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CHILDRENS ISLAND POOL 2008-2017 CHILDREN'S ISLAND POOL C1 9 t c =mac s r� i City of Salem, Massachusetts LJ Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 PublicHeaIth Pte m[.Pwmole.Prorce,. Tel. (978) 741-1800 Fax. (978) 745-0343 Kimberley Driscoll health@salem.com Larry Ramdin, MPH, REHS, CHO Mayor Health Agent PUBLIC POOL HEALTH PERMIT Permit# PO-17-14 License For : SWIMMING POOL - SEASONAL Date of Print 6/26/2017 Granted To: Children's Island, LVO YMCA Permit Issued 6/26/2017 Address: Salem Harbor Salem MA 01970 Permit Expires 8/25/2017 Location of Establishment: CHILDRENS ISLAND Permit Fee $40.00 Restrictions: Children's Island Pool Permit 2017 Late Fee $0.00 Notes: This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 8/25/2017 , unless sooner revoked or suspended. Larry Ramdin, MPH, REHS, CHO Health Agent a City of Salem, Massachusetts Board of Health V r 120 Washington Street, 4th Floor, Salem, MA 01970 PubticIiealth Prc.em.Promote.Protect. i Tel. (978) 741-1800 Fax. (978) 745-0343 Kimberley Driscoll Iramdin@salem.com Larry Ramdin, MPH, REHS,CHO Mayor - Health Agent PUBLIC POOL HEALTH PERMIT Permit# PO-15-16 License For : SWIMMING POOL - SEASONAL Date of Print 7/7/2015 Granted To: Children's Island, LVO YMCA Permit Issued 6/29/2015 Address: Salem Harbor Salem MA 01970 Permit Expires 9/4/2015 Location of Establishment: CHILDRENS ISLAND Permit Fee $40.00 Restrictions: Children's Island Pool Permit Late Fee $0.00 Notes: This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 9/4/2015 , unless sooner revoked or suspended. ^ 0 A LJ CITY OF SALEM, MASSACHUSETTS t_��}t''1/ter-1 BOARD oP HEACTI1 - Pub11CI�ealfh 120 WASHIM fON S'IREM',4"t FLOOR Prevent,Promote.Protect. IY I..(978)741-1800 FAX(978)745-0343 KIMBERLEYDRISCOLL Iramd .salem.com LARRY RAbDIN,RS/RBHS,CiiO,CP-PS MAYOR H B.AI;l'FI AGP.N`1' APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL_ NAME OF APPLICANT L/I n#6, Al��ti L# MAILING ADDRESS �� '(�dig"VA a CERTIFIED O TO Name: l s � g4Q�r7Q �y Name: Cert#: TEL# DATES OF OPERATION(if not annual): 7 S"Oa r S V V —� DAYS & HOURS OF OPERATION: g Q Q a^._ r S� 'la'/ TYPE OF POOL / Public Semi-Public Special Purpose FEE: $210.00 for year round pools $140.00 for seasonal$40.00 Non-Profit (Please pay total with one check payable to the City of Salem) This permit is not transferable and must be reissued upon change of ownership. In accordance with the State Sanitary Code,before any renovations,improvements,or Equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 3C, Section 49a,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all to ax r toms d paid all s to taxes required under the law. Signature Date SS#or Federal Identification Number Revised 523/11 poolappl l.dm Check#Date • CITY OF SALEM, MASSACHUSETTS 10 BOARD OF HEALTH 120 WASHINGTON STREET,4t"FLOOR PublicHealth TEL. (978) 741-1800 FAx (978) 745-0343 Prevent,Promote.Protect. KIMBERLEY DRISCOLL Iramdin@salem.com MAYOR LARRY RAMI)IN,RSAI3HS,CHO,(P-FS Hi- ALTI'I AGENT Swimmine Pool Inspection Report Pool: Q4) UQ Zk,'s'f )-s Date: Address Phone: Operator: Max Bathing Load: In accordance with 105 CMR 435.00 Minimum Standards for Swimmine Pools•State Sanitary Code Chapter K Annual Permit Posted Health and Showers signs Posted _Health:no sick employees,no sick bathers,bathers take showers,spitting prohibited,no glass. =�Life$�°rds: Present / Certification / Red/orange suit ✓ "Guard"printed on jersey _�Sun block avail. Voice Amplifier 4�Elevated seat Emey Communication:phone at pool Phone instructions _Emergency numbers _7Phone in unlocked area �Safet¢Equip: for each 2000,sq.feet IV/�scue tube or ring buoy with rope) t/Backboard with collar and straps First Aid:Equipment area 5) 1"band-aids ✓(10)3x3 gauze f2)5x9 surgipads 12)antiseptic wipes 41)8x10 Surgi )2"soft roller bandages ✓Scissors )3"Soft roller bandages Tweezers �l) %roll hypoallergenic tape iRescue blanket ice packs 17 �• Pocket mask sterile isotonic eyewash t!Dist ction Chlorine �H 7.2—7.8 Residual free 1-3,Combined 0-0.2 2' 7, _Bromine _pH 7.2—7.8 Residual 2-6 (ppm)(mg/1) V Recur _ s Kept: // Recur tests -Itemicals Used ✓_Backwashing Attendance _✓Hours of operation 1�epth Markings Sidewalk and inside pool Diving Boards rigidly constructed,properly anchored,braced for heaviest load,no splinters or c cracks,non-slip surface,not over 10' above water level and at least 13'unobstructed headroom Bathhouse: Separate dressing and sanitary facilities for each sex,adjacent to pool,well lighted, drained,ventilated, impervious construction,one shower and one toilet per 40 bathers,hot and cold water,soap provided,no common cups,towels,combs,pool adequately enclosed,approved drinking water facilities Notes: Received by: Inspected by: Inspection of t' isia — p=1 1 Date C 7 -Time Name Address Owner Tel. No. Type of Inspection Inspector 1 Remarks and Violations are listed below: Cu '�11C►3��_..�_sl �__`�'�.t.. 1n �nE?, �'�T i" 'T (h�i -�i`��1' �„2,A�C¢,�t' ` t r a Report Raceived by: —------------ 71-7 1 1�17 I I it 4A it izIt, L'P 11 9v -til 'I "'tik *W'i; -til -til gelt I"r1t, I tt t T, I"Al., te V . I ,�. a RI IiQ al, - "I, 11 , tt AII, '17 1?t "tI Ia It "Itt: ilv,tz I It, tt'. v Lm; 'It It, tI 4e +x ' ,P It -tIt, Is C> i4 cw It eIII 4p ti, t 14 A., It gn Ql� imrw, lt, w 0jIt UD ti, 11 R, C4.) a. A ✓ jo titil V 't 1p, t OV i,' tt" , , - �'I I tt,, CL q co t,0 con 1-0 Z41 't," >; WW 4 14' Th7 Cn V� ant CITY OF SALEM, NLASS '1CHUSETTS �'PRq BOARD OF H1:A1:I'1-1 120 WAsruNc'rowvI S'r'Re[:'r,4'°1 Fr oOR KTMBE.I2LEY D}tISCOLT. T)71-(978)741-1800 FAX(978)745-0343 MAYOR Irrmd3n(asalcm.com LARl2l"RAMpIN,ILti�RGHS,CI10,Cl-'-1.5 L-L 'AC1'I-I AGESV,'1' 2011 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL /� LOCATION OF POOL L.1'vl I psf6 wt> ZS)MA p NAME OF APPLICANT �n A I�M OtJS/IL/etc ti�,l 'TEL# 7D�l �?79 ` ?)S ( MAILING ADDRESS 10 bF, S R11 RJ Mw)Ja-t"W MA 0013` CERTIFIED POOL OPERAflTOR 11 Name: Sw 'Per ®fQ.66 Cert#:01' 943 TEL# b17 W1 A1"27 DATES OF OPERATION(if not annual): DAYS & HOURS OF OPERATION: —P 1Ar - tie N TYPE OF POOL Public Semi-Public Special Purpose 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 Date SS#or Federal Identification Number Revised 5/23/11 poolapp l Ldoc Check#Dam g 4a CITY OF SALEM, MASSACHUSETTS IV •` '- BOARD OF HEALTH Ith 120 WASHINGTON STREET,4vi FLOOR ':CEI_. (978)741-2800 FAX()78)745-0343 KIMBERLEY DRISCOLI. Itamdin psalem.com Rit)' / LAiLiI�21?IN,RS It t3IIS,CI 10,to iti MAYOR I I FZA]:1'l I AG ,,--{{��{{ i,wdSwimming Pool Inspection Report Pool:_ v- fP SklCt` d Date: IS4 [Ia, Address Phone: Operator: L\)0 1 CA Max Bathing Load: In accordance with 105 CMR 435.00 Minimum Standards for Swimming Pools•State Sanitary Code Chapter V. _Annual Permit Posted Health and Showers signs Posted Health:no sick employees, no sick bathers,bathers take showers,spitting prohibited,no glass. c�Lifeguards:Present -Certification ✓Red/orange suit /"Guard"printed on jersey ✓ Sun block avail. /Voice Amplifier Elevated seat Emer.Communication: phone at po 1 f _Phone instructions (;f,$t1 5 0J ctActG�Emergency numbers _Phone in unlocked area ff VVVV y Safety Equip: for each 2000,sq. feet _✓Rescue tube or ring buoy(with rope) -aL Backboard with collar and straps _First Aid:Equipment area (3 5) 1"band-aidsptxj_Z(10)30 gauze :/(2)5x4 surgipads _/(l2)antiseptic wipes -<(1) 8x10Surgi 1 (2)2"soft roller bandages Scissors (2)3"Soft roller bandages Tweezers (1) /,roll hypoallergenic tape Rescue blanket ✓ice packs -Pocket mask :/'sterile isotonic eyewash Disinfection —Chlorine `c} °J• pH 7.2-7.8 Residual free 1-3,Combined 0-0.2 _Bromine pH 7.2-7.8 Residual 2-6 (ppm)(1119/1)records Kept: _Water tests Chcmicals Used _Backwashing A Attendance —Hours of operation Depth Markings Sidewalk and inside pool Diving Boards rigidly constructed,properly anchored,braced for heaviest load,no splinters or c cracks,non-slip surface,not over 10' above water level and at least 13' unobstructed headroom Bathhouse:Separate dressing and sanitary facilities for each sex,adjacent to pool,well lighted, drained,ventilated, impervious construction,one shower and one toilet per 40 bathers,hot and cold water,soap provided,no common cups,towels,combs,pool adequately enclosed,approved inking w ter act At s _ Notes: J. Cy,ife - (l3iced, Ce n nov e. Received by: Inspected by: t CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL, FAX (978) 745-0343 MAYOR Iramdin@salcm.com LARRY RANIDIN,WS/RHI N,(:110,CP-I S HEAI:rFIAGFNF SwimminE Pool Inspection Report Pool: CV1J8't%f`5JSkinLJ Date: �hO/ll Address Phone: I— Operator: Max Bathing Load: /n accordance with 105 CMR 435.00 Minimum Standards for Swimming Pools;State Sanitary Code Chapter V. /Annual Permit Posted tj ealth and Showers signs Posted Health: no sick employees,no sick bathers, bathers take showers,spitting prohibited,no glass. Lifeguards: Present _Certification _Red/orange suit _"Guard"printed on jersey _Sun block avail. _Voice Amplifier _Elevated seat _Enter.Communication:phone at�ool -, p _Phone instructions Cel IJV00S _Emergency numbers Phone in unlocked area P Safety Equip: for each 2000, sq. feet escue tube or ring buoy(with rope) V Backboard with collar and straps First id: Equipment area (�Q� 1(3 5) 1"band-aids 1 10)3x3 gauze ��r�.I e��s 2)5x9 surgipads (12)antiseptic wipes K#1" 5B I)8x 10 Surgi f )2"soft roller bandages e�clssors i/f�)3" Soft roller bandages �veezers _1) '/z roll hypoallergenic tape �t// escue blanket a packs Pocket mask sterile isotonic eyewash Disinfection CI -�,Ypp� Chlorine _pH 7.2–7.8 Residual free 1-3, Combined 0-0.2 y v� Bromine _pH 7.2–7.8 Residual 2-6 (ppm)(mg/1) 3 ✓ Recor s Kept: Water tests ��hemicals Used _ZBackwashing / Attendance ✓ Hours of operation U-1/ Depth Markings Sidewalk and inside pool IDiving Boards rigidly constructed,properly anchored,braced for heaviest load,no splinters or c / cracks,non-slip surface,not over 10' above water level and at least 13'unobstructed headroom Bathhouse: Separate dressing and sanitary facilities for each sex,adjacent to pool,well lighted, drained,ventilated, impervious construction,one shower and one toilet per 40 bathers,hot and cold water,soap provided,no common cups,towels,combs, pool adequately enclosed,approved di king water facilities /� Notes: IfeSl' l �(� CYC2C �' CTY�t�Ylt� i3col O{1 d0c };. ,�DALSeL�_M � Received by: Inspected by: 06/20/2011 11:25 FAX 5184944045 NAC INC 2001 Nationwide Aquatic Consulting, Inc. NAC, Inc. Box 193 Box 695 Nahant, MA 01908 Chestertown, NY 12817 1-888.833-5770 Fax 781.68145941518.494.4046 6!18!2011 Richard Simula 412 Hale st. Ben" MA .01965 Children's Island Dear Richard, Congratulations on your successful completion of the CERTIFIED POOUSPA OPERATORS course. I hope your experience was a positive one. You will be listed in the National Swimming Pool Foundation's Certified Pool/Spa Operator National Registry. Within 4-6 weeks, you will receive an official ial GPO Wall Certificate and Wallet Card. These will list your registration number. Thank you for your participation. If you have any questions, or If 1 or my company can be of any assistance to you now or in the future, please don't hesitate to contact me at 1-888-833-5770. Singly, f , Score: e88>s Robert R. Freligh, CPO IIN✓STR. Pres. NAC, Inc. i cc: file I 06/20/2011 11 : 21AM (GMT-04:00) ` CITY OF SALEM, MASSACHUSETTS BOARD OF HHAIA71 120 WASHINGTON S"IREH'1,411'FLOOR • TEL.(978)741-1800 I�IMAERLEY DRISCOLL FAX(978)745-0343 MAYOR DGRHHNBAUNI SALF.M.COM DAVID GRH'ENBAum,RS ACPINGHEAI;II]AG1:iNl' 2011 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL �NL ( , J ern IS k S hill 1 NAME OF APPLICANT L tiI/(12r'l &64&}�# &3 MAILING ADDRESS CERTIFIED POOLERATO / Name: K ((C swlLl a16( -Cert 9: TEL# DATES OF OPERATION (if not annual): J_U KP_ 3-7 d (t jl l I Do & HOURS OF OPERATION: � }v�i - da✓L TYPE OF POOL Public Semi-Public Special Purpose 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 most 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 a state tax returns and paid all state taxes required under the law. Signa Ire Date SS#or Federal Identification Number Revised 10/6/10 poolappl l.doc Check# Date CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,461 FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR txRFtRNBAUM�}a s vi ru COM DAVID GRI',I NIIAUM AcHNG HF*AJAU A(;GN'I' Swimming Pool Inspection Report Pool: (� la 1 L�,1RG6 t S ) S�AyJ Date: Address Phone: Operator: Yk�_Ur� Max Bathing Load: In accordance with 105 CMR 435.00 Minimum Standards for Swimming Pools:State Sanitary Code Chanter V. — Annual Permit Posted ✓Health and Showers signs Posted Health:no sick employees,no sick bathers,bathers take showers,spitting pprohibited,no glass. _,Lifeguards:Present Certification �Redtorange suit Guard"printed on jersey ,"Sun block avail. :�oice Amplifier ✓elevated seat ✓Emer.Communication:phone at pool Phone instructions emergency numbers - ;;_phone in unlocked area T Safety Equip:for each 2000,sq.feet ✓'Rescue tube or ring buoy(with rope) Backboard with collar and straps �rst Aid:Equipment area band-aids10)3x3 gauze .(2}Sx9 surgipads _(12)antiseptic wipes Q (1)8x10 Surgi v(2)2"soft roller bandages V Scissors - (2)3"Soft roller bandages i---Tweezers — (1) Yz roll hypoallergenic tape ,Rescue blanket �21ce packs ; "Pocket mask w-srerile isotonic eyewash _Disinfection Q _✓Chlorine _pH 7.2-7.8 Residual free 1-3,Combined 0-0.2 _Bromine _pH 7.2-7.8 Residual 2-6 (ppm)(mg/1) �Reeords Kept: --Water tests_ hemicals Used Y--'Backwashing attendance _rHours of operation i ✓^Depth Markings Sidewalk and inside pool jtbDiving Boards rigidly constructed,properly anchored,braced for heaviest load,no splinters or c cracks,non-slip surface,not over 10'above water level and at least 13'unobstructed headroom Bathhouse: Separate dressing and sanitary facilities for each sex,adjacent to pool,well lighted, drained,ventilated, impervious construction,one shower and one toilet per 40 bathers,hot and cold water,soap provided,no common cups,towels,combs,pool adequately enclosed,approved drinking water facilities Notes: f� CR 4 l < )t 1 1gyW Received by: Inspected by: � _ 3 e - ' -- - _ _ _ I' -'l Inspection of C-H) L7 2,1 _ N'S I S LJS�f.17 Date ( '2 1 y Time Name Address Owner Yl�-iCA Tel. No. Type of Inspection ?6aL Yt+(T. Inspector ��t�N}fl vas l3 ,Srl�Qr7RLP� ( ' Remarks and Violations are listed below: �00 L ��ZoVI Dl- l Al- i vLLo IJir.l(a 112 n V S\)g-w - PA T) 2." SoF l - ?7cv ,r�e: PS 2 a- i'i') �21.0 �A'N Z60r-\r, 1Zt?Ca, L �L� C2AC.�( S 1 Tilt �)E` - -- �ALc4bL, �ooL ��t�.e.� ( �� 2 a2 � DPl� 2Afld� Report Received by: `9 _ !".✓V v Commonwealth of.:Massachusetts o City of Salem Board of Health Kimberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Swimming Pool Seasonal Permit DATE PRINTED: 06/20/2008 ESTABLISHMENT NAME: Childrens Island Salem Harbor Pool File Number:BHF-2004-000177 Childrens Island Salem Harbor Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes SWIMMING POOL- BHP-2008-0490 Jun 23,2008 Aug 29,2008 $40.00 SEASONAL Total Fees: $40.00 PERMIT EXPIRES lAugust Z9, 2008 Board of Health Page 1 r . r CITY OF rSALEM, MASSACHUSETTS _ BOARD OF HEALTFI 120 WASHINGTON STREET,41,'FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR ISCOrf[&SALEM.COM JOANNE SCOTT, HEAun-I AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL C �7lId(P/) ' O NAME OF APPLICANT TEL##7 MAILING ADDRESS CERTIFIED�POOL OP RANR Name: p _ V en (nS, n Cert#: TEL# ( 1-67? DATES OF OPERATION (if not annual): ky2 9 •AYS &HOURS OF OPERATION: M 07,14 / — (' I �s I/ TYPE OF POOL Public Semi-Public Special Purpose 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 t e law. kI dl2-S��2y1 Signature Date SS#or Federal Identification Number s Revised 8/14/07 poolappmpd Check# Date