\2024-04-03-Board of Health Response Letter.docx Page 2 of 2
Commonwealth of Massachusetts
�( City/Town of Salem Number
_} Application for Disposal System
_ pp $
Construction Permit Fee
Form 1A
DEP has provided this form for use by local Boards of Health if they choose to do so. Before using
the form, check with your local Board of Health to make sure that they will accept it.
A. Facility Information
Important:When
filling out forms Application is hereby made for a permit to: ® Construct a new on-site sewage disposal system
on the computer, ❑ Repair or replace an existing on-site sewage disposal system
use only the tab ❑ Repair or replace an existing system component
key to move your
cursor-do not
use the return 1. Location of Facility-
key.
U-6
Children's Island - Up Island (North End)
1 Address or Lot#
Salem Massachusetts 01970
—� City/Town State Zip Code
2. Owner Information
YMCA of the North Shore
Name
200 Cummings Center, Suite 173D
Address(if different from above)
Beverly Massachusetts 01915
City/Town State Zip Code
9( 78)922-0990
Telephone Number
3. Installer Information
Scott Faulkner(Building_ ) Groom Construction (Building)
Name Name of Company
96 Swampscott Road
Address
Salem Massachusetts _ 01907
City/Town Plumbing: State Zip Code
Walsh Plumbing and Heating (781)592-3135 ext. 204
John Walsh Telephone Number
209 Somerset Ave
Winthrop, Massachusetts 02152
(978)777-2406
4. Designer Information
Joe Ducharme Clivus New England
Name Name of Company
PO Box 127
Address
North Andover Massachusetts 01845
City/Town State Zip Code
9( 78)794-9400
Telephone Number
t5forml a.doc•06/03 Application for Disposal System Construction Permit-Page 1 of 3
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Commonwealth of Massachusetts
City/Town of Salem Number
-` -rG Application for Disposal System
_ Construction Permit Fee
Form 1A
A. Facility Information (continued)
5. Type of Building:
❑ Dwelling ❑ Garbage Grinder(check if present)
Other: Type of Building Self-Contained Composting Toilet Facility for up to 200
Day Camp Number of Persons Served
❑ Showers Number of showers ❑ Cafeteria ❑ Other fixtures
Specify other fixtures: -
6. Design Flow: Gallons per Day
Calculated Daily Flow: Gallons
7. Plan: September 9, 2023
Date of Original
7 None
Number of Sheets Revision Date
YMCA Children's Island Structures Up-Island Toilets: Cover, Proposed Plans, Proposed Elevations,
Proposed Sections, Proposed Wall Section (2), Foundation & Framing Plans;
8. Description of Soil:
The soils on the northern portion of the island are comprised of Udorthents which are comprised
primarily of man-made soils over top of loose sandy and fine sandy loam to bedrock at a depth of
around thirty-six (36)inches
9. Nature of Repairs or Alterations (if applicable):
Installation of Self-Contained Composting Toilet Facility
10. Date last inspected: Date
t5forml a.doc•06/03 Application for Disposal System Construction Permit•Page 2 of 3
r't--IM.
Commonwealth of Massachusetts
City/Town of Salem Number
Application for Disposal System $
Construction Permit Fee
Form 1A
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site
sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and
not to place the system in operation until a Certificate of Compliance has been issued by this Board of
Health. � G� O_ March 26, 2024
Signature Date
Application Approved By:
Name Date
Application Disapproved for the following reasons:
t5formla.doc•06/03 Application for Disposal System Construction Permit•Page 3 of 3
M. in• n� �e n+��ctio E�n�na ern-�a�nca os n
Commonwealth of Massachusetts
City/Town of Salem Number
Application for Disposal System $
Construction Permit Fee
Form 1A
DEP has provided this form for use by local Boards of Health if they choose to do so. Before using
the form, check with your local Board of Health to make sure that they will accept it.
A. Facility Information
Important:When
filling out forms Application is hereby made for a permit to:® Construct a new on-site sewage disposal system
on the computer, ❑ Repair or replace an existing on-site sewage disposal system
use only the tab ❑ Repair or replace an existing system component
key to move your
cursor-do not
use the return 1. Location Of Facility:
key.
Children's Island_- Down Island i,South Side) _
�,� Address or Lot#
Salem Massachusetts 01970
X
City/Town State Zip Code
2. Owner Information
YMCA of the North Shore
Name
200 Cummings Center, Suite 173D
Address(if different from above)
Beverly Massachusetts 01915
City/Town State Zip Code
(978)922-0990
Telephone Number
3. Installer Information
Scott Faulkner(Building)- _ Groom Construction (Building)
Name Name of Company
96 Swampscott Road
Address
Salem Massachusetts 01907
City/Town Plumbing: State Zip Code
Walsh Plumbing and Heating (781)592-3135 ext. 204
John Walsh Telephone Number
209 Somerset Ave
Winthrop, Massachusetts 02152
(978)777-2406
4. Designer Information
Joe Ducharme C_livus New England
Name Name of Company
PO Box 127
Address
North Andover Massachusetts 01845
CitylTown State Zip Code
(978)794-9400
Telephone Number
t5form1a.doc•06/03 Application for Disposal System Construction Permit•Page 1 of 3
n.... in• Q�on..�cti .+47G•1GG70Fn 4..[17.�...IAi.,.1(14700.d(1Gn
Commonwealth of Massachusetts
F, City/Town of Salem Number
- - ` Application for Disposal System
Construction Permit Fee
Form 1A
A. Facility Information (continued)
5. Type of Building:
❑ Dwelling ❑ Garbage Grinder(check if present)
Other: Type of Building Self-Contained Composting Toilet Facility for up to 200
Day Camp Number of Persons Served
❑ Showers Number of showers ❑ Cafeteria ❑ Other fixtures
Specify other fixtures:
6. Design Flow: Gallons per Day
Calculated Daily Flow: Gallons
7 Plan: September 9, 2023
Date of Original
7 None _
Number of Sheets Revision Date
YMCA Children's Island Structures Down Island Toilet Facility: Cover, Proposed Plans, Building
Elevations, Building Sections, Building Sections/Details, Proposed Wall Sections/Details, Foundation
8. Description of Soil:
The soils on the southern portion of the island are comprised of Chatfield-Hollis-Rock soils which are
comprised primarily of fine sandy loam and gravelly fine sandy loam to bedrock at a depth of between
twenty-six (26)and forty (40)inches.
9. Nature of Repairs or Alterations (if applicable):
Installation of Self-Contained Composting Toilet Facility
10. Date last inspected: Date
t5formla.doc•06/03 Application for Disposal System Construction Permit-Page 2 of 3
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Commonwealth of Massachusetts
�i City/Town of Salem Number
Application for Disposal System $
Construction Permit Fee
Form 1A
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site
sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and
not to place the system in operation until a Certificate of Compliance has been issued by this Board of
Health.
March 26_, 2024
Signature Date
Application Approved By:
Name Date
Application Disapproved for the following reasons:
t5form1a.doc•06/03 Application for Disposal System Construction Permit•Page 3 of 3
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the
��
Lynch/van Otterloo YMCA
Children's Island
Hand Sanitizer Maintenance Plan
Location: The checklist will be placed near each hand sanitizer dispenser station in
YMCA facilities.
General Inspection:
Visual Inspection:
• Check for any signs of damage or wear on the dispenser.
• Ensure the dispenser is securely mounted to the wall or stand.
Functionality Check:
• Push the dispenser button to ensure it dispenses sanitizer properly.
• Confirm that the dispenser mechanism is functioning smoothly without any
sticking or jamming.
Sanitizer Level:
• Check the sanitizer level in the dispenser.
• Ensure the sanitizer is above the minimum level indicator.
Refill and Maintenance:
Refill Procedure:
• If sanitizer is low, refill the dispenser with an appropriate solution.
• Use approved YMCA sanitizer* refill supplies.
Cleaning:
• Wipe down the exterior of the dispenser with a disinfectant wipe.
• Clean any spills or drips around the dispenser area.
Check Labels:
• Ensure all labels and instructions on the dispenser are intact and legible.
• Replace or update labels as necessary.
Report Maintenance Issues:
• If any issues that require repair or maintenance beyond refilling are identified,
report them to the maintenance department.
Additional Notes:
• *Approved YMCA hand sanitizers meet the Department of Health (MA) and CDC
recommendations of at least 60% alcohol, an effective alternative for cleaning hands.
• Inspections should be performed at least once per week.
• Wear gloves and follow hygiene protocols during inspections.
• Report any maintenance issues promptly to the maintenance department.
the
�o
Sample Weekly Checklist
YMCA Facility: [Enter Facility Name]
Inspector's Name: [Enter Inspector's Name]
Date of Inspection: [Enter Date]
Inspection:lGeneral
[ ] Visual Inspection: [ ] Damage or wear on dispenser
[ ] Secure mounting
[ ] Functionality Check: [ ] Smooth dispenser button operation
[ ] Proper dispenser mechanism function
[ ] Sanitizer Level: [ ] Above minimum level
[ ] Expiration Date: [ ] Verify expiration date
Refill and Maintenance:
[ ] Refill Procedure: [ ] Refill if low
[ ] Use approved supplies
[ ] Cleaning: [ ] Wipe down exterior
[ ] Clean spills/drips
[ ] Check Labels: [ ] Intact and legible
[ ] Replace/update labels
[ ] Note any issues requiring repair
[ ] Report Maintenance
Issues:
Additional Notes: *Approved YMCA hand sanitizers meet the Department of Health (MA) and
CDC recommendations of at least 60% alcohol, an effective alternative for cleaning hands.
• Inspections should be performed at least once per week
• Wear gloves and follow hygiene protocols during inspections.
• Report any maintenance issues promptly to the maintenance department.
Inspector's Signature:
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Commonwealth of Massachusetts �SG� z�
as City/Town of Salem, MA Number
Disposal System Construction Permit
Form 2A
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Permission is hereby granted to:
Important:When Scott Faulkner Groom Construction
filling out forms Name Name of Company
on the computer,
use only the tab 96 Swampscott Road
key to move your Address
cursor-do not Salem MA 01970
use the return City/Town State Zip Code
key.
r�
to perform the following work on an on-site sewage disposal system:
® Construction
ICI ❑ Repair or replacement
❑ Repair or replacement of system components
Children's Island -Salem Harbor
Facility Address
Salem MA 01970
City/Town State Zip Code
YMCA of the North Shore 978-922-0990 _
Owner Telephone Number
The work to be performed is further described in the Application for Disposal System Construction
Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions
or special conditions:
Install self-containd composting facility for the day cap for up to 200 people on Children's Island - Up
Island (North End).
All construction must be completed within three years of the date below.
David Greenbaum April 16, 2024
Approved by Date
Health Agent
Title
t5form2a.doc•06/03 Disposal System Construction Permit•Page 1 of 1
Commonwealth of Massachusetts -DS OF 2q- Z
City/Town of Salem, MA Number
Disposal System Construction Permit
Y% Form 2A
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Permission is hereby granted to:
Important:When Scott Faulkner Groom Construction
filling out forms Name Name of Company
on the computer,
use only the tab 96 Swampscott Road
key to move your Address
cursor-do not Salem MA 01970
use the return City/Town State Zip Code
key.
to perform the following work on an on-site sewage disposal system:
® Construction
❑ Repair or replacement
❑ Repair or replacement of system components
Facility Address
Salem MA 01970
City/Town State Zip Code
YMCA of the North Shore 978-922-0990
Owner Telephone Number
The work to be performed is further described in the Application for Disposal System Construction
Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions
or special conditions:
Install self-containd composting facility for the day cap for up to 200 people on Children's Island -
Down Island (South Island).
All construction must be completed within three years of the date below.
David Greenbaum April 16, 2024
Approved by Date
Health Agent
Title
t5form2a.doc•06/03 Disposal System Construction Permit•Page 1 of 1
RECEIVED
- MERIDIAN APR 0 4 2024
ASSOCIATES
1 U) 0 CtTY OF SALEM r: y
BOARD OF HEALTH
LETTER OF TRANSMITTAL
TO: City of Salem Health Department DATE: April 3, 2024
Attention: David Greenbaum, RS, CHO JOB NO: 6511
Salem City Hall RE: Children's Island
93 Washington Street Toilet Facilities
Salem, Ma 01970 VIA: Email and Hand Delivery
We are sending you the following items:
Copies Date Description
2 04/03/24 Board of Health Cover Letter
2 03/28/24 DSCP Application (North Facility)
2 03/28/24 DSCP Application (South Facility)
2 04/03/23 Down Island Toilet Permit Set of Plans (with SK-1)
2 04/03/23 Up Island Toilet Permit Set of Plans (with SK-1)
2 -- Hand Sanitizer Checklist for Staff
Remarks: Copies of these documents were sent via email on Thursday April 4, 2024
and hard copies are being hand delivered on Thursday April 4, 2024.
Copy To:
Signed:
If enclosures are not as noted, kindly notify us at once.
500 Cummings Center, Suite 5950, Beverly, Massachusetts 01915 P 978-299-0447 F 978-872-1157
www.meridianassoc.com
iMERIDIAN
ASSOCIATES
_ 1 w0% Employee Owned
VIA EMAIL:dizreenbaumOsalem.com and dano@millriverconsultina.com
April 3, 2024
City of Salem Health Department
Attention: David Greenbaum, RS, CHO
Salem City Hall
93 Washington Street
Salem, Massachusetts 01970
Re: Children's Island—Comment Response Letter
Proposed Self-Contained Composting Toilet Facilities
Permit Application
Dear Mr. Greenbaum:
The YMCA of the North Shore,the (Client)and Meridian Associates, Inc(MAI) are in receipt of an email
from the City of Salem Board of Health's Peer Review Consultant, Mill River Consulting,dated March 19,
2024, in regard to the proposed Self-Contained Composting Toilet Facilities that are being proposed at
Children's Island.The Consultant has offered the comments listed below to the original submittal and
MAI has provided the following responses in blue.
For the proposed compost toilet use:
• Provide a DSCP application for each building;
• MAI has provided two (2) Disposal System Construction Permit(DSCP) applications, one(1)
for each facility/building. Each of the applications are attached as a part of this
resubmission.
• Provide information to explain how the liquid by-product will be transferred from the composter to
the storage tank, and how the owner is to monitor the liquid storage tank for contacting a septage
hauling company if needed;
• As shown on the system plans, each composter is equipped with a liquid removal pump.
When the level in the composter reaches the high point,the pump is engaged and transfers
the liquid to the storage tank. Each composter and the storage tank are also equipped with
a float alarm to alert staff and personnel if a high level has been reached.
• The liquid will be removed by the Clients licensed contractor, as needed, and as outlined in
the maintenance agreement, via a pump truck or other similar pumping device,that will
pump the liquid product from the facilities into a proper container that will be shipped back
to the mainland for disposal in accordance with applicable Local,State and Federal
requirements;
• The liquid storage tanks are translucent with a high-level alarm that will have an audible and
visual alarm that will sound and flash when the liquid levels exceed the specified level in the
container.The translucent tan will allow for the Client to visually see the liquid level within
the container. A description of the high-level alarm and the associated audible and visual
500 Curnmings Center, Suite 5950, Beverly, Massachusetts 01915 P 978-299-0447 F 978- 872-1157
www.meridianassoc.com
PA651 1_ChiIdrens Island Salem,Ma\ADMIN\Letters__Memos\2024-04-03-Board of Health Response Letter.docx Page 1 of 2
warning alarms are provided in the facility system plans that were provided by Clivus in the
initial submittal.
• Provide a drawing which has been endorsed by a professional engineer;
• MAI has provided a stamp and signature of a professional engineer to the Toilet Facility
Plans. It should be noted that the facilities certified by NSF 41 as per DEP requirements.
For the proposed hand sanitizer use:
• Provide a rendering depicting the location of proposed had sanitizer dispensing units as well as any
signage or other features which would be relevant;
• The Self-Contained Composting Toilet Facility Plans have been revised to specify the hand
sanitizer dispensers that are to be used as well as to show the locations of the hand sanitizer
dispensers within the facilities.These plans are attached as a part of this resubmission.
• Provide a checklist for YMCA staff to use to examine the sanitizer dispensers for proper operation
and needed refill;
• A checklist for YMCA staff to use to examine the sanitizer dispensers for proper operation
and needed refill, has been prepared and is attached as a part of this resubmission.A copy
of this checklist will be posted in each of the facility buildings, in a location that is visible to
staff.
Please do not hesitate to contact me at lkellev(@meridianassoc.com or(978) 265-5402 if you have any
questions, comments or concerns regarding this submittal and any of the attachments.
Sincerely,
MERIDIAN ASSOCIATES, INC.
David S. Kelley, PE f5�_e
Vice President
500 Cummings Center, Suite 5950, Beverly, Massachusetts 01915 P 978-299-0447 F 978-872-1 157
www.meridianassoc.com
PA6511 Childrens Island Salem,Ma\ADMIN\Letters_Memos\2024-04-03-Board of Health Response Letter.docx Page 2 of 2
N
f _ Commonwealth of Massachusetts
City/Town of Salem Number
Application for Disposal System $
Construction Permit Fee
Form 1A
DEP has provided this form for use by local Boards of Health if they choose to do so. Before using
the form, check with your local Board of Health to make sure that they will accept it.
A. Facility Information
Important:When
filling out forms Application is hereby made for a permit to:® Construct a new on-site sewage disposal system
on the computer, ❑ Repair or replace an existing on-site sewage disposal system
use only the tab ❑ Repair or replace an existing system component
key to move your
cursor-do not
use the return 1. Location of Facility:
key.
Children's Island - Up Island t.North End;
V4 Address or Lot#
Salem Massachusetts 01970
City/Town State Zip Code
2. Owner Information
YMCA of the North Shore _
Name
200 Cumminc;s Center,_Suite 173D
Address(if different from above)
Beverly _ Massachusetts 01915
City/Town State Zip Code
(978)922-0990
Telephone Number
3. Installer Information
Scott Faulkner(Building) Groom Construction (Building)
Name Name of Company
96 Swampscott Road
Address
Salem Massachusetts 01907
City/Town Plumbing: State Zip Code
Walsh Plumbing and Heating (781) 592-3135 ext. 204
John Walsh Telephone Number
209 Somerset Ave
Winthrop, Massachusetts 02152
(978)777-2406
4 Designer Information
Joe Ducharme Clivus New England
Name Name o(Company
PO Box 127
Address
North Andover Massachusetts 01845
City/Town State Zip Code
9( 78)794_-9400
Telephone Number
t5form1a.doc•06/03 Application for Disposal System Construction Permit•Page 1 of 3
n..,.in• e�..��..11.J��CL.']nF..iGA')[]C..A�A7L.`7(1C�.,oF,.Fn„�
Commonwealth of Massachusetts
s, City/Town of Salem
I Number
Application for Disposal System
`C
Construction Permit Fee
Form 1A
A. Facility Information (continued)
5. Type of Building:
❑ Dwelling ❑ Garbage Grinder(check if present)
Other: Type of Building Self-Contained Composting Toilet Facility for up to 200
Day Camp Number of Persons Served
❑ Showers Number of showers ❑ Cafeteria ❑ Other fixtures
Specify other fixtures:
6. Design Flow: Gallons per Day
Calculated Daily Flow: Gallons
7 Plan: September 9, 2023
Date of Original
7 None
Number of Sheets Revision Date
YMCA Children's Island Structures Up-Island Toilets: Cover, Proposed Plans, Proposed Elevations,
Proposed Sections, Proposed Wall Section (2), Foundation & Framing Plans;
8. Description of Soil:
The soils on the northern portion of the island are comprised of Udorthents which are comprised
primarily of man-made soils over top of loose sandy and fine sandy loam to bedrock at a depth of
around thirty-six (36)inches
9. Nature of Repairs or Alterations (if applicable):
Installation of Self-Contained Composting Toilet Facility
10. Date last inspected: Date
t5form1a.doc•06/03 Application for Disposal System Construction Permit•Page 2 of 3
r'l-in. A4^'21 .nAlIr_W2.f,.FCn')nc.,A l W)97119.`4-Qfnfn..7
Commonwealth of Massachusetts
City/-rown of Salem Number
Application for Disposal System
Construction Permit Fee
Form 1A
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site
sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and
not to place the system in operation until a Certificate of Compliance has been issued by this Board of
Health. -4ccaL�y
March 26, 2024
Signature Date
Application Approved By:
Name Date
Application Disapproved for the following reasons:
t5formia.doc•06/03 Application for Disposal System Construction Permit•Page 3 of 3
n....in• n�..��„na� c�o.,c..r���na..n�n�a�na�..Qc..sn„�
I
Commonwealth of Massachusetts
City/Town of Salem Number
Application for Disposal System
Construction Permit Fee
Form 1A
DEP has provided this form for use by local Boards of Health if they choose to do so. Before using
the form, check with your local Board of Health to make sure that they will accept it.
A. Facility Information
Important:When
filling out forms Application is hereby made for a permit to:® Construct a new on-site sewage disposal system
on the computer, ❑ Repair or replace an existing on-site sewage disposal system
use only the tab ❑ Repair or replace an existing system component
key to move your
cursor-do not
use the return 1. Location of Facility-
key-
Children's Island - Down Island (South Side)
ay Address or Lot#
Salem Massachusetts 01970
City/Town State Zip Code
2. Owner Information
YMCA of the North Shore
Name
200 Cummings Center, Suite 173D
Address(if different from above)
Beverly Massachusetts 01915
City/Town State Zip Code
(978) 922-0990
Telephone Number
3. Installer Information
Scott Faulkner Building) Groom Construction (Building)
Name Name of Company
96 Swampscott Road
Address
Salem Massachusetts 01907
City/Town Plumbing: State Zip Code
Walsh Plumbing and Heating 7( 81) 592-3135 ext. 204
John Walsh Telephone Number
209 Somerset Ave
Winthrop, Massachusetts 02152
(978)777-2406
4. Designer Information
Joe Ducharme Clivus New England
Name Name of Company
PO Box 127 _
Address
North Andover Massachusetts _ 01845
City/Town State Zip Code
i 978) 794-9400 _
Telephone Number
t5form1a.doc•06/03 Application for Disposal System Construction Permit•Page 1 of 3
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Commonwealth of Massachusetts
City/Town of Salem Number
!4 !a Application for Disposal System
Construction Permit Fee
Form 1A
A. Facility Information (continued)
5. Type of Building:
❑ Dwelling ❑ Garbage Grinder(check if present)
Other: Type of Building Self-Contained Composting Toilet Facility for up to 200
Day Camp Number of Persons Served
❑ Showers Number of showers ❑ Cafeteria ❑ Other fixtures
Specify other fixtures:
6. Design Flow: Gallons per Day
Calculated Daily Flow: Gallons
7 Plan: September 9, 2023
Date of Original
7 None
Number of Sheets Revision Date
YMCA Children's Island Structures Down Island Toilet Facility: Cover, Proposed Plans, Building
Elevations, Building Sections, Building Sections/Details, Proposed Wall Sections/Details, Foundation
8. Description of Soil:
The soils on the southern portion of the island are comprised of Chatfield-Hollis-Rock soils which are
comprised primarily of fine sandy loam and gravelly fine sandy loam to bedrock at a depth of between
twenty-six(26)and forty(40) inches.
9. Nature of Repairs or Alterations (if applicable):
Installation of Self-Contained Composting Toilet Facility
10. Date last inspected: Date
t5formla.doc-06/03 Application for Disposal System Construction Permit•Page 2 of 3
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_ Commonwealth of Massachusetts
City/Town of Salem Number
Application for Disposal System $
Construction Permit Fee
Form 1A
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site
sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and
not to place the system in operation until a Certificate of Compliance has been issued by this Board of
Health.
_ March 2_6, 2024
Signature Date
Application Approved By:
Name Date
Application Disapproved for the following reasons:
t5formla.doc•06/03 Application for Disposal System Construction Permit•Page 3 of 3
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the
Lynch/van Otterloo YMCA
Children's Island
Hand Sanitizer Maintenance Plan
Location: The checklist will be placed near each hand sanitizer dispenser station in
YMCA facilities.
General Inspection:
Visual Inspection:
• Check for any signs of damage or wear on the dispenser.
• Ensure the dispenser is securely mounted to the wall or stand.
Functionality Check:
• Push the dispenser button to ensure it dispenses sanitizer properly.
• Confirm that the dispenser mechanism is functioning smoothly without any
sticking or jamming.
Sanitizer Level:
• Check the sanitizer level in the dispenser.
• Ensure the sanitizer is above the minimum level indicator.
Refill and Maintenance:
Refill Procedure:
• If sanitizer is low, refill the dispenser with an appropriate solution.
• Use approved YMCA sanitizer* refill supplies.
Cleaning:
• Wipe down the exterior of the dispenser with a disinfectant wipe.
• Clean any spills or drips around the dispenser area.
Check Labels:
• Ensure all labels and instructions on the dispenser are intact and legible.
• Replace or update labels as necessary.
Report Maintenance Issues:
• If any issues that require repair or maintenance beyond refilling are identified,
report them to the maintenance department.
Additional Notes:
• *Approved YMCA hand sanitizers meet the Department of Health (MA) and CDC
recommendations of at least 60% alcohol, an effective alternative for cleaning hands.
• Inspections should be performed at least once per week.
• Wear gloves and follow hygiene protocols during inspections.
• Report any maintenance issues promptly to the maintenance department.
the
Sample Weekly Checklist
YMCA Facility: [Enter Facility Name]
Inspector's Name: [Enter Inspector's Name]
Date of Inspection: [Enter Date]
Inspection:iGeneral[ ] Visual Inspection: [ ] Damage or wear on dispenser
[ ] Secure mounting
[ ] Functionality Check: [ ] Smooth dispenser button operation
[ ] Proper dispenser mechanism function
[ ] Sanitizer Level: [ ] Above minimum level
[ ] Expiration Date: [ ] Verify expiration date
,-R—efi-11 and- Maintenance.] Refill Procedure: [ ] Refill if low
[ ] Use approved supplies
[ ] Cleaning: [ ] Wipe down exterior
[ ] Clean spills/drips
[ ] Check Labels: [ ] Intact and legible
[ ] Replace/update labels
[ ] Note any issues requiring repair
[ ] Report Maintenance
Issues:
Additional Notes: *Approved YMCA hand sanitizers meet the Department of Health (MA) and
CDC recommendations of at least 60% alcohol, an effective alternative for cleaning hands.
• Inspections should be performed at least once per week
• Wear gloves and follow hygiene protocols during inspections.
• Report any maintenance issues promptly to.the maintenance department.
Inspector's Signature,
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