ESSEX CONDOMINIUMS POOL Inspection of E' St �aF�1e.S II'' �dZJL Date It 1 Time )0
Name GF,—Uw e�y
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Owner ;�`, Tel. No.
Type of Inspection ,` Inspector� G lCJTJ•7gVi`fl
( ' 1 Remarks and Violations are listed below:
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Owner Tel. No.
Type of Inspection P=0�. Inspector
{ ' Remarks and Violations are listed below:
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( ' I Remarks and Violations are listed below:
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Owner + Tel. No. ff���� �
Type of Inspection. R&a�. Inspector + bF r7 tiJM L 6,At�(1eo
-(•' ) Remarks and Violations are listed below:
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APPENDIX A SWIMMING POOL TESTING RECORDS_
FREE CMIORINE LOM8INED TOTAL AUTO IC CNLDRMATOR
DATE IME RESIDUALp03.0) CHORINTY
E (7.2 N7:8) CLARITY (60-I�SOlypo) FUNCTIONINO SETTING BATHER CHEMICALS
YES NO WMHER TE1NT LOAD USED TESTER
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NAME OF CITY OR TOWN
STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS,
105 CMR 435.000
SWIMMING POOL INSPECTION REPORT
TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC ❑ SPECIAL PURPOSE POOL ❑
NAME OF POOL ADDRESS
OWNER ADDRESS
DATE OF POOL CAPACITY INSPECTED BY
INSPECTION #OF GALS
METHOD OF WATER BATHER #OF LIFEGUARDS WATER SOURCE:
TREATMENT LOAD
Regulation 105 CMR 435.000 The items marked below with an"X"indicate the violated provisions of 105 CMR 435.000.
Items marked with a"✓' are satisfactory.
REGULATION X/✓ VIOLATIONS/COMMENTS
.03 Bathhouse and sanitary facilities adequate lighting, i/
ventilation. sanitary condition.
.03 Adequate enclosure around pool. Gate self-latching w/
latch 4 it above ground. t�
.04 Sewage Disposal
.05 Location, structural stability, finish.
.06 Water circulation&filtration systems. Filter Effluent flow
meter reading:_gpm. #of turnovers
.06 Suitable automatic equipment for disinfection of pool
water.
.06 Carbon dioxide(CO2)equipment for pH control J/adequate. CO2 cylinders anchored. Inaccessible to
public,adequate ventilation provided.
.08 Inlets and outlets-Inlets located to produce uniform v1*1
circulation. Over rim fill spout 6"above maximum
water level. Properly shielded and located.
.08 Main drain suction outlets covered with suitable
protective covers or grates. Cannot be removed ✓
without the use of tools. Open area does not provide
entrapment of fingers,toes, etc. At least one
antivortex drain provided.
.08 Each system outlet protected against user entrapment
by antivortex cover or other means. Minimum of 2
suction outlets provided for each pump, properly
located and plumbed.
.08 Suction outlet covers in place, unbroken and secure
and cannot be removed except with the use of tools.
Close pool immediately if outlet covers missing,
broken,loose or can be removed without tools
until repairs can be made.
.08 Special purpose pool and wading pools equipped with #h
emergency shut off pump switch. Accessible and
prominently marked.
.09 Cross connections. Portable water supplied through air V1,
gap. /
.10 Skimming facilities. 50%of recirculation drawn from 1V
surface of pool.
12 Line with floats separates non-swimmer area from
deeper water.
.12 Water depth markings on deck and walls. Properly
spaced. Boundary line on pool floor and wails. Step
edges marked with contrasting color.
.13 Walkway and decks 4 feet wide, safe condition.
.14 Ladders,steps-one per 75 feet. Not less than 2
ladders. )�
.15 Diving equipment in safe condition. j
.17 Pool supervision-Pool supervision provided.
Effective Jan, 1, 1999, pool supervisor certified as pool ✓
operator from YMCA or NSPF.
.21 Permit requirements- Permit issued. Adequate ai
maintenance and testing records maintained. Records
initialed by person making tests.
.22 Health regulations: Signs posted. Health warning t/
signs posted for special purpose pools.
.23 Lifeguards required: Yes rl No
If lifeguards required. Proper credentials, proper suits
and garments worn. Whistle and bullhorn provided
.24 Safety equipment. Ring buoys and rescue hook
provided. Rescue tube and backboard with straps at
pools attended by a lifeguard.
.25 First Aid equipment provided. x
.25 Emergency Communication System at the pool and in ✓
working order. Emergency communication device in
unlocked area and available at all times to staff and the
public. Operating instructions and emergency
numbers posted.
.26 Waste and backwash water disposal properly V
discharged. No direct connection to sewer system.
Separation tank provided for diatomaceous earth filter
backwash water.
.29 Chemical standards
POOLSIDE READINGS
Bromine 2 0�6,0; "m fMh, Total Chlorine � -nf, AZ del;
Alkalinity50ISQ°' ��i Free Chlorine `; d}3,0 "rti
Cyanuric Acid 001,00 p�jm) Comb. {Y}0 0?ppit0'O(
a
Chlorine
Water Temp. f.104°k:Lr°T a H level ` ?2 7.8), ,€t+:r'u=
* arts permillion Other
29 Pool water tested with appropriate frequency.
30 Water testing equipment. DPD kit provided for
chlorine and bromine. Unbreakable thermometer for }f
special purpose pools.
.31 Water clarity X
.32 Water clarity maintenance. Filtration system operating
continuously.
32 Special purpose pool drained,cleaned and every 14
days.
Maximum Operating Temperatures for Special Purpose
Pools. (SPP).
.33 a. Thermostatic control provided for each SPP.
b. Thermostatic control only accessible to the pool
operator
38 General sanitation
### CROWNINSHIELD
### MANAGEMENT CORPORATION Ami
NATHANIEL W. BROWN, CMCA
PROPERTY MANAGER
CROWNINSHIELD MANAGEMENT
18 CRONNINSHIELD STREET•PEABODY,MASSACHUSETTS�01960
TEL(978)532-4800-FAX(978)532-6023
E-MAIL:nbTown@cmwn[mhicid.com
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pit CROWNINSHIELD
' aa# MANAGEMENT CORPORATION AMO®
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NATHANIEL W. BROWN, CMCA
PROPERTY MANAGER
CROWNiNSHIELD MANAGEMENT
18 CRONVNINSHiELD STREET- PEABODY,MASSACHUSETTS 01960
TEL(978)532-4800-FAX(978)532-602.3 ..
.. E-MAIL:nbrow aow inshield,
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Please Remit Payment To:
D&P SWIMMING POOL 772478
26 MAIN STREET
PLAISTOW, NH 03865
DATE: 1/19/2012
Phone# 603-382-7631 dam
BILL TO:
SHIP
The Essex Condos THE ESSEX'S
C/O Crowninshield Management Company 11 CHURCH ST
18 Crowninshield Street SALEM,MA 01970
Peabody,MA 01960
P.O.#
ALL PARTS COME WITH A 30 DAY
WARRANTY.LABOR IS NOT INCLUDED. TERMS Net 30
ITEM# CITY DESCRIPTION UNIT PRICE TOTAL
011017 2 PM?INTELLIFLOVS+SVRS 1,395.00 2,790.00T
BILLABLE SVC 2 Install 2 Intelliflo Pumps 200.00 400.00
RLP8AVVGBI01 1 8"Round Main Drain 29.95 29.95T
AS4HP101 2 4"ROUND SUCTION COVER OUTLET WHITE For SPA MAIN 44.95 89.90T
DRAIN
BILLABLE SVC I Dive to install new Main Drain in Pool 295.00 295.00
521109 2 Intellicom 2 225.00 450.00T
Subtotal $4,054.85
CUSTOMER SIGNATURE: MA Sales Tax (6.25%) $209.99
UPON SIGNING THIS THE CUSTOMER HAS RECEIVED THE ABOVE ITEMS
T] U11,9j-4,T,T,T,1STa."L1T:1n;U- V. "w"a"
THANK YOU!
CITY OF SALEM, MASSACHUSETTS
M BOARD OF HFAi TH
120 WASHINGTON STREET,4"'FLOOR
KIMBERLEY DRISCOLL TEL. (978) 741-1800
FAZ(978) 745-0343
MAYOR lraindin(@sgeln.com
salern.com
LARRY RAMUIN,RS/REI-IS,C110,CP-FS
HYALTt1 AGENT Swimming Pool Inspection Report
Pool: G5Itw Caipt3,$ Date: I ^I
Address) I I^-14v ftG�) 6 Phone:
Operator: Max Bathing Load:
In accordance with 105 CMR 435.00 Minimum Standards for Swimmine Pools:State Sanitary Code
Chapter V.
"Y Annual Permit Posted
✓' Health 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
✓ EmeyCommunication:phone at pool
hone instructions _Emergency numbers
_Phone in unlocked area
�Safety_Equip: for each 2000,sq.feet
K Rescue tube or ring buoy(with rope)
^— Backboard with collar and straps
First Aid: Equipment area
(3 5) 1"band-aids �10)3x3 gauze
(2)5x9 surgipads (12)antiseptic wipes
(1)8x10 Surgi _(2)2"soft roller bandages 9
Scissors _(2)3"Soft roller bandages
_ 4
_✓Tweezers _(1) 'hroll hypoallergenic tape
_Rescue blanket �-`Ice packs
Pocket mask _sterile isotonic eyewash
Disinfection
_Chlorine U• b _pH 7.2-7.8 Residual free 1-3,Combined 0-0.2 - )o•p
_Bromine _pH 7.2-7.8 Residual 2-6 (ppm)(mg/1)
_Records Kept:
_Water tests _Chemicals Used _Backwashing
_Attendance _Hours of operation
Depth Markings Sidewalk and inside pool
44Diving 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
_0--11 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:
REGULATION
NO. THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE
W✓
.34 Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF
105 CMR 435.29 THROUGH 435.31.
SIGNED SIGNED
Operator Board of Health/Health Department
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reb 11 1411:41a The Essex Condominium 97$7442521 p.1
CITY OF SALEM, MASSACHUSETTS
BOARDOr."HBA m
120 WASHINGTON StREST,41"171,0012 PLWh
itcveat.Pwmox.Pxottxt.
Ter.(978)741-1900 Fnx(978)745-0343
KIMI3ERLEY DRISCOLL lramdw2salem cpm
LARRY 1L1MllIN,RS/M113,Cl{Cl,CP-F>
MAYOR Hr-A1:171AC'CN-1'
APPLICATION FOR PERMIT TO OPERATE /A SWIMMING POOL
LOCATION OF POOLI� QJ1kV lGlM 1 t &r-k `-'� -
NAME OF APPLICANT��� C rN r1 a?" TEL# f 7-' S c —Y
MAILINGADDRESS_(/0 Cfl��V1i71�G( �"lPlt 7'� 6 CRY"�7 y , r l+�a }'i ��tvc?
CERTIFI�%POQLOLF?ATOR rName: Cert#:O)-
TEL 0�7 ! - t✓'� � 5��
DATES OF OPERATION(if not annual): M�
DAYS &HOURS OF OPERATION: 7
TYPE OF POOL
Public
Semi-Public
Special Purpose
FEE: $210.00 for year round pools $140.00 for seasonal$40.00 Non-Profit
(Pleasepay 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 trade,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
fil s e i�g9feturns and prod all state taxes required under the law.
n a nrr�
Signaell
ture Date 55#or Federal Identification Number
Revised 523111 poolappl i.dw Chock M Date