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HIGHLAND CONDOMINIUMS POOL City of Salem, Massachusetts O Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 PubiicHealt . PrerenL Pmmem.Proeeu. 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-17-9 License For : Pool (seasonal) Date of Print 5/16/2017 Granted To: East Coast Properties Permit Issued 5/16/2017 Address: 400 Highland Avenue SALEM MA 01970 Permit Expires 9/4/2017 Location of Establishment: 19 INDIAN HILL LANE Permit Fee $140.00 Restrictions: Highland Condominium At Salem Trust 19 Indian Hill Lane Late Fee $0.00 Notes: This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 9/4/2017 , unless sooner revoked or suspended. Larry Ramdin, MPH, REHS, CHO Health Agent t' 4 CITY OF SALEM, MASSACHUSETTS BOARD or'He.A1.11i 120 WAS[I INGTON S'1Rl.i r,4" FLOOR IQMBERLEY DRISCOLL Tel-(978)741-1800 RECEIVED ent F (978)745-0343 MAYOR Iramdin e salem.com MAY 112017 LARRY RADIDIN,RS/RFHS,CHO,CP-FS HEAf.TI I AGENT CITY OF SALEM BOARD OF HEALTH 2017 X14 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OFPOOL end of Indian Hill Lane NAME OF APPLICANT EAST COAST PROPERTIES LLC TEL# 978-741-2001 MAILING ADDRESS 400 HIGHLAND AVENUE, STE 11, ,514JLC4NA 01970 CERTIFIED POOL OPERATOR Name: Andrew J. Anseltno Cert#:01-182573 TEL#978-852-4001 DATES OF OPERATION(if not annual): MEMORIAL DAY thru LABOR DAY DAYS &HOURS OF OPERATION: SUNDAY thru MONDAY 10 AM — 9 PM TYPE OF POOL Public Semi-Public ygg Special Purpose FEE: $210.00 for year round pools $140.00 for seasonal$40.00 Non-Profit (Please pay total with one check payable to the City of Salem) This pemtit is not transferable and must be reissued uportchange of ownership. In accordance with the State Sanitary Code,before any renovations,improvements,or Equipment changes are made,an plans for such must be submitted to and approved by the Salem Board of Health. Pur an to MGL Ch ter 3C,Section 49a,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have flI tate tax re ms a d paid all state taxes required under the law. 5/09 A7 04-6568871 i nat a Date SS#or Federal Identification Number Revised 5/23/11 poolappll.doc Check#Date 2-21 / REcENED MAY 112017 CITY Of:SALEM BOARD OF HEA 4 f � l De Cex21e Cott", - DL t #x3 �uBgH'Ff'.5j'�j t{htC�k■�+�`}g��y t '��a� r��x#s�`w4F,�T� � a '�!� 1 :. �e1 ii '(�0J1fN'- �.,�`W�x.,$d�4�a,�,�." mu' ..mane"•' :�""C �`w . �. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR PIIIIIICHe8Itt1 Prevent.Promote.Protect. TEP.. (978) 741-1800 Fax(978) 745-0343 KIMBERLEY DRISCOL L Iramdin@salem.com LARRY RADIDIN,RS/RI31-1S,CIAO,CP-RS MAYOR I-Irnl:rr-L AGi?N'r I t f / (SWIMMING POOL INSPECTION REPORT NAME: �T �TYt Iaj� L jvlGi n$ DATE: QV 241W2TIME IN:1�,0(�a ADDRESS: 1-r1�my II' I_GV l� PHONE: TIME OUT: CERTIFIED POOL OPERATOR: A Jre"l An tel mn 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 eaxSitnura ding Pools-Once every four hours cial Purpose Pools (Spas)-Once every half hour 00 design filtration for filters: • High rate sand filter- 15 gpm/ ft2 - 20 gpm/ft2(NSF filters) • DE filters-2 gpm/ft' • Cartridge filters-0.375 gpm/ft' 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 j 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: { LA c...,d 5 DATE:`O_� 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 PPM Combined Chlorine 0.0—0.2 PPM • Bromine 2.0—6.0 PPM • pH 7.2-7.8PPM • Alkalin 50— 150 PPM 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 for special 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 ten yards) 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 through 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 M Chlorine Chlorine Chlorine Chlorine Combined \ Combined Combined Combined Combined Chlorine Chlorine Chlorine Chlorine Chlorine Bromine Bromine Bromine Bromine Bromine pH �� pH pH pH pH Alkalinity 100417 Alkalinity Alkalinity Alkalinity Alkalinity Calcium Calcium Calcium Calcium Calcium Hardness 3�� P Hardness Hardness Hardness Hardness SWIMMING POOL INSPECTION REPORT Regulations 105 CMR 435.000 Minimum Standards for Swimming Pools, State Sanitary Code, Chapter V NAME: r�j IsOn�S DATE:' S � —6 Remarks, Results and Actions: Type: Type: Type: Free Free Free Chlorine Chlorine Chlorine Combined Combined Combined Chlorine Chlorine Chlorine Bromine Bromine Bromine PH pH pH Alkalinity Alkalinity Alkalinity Calcium Calcium Calcium Type Type' Hardness Hardness Hardness Type' Pool2�{ Pool Pool Volume g /O�0 Volume g Volume g Sand Sand Sand DE Filter Type E Filter Type DE Filter Type Cartridge rrt�rid a Cartridge Filter Size ft' v Filter Size ft' Filter Size ft' Minimum Minimum Minimum Flow Rate gpm Flow Rate gpm I Flow Rate gpm Maximum Maximum Maximum Flow Rate g m D Flow Rate gpm Flow Rate gpm Actual ^ Actual Actual Flow Rate gpm 100 Flow Rate gpm Flow Rate gpm r 1t r (/ Passed Inspection: Yes A Wo ❑ Re-Inspection Date: Inspector's Signature: Person In Charge: a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4 FLOOR PublicHealth PrcvmL Pmmole.Profee. TEL. (978) 741-1800 F AZ(978) 745-0343 KIMBERLEY DRISCOLL lramdin e salem.com L,VtRv RA(\9DIN,RS/RF.HS,GHO,CP-FS N AYOR Hum,:n AGENT 1 _. I &t) ff SWIMMING POOL INSPECTION REPORT NAME: fTlcIakli 1 �1Y)dbJ DATE: 5 y TIME IN: (i i5 ADDRESS: �q 'KkLuw [f n tome, PHONE: TIME OUT: CERTIFIED POOL OPERATOR: Regulations 105 CMR 435.000 :Minimum Standards for Swimming Pools, State Sanitary Code, Chapter V Regulation Compfiance Number Yes No Title and Description 435.03 Bathhouse: Separate sanitary dressing facilities and water closet for each sex which are well I v 1 A 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 • Wading Pools—Once every four hours • Special Purpose Pools(Spas)—Once every half hour Maximum design filtration for filters: • High rate sand filter— 15 gpm/ft' -20 gpm/ft' (NSF filters) • DE filters—2 gpm/ft' • 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 1J 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 104°F—Observe reasonable time limits—No oils and body lotions" Easily readable large dial clock l SWIMMING POOL INSPECTION REPORT Regulations 105 CMR 435.000 Minimum Standards for Swimming g(Pools, State Sanitary Code, Chapter V i NAME: u ) kiczy14 lzYK1b DATE: a h Regulation Compfiance 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 ft , 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 PPM Combined Chlorine 0.0—0.2 PPM • Bromine 2.0—6.0 PPM • pH 7.2—7.8 PPM • Alkalin 50—150 PPM 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 N p Water Quality Maintenance—Special purpose pools shall be drained, cleaned and refilled a m minimum of once every 14 days 435.33 Al p Mawmum 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 through 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 /'1 Chlorine Chlorine Chlorine Chlorine Combined Combined Combined Combined Combined Chlorine Chlorine Chlorine Chlorine Chlorine Bromine Bromine Bromine Bromine Bromine HH H H PH Alkalin �Q Alkalinity Alkalinity Alkalinity Alkalinity Calcium Calcium Calcium Calcium Calcium Hardness y Hardness Hardness Hardness Hardness /1 �x bx� o)-x $ f� 1 SWIMMING POOL INSPECTION REPORT Regulations 105 CMR 435.000 Minimum Standards for Swimming Pools, State Sanitary Code, Chapter V NAME: T1 SV110� cn%U 0 DATE: S a q � Remarks,Results and Actions: T e• T e• Ty e• Free Free Free Chlorine Chlorine Chlorine Combined Combined Combined Chlorine Chlorine Chlorine Bromine Bromine Bromine H PH pH Alkalin A!kalinity Alkalinity Calcium Calcium Calcium Type: Hardness Hardness Hardness Type: Type Pool Pool Pool Volume g Volume g Volume Sand Sand Sand DE Filter Type Filter Type DE Filter Type Cartridge artrid a Cartridge Filter Size ft' I 6 c Z Filter Size ftp Filter Size ft' Minimum Minimum Minimum Flow Rate gpm Flow Rate gprn Flow Rate gpm Maximum ()f l2 t) h Maximum Maximum Flow Rate m Flow Rate gpm Flow Rate gpm Actual Actual Actual Flow Rate gpm Flow Rate gpm Flow Rate gpm A S loE i i s Passed Inspection: Yes []No Re-Inspection Date- Inspector's ate:Ins ector's Signature: Person In Charge: City of Salem, Massachusetts lu g Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 PublicHealth Prevent Pramom.Protect. 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-16-8 License For : Pool (seasonal) Date of Print 5/24/2016 Granted To: East Coast Properties Permit Issued 5/24/2016 Address: 400 Highland Avenue SALEM MA 01970 Permit Expires 9/30/2016 Location of Establishment: 19 INDIAN HILL LANE Permit Fee $140.00 Restrictions: Highland Condominium At Salem Trust 19 Indian Hill Lane Late Fee $0.00 Notes: This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 9/30/2016 , unless sooner revoked or suspended. CITY OF SALEM, MASSACHUSETTS mn BOARD or HEAlm I P11bliCHealth 120 WASHINGTON STREET,4TM FLOOR ere.cne.Promote,Protect. TEL.(978)741-1800 FAx(978)745-0343 KIMBERLEY DRISCOLL ImmdinQsalem.com LARRY RAMDIN,RS/REHS,CHO,CP-I'S MAYOR HEAI;11-i AGEN'r APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL INDIAN HILL LANE NAME OF APPLICANT EAST COAST PROPERTIES LLC TEL# 978-741-2003 MAILING ADDRESS 400 HIGHLAND AVENUE, STE 11, SALEM MA 01970 EMAIL ADDRESS cyndy@ecpllc.net CERTIFIED POOL OPERATOR Name: ANDREW J. ANSELMO Cert#:01-182673 TEL#978-852-4001 DATES OF OPERATION(if not annual): MEMORIAL DAY thru LABOR DAY DAYS& HOURS OF OPERATION: SUNDAY thru MONDAYS 10 AM — 9 PM 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 MGLaurnsan Section 49a,I certifyunder the pains and penalties of perjury that I,to my best knowledge and belief,have file ataxd all state taxes required under the law. Sign Date SS#or Federal Identification Number Revised 1120/13 limlappl Ldoc Check#Date 1 ll"-jb . n City of Salem, Massachusetts r � Board of Health lu R - 120 Washington Street, 4th Floor, Salem, MA 01970 PablicHeatth 0 P,ev<u.Promote.Prottt. Tel. (978) 741-1800 Fax. (978) 745-0343 Kimberley Driscoll Iramdin@salem.com Larry Ramdin, MPH, RENS, CHO Mayor Health Agent PUBLIC POOL HEALTH PERMIT Permit# PO-16-8 License For : Pool (seasonal) Date of Print 6/2/2016 Granted To: East Coast Properties Permit Issued 5/27/2016 Address: 400 Highland Avenue SALEM MA 01970 Permit Expires 9/30/2016 Location of Establishment: 19 INDIAN HILL LANE Permit Fee $140.00 Restrictions: Highland Condominium At Salem Trust 19 Indian Hill Lane Late Fee $0.00 Notes: This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 9/30/2016 , unless sooner revoked or suspended. e— r� Commonwealth of Massachusetts s City of Salem Board of Health lGmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Swimming Pool Seasonal Permit DATE PRINTED: 05/14/2009 ESTABLISHMENT NAME: Highland Condo Pool File Number:BHF-2004-000197 East Coast Properties 400 Highland Ave Ste. 11 Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes SWIMMING POOL- BHP-2009-0460 May 11,2009 Sep 30,2009 $140.00 SEASONAL Total Fees: $140.00 PERMIT EXPIRES ISeptember3O, 2009 Board of Health (XI�\,I,. ..,lei Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OIC HIi4AL111 120 WASHINGTON SIREET,411 FLOOR TE1..(978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 RECEIVE D` MAYOR IMANCINI([l7SALEM.COM JANETMANCIN,, MAY 1 L 200:1 ACTING HH Aum AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL end of INDIAN HILL LANE, SALEM HIGHLAND CONDOMINIUM AT NAME OF APPLICANT SALEM TRUST TEL# 978-741-2003 MAILING ADDRESS 400 HIGHLAND AVENUE, SALEM MA 01970 CERTIFIED POOL OPERATOR 01-182673 Name: ANDREW J. ANSELMO CertM TEL# 978-852-4001 DATES OF OPERATION (if not annual): MEMORIAL DAY to LABOR DAY DAYS &HOURS OF OPERATION: MONDAY thu SUNDAY — 9 AM — 9 PM TYPE OF POOL Public Semi-Public xx 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. P suant to MGL Chapte 63C, Section 49a,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have 1 1 ate tax re s an l paid all state taxes required under the law. / 5 / 11 / 09 0 _656��7� I ah a Date SS#or Federal Identification N ber ' ANSELMO, EAST COAST PROPERTIES , MANAGER Revised 8/14/07H'Pd ota Check# Date 5 W PP 6ast CoaUt PWpertfl 400 Highland Avenue Salem, MA 01970 (978)'741.2003 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 K.IMBERLEY DRISCOLL FAx(978)745-0343 MAYOR 1 Air NCINI&AI.ED4.COM � V: JANETMANCINI 'MAY 1 g4V�J ACTING HEALTH AGENT G V J Salem Board of Health 120 Washington Street 4's Floor Salem,MA 01970 Pursuant to The Virginia Graeme Baker Pool&Spa Safety Act and the Commonwealth of Massachusetts Minimum Standards For Swimming Pools(State Sanitary Code:Chapter V -105 CMR 435.00),I certify that the pool and all pool drain/grate covers in the semi-public or public pool (choose the type of pool below) swimming wading special purpose_ located at end of INDIAN HILL LANE HIGHLAND CONDOMINIUM AT SALEM TROST Establis�n ent Name c/o EAST COAST PROPERITES 400 HIGHLAND AVENUE SALEM MA 01970 Establishment Address 0"contbrm to the The Virginia Graeme Baker Pool&Spa Safety Act and the American National Standard ASME Al 12.19.8—2007 OR: ❑ do not conform to The Virginia Graeme Baker Pool&Spa Safety Act and the American National Standard ASME Al 12.19.8—2007 and that the pool will be shut down effective December 19,2008. t6re owfier/Corporation President Title Print name Date 400 alem, MA 01970hland e (978) 741-2003 City of Salem, Massachusetts Board of Health lu 120 Washington Street, 4th Floor, Salem, MA 01970 PublicmFleaIth Q) 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-15-9 License For : Pool (seasonal) Date of Print 5/29/2015 Granted To: East Coast Properties Permit Issued 5/15/2015 Address: 400 Highland Avenue SALEM MA 01970 Permit Expires 9/7/2015 Location of Establishment: 19 INDIAN HILL LANE Permit Fee $140.00 Restrictions: Highland Condominium At Salem Trust 19 Indian Hill Lane Late Fee $0.00 Notes: This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 9/7/2015 , unless sooner revoked or suspended. r CITY OF SALEM, MASSACHUSETTS BOARD of HEAI.n-1 120 WASHINGTON STRUT,4Q1 FLOOR KIMBERLEY DRISCOLL Ti.-'L.(978)741-1800 FAX(978)745-0343 MAYOR LRANIDINGa SALEM COM LARRY RAMDIN,RS/REHS,CHO,CP-PS HEALTHAGENT 2011 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL end of 19 Indian Hill Lane NAME OF APPLICANT—Highland Condominium at Salem Trust—TEL# 978-741-2003 MAILING ADDRESS-400 Highland Avenue, Ste 11, Salem MA 01970 CERTIFIED POOL OPERATOR Name: ANDREW J. ANSSELMO Cert#: CPO-251439 TEL# 978-852-4001 DATES OF OPERATION (if not annual): Memorial Day,5/15/15 thru Labor Day–9/07/15 DAYS & HOURS OF OPERATION: Monday thru Sunday 10 Am to 8 PM TYPE OF POOL Public Semi-Public x 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 Cha ter 63C, Section 49a, I certify under the pains and penalties of perjury that 1,to my best knowledge and belief,have filaq all state tax r Y Ir and paid all state taxes required under the law. L� l�� l/ , 0�6'�g '1 9 S gn ure Date SS#or Federal Identification Number Revised 5/23/11 poolappl Ldoc Check#Dated , 00 Inl ��, I � II� II"' ,I.I,I,. .Ire � •I. I I n I r UI11du4' � 'I' _ II I II llp I ,I II:I I �I .I 'II -1111 }I ' II,I�,II'° -IIIIII'IIIII 14111 �I1PN�'Ci °'�� .. �♦ f ♦ 1 ♦♦ ♦ ~ , •`v! J i'�. '�ivv J'� i. � � +. v �,fv.Jf+�/v` •.V A�•,w1'vv'.5'.i 'I �� C��'`w ♦ t t { (gyp � >9„a� <�F k.^ sy, ,.1 ".1 vA ,°r �"Jyi ib%i �.'.p ^+ `finM� )°I�+Ildv"d I�L+I 4prv4 .vryl'IGyrY� /� ♦ r 1 sr ;�'iM7F`h f! pal ^ul lel I^r �w�+IiP� + bs. 0�:, �'ibl� � . a ,... il�rll� '� Vli, �(IYI �i l�:if'. li 6 '��Iali SPYi nPI�''grc �'p'rip IIyiIP ✓ ilyigl J"ii t", t l�IC �,fa.�;'�� Ir� ��yy'�M�,k �°��I a !e� `� �..'7 ��SSl +. r' . � lnY,i '4Mk I^�I 'N`h�i �V4y �'�� QS11 �;�' �'p'� �li4 ip-1�� "sNy' rp r,,dlOk�'' y4hl 111' Ir II{ 1�r ^,�SS,' � �� r� • y r illlll'II,••• III IIII!'., Pill lL. 11'11111�IIn ,I I,. 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III'iIl"'..L;T r II!".0 r, rn P11I(IIII 111111 VIII IIIIIIII 111111 11111'1 IIIIIIII II II I IIl!�U III .1.11111 ., (a) II II 'll 11, 1 I I ,lI r & JIII, 01141 I,II IIII,IIIIIII' �� ' I I� III 4II�1 �r 1r 3 on Da VIII I IF�1111111 6 �2dII F� m Ce � a - f raifl6i tion Number: , CPO-25:439° A Expires.: Mar"chi- 6j)2020. - r Y.. a /Yl a' 5 r{ I + a "��' ♦ 14 !y -I h ^ a ry I to �y1i'� ��.lr+�-t'�I S` I!p 11 48W.0 ptAI eI y. 1 V' LJ II I!I N I �" , I ipi Vsp fLT IJtStPIIC w k r IA da iti4f 1� L, vVVI___ 1114 m ,ryl u i 4S {♦+ Ihwl All f " 1 4 YY AMA ,Ihn lrn„u 1�104n "10 bit R. Fsesagh� r � V s � ornas M Lachocki f Beal RT...ok HealthyBodi ? Chief Executive Officer 10111 �� VIII �. '•9. t.i 4!t w. � .t\y sr .r_ 4 r .f�,Jti.�;. RS4✓ • v e CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4 ..FLOOR KIMBERLEY DRISCOLL TEL. (978)741-1800 MAYOR FAX(978)745-0343 Iramdin@salein.com LARRY RAMDIN,RS/RENIS,CNIO,CP-FS HEALTHAGI:''NT Swimming Pool Inspection Report Pool: b b Date: Address cw Phone: Operator: Vno Max Bathing Load: In accordance wit 105 MR 435.00 Minimum Standards for Swimming Pools:State Sanitary Code C"ha VAnnual Permit Posted ✓ Health and Showers signs Posted Health: no sick employees,no sick bathers,bathers take showers,spitting prohibited,no glass. 4KLifeguards: Present _Certification _Red/orange suit _"Guard"primed on jersey _Sun block avail. _Voice Amplifier _Elevated seat Emer.Communication:phone at pool Phone instructions _Emergency numbers _Phone in unlocked area _Safe quip: for each 2000,sq.feet rope)tube or ring buQy(with IV� ackbqouard with collar and straps Fird: Epment area 5) 1"band-aids ✓ (�)5x9 surgipads �)ant)3x3 iseptgauize c wipes 8x10 Surgi soft roller bandages tssors 3"Soft roller bandages _ eezers '/z roll hypoallergenic tape escue blanket V gee packs Pocket mask V sterile isotonic eyewash Disinfection t Chlorine 6, _pH 7.2—7.8 Residual free 1-3,Combined 0-0.2 1/. d _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 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 NIA 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 f ilities Notes: Ion.m m u Y. Received Inspected by: �/ r 'r wr rx •'tivz �t:F: x k , ':.�. 4 n- a '-c. v , 'y c- : `` 4JF:.,y' .t k'� � Y� �!,'i+'"y'�^z ?� ra�,' 1'd. xd"4yyl r �<!.M r,,,�. �.":.s`�[[ k¢'`� ', �", �Sc '."4' �'�g ,r�r + ':w dff sr '�'*„^.� ( .,�1a'r• 'Y i e�+ ",15,1Pg"�''RP a?':wN :� +, r„�t9 Ap"�iy an .„ y yy r 4...n� ,i+", � 5 d r « t f s til.!S ;v-r t � , a u d r• d :r;;ag,"�`'r „,; + U aCit, of Salern IUlassach:usetts y#�y vr,r . , S ` , WY �T! Fv�''�u. '� �S '.} ',. r✓= F u§ a +�, ," � s �{ %..N`-;�$ ,Xv�M�f�}1 �aX.k4 '�� i a }+. vM� � .,r3( d w$'°''.,n,'k''h+ "a+�,r f,� .x°. ,Z.#y" xr t `"d✓,UN ° ''u'r itIMFa.'° 2 x ' t 5y7+".'w.X"t ' ,F”` v 'k'Ss7••t t t , s 1 : 3 r+ vt;. ,54:ry k.+ ., ;..� } ;:i ,x f�aStreef.4th, loot, Salem, r ._»tj, r F ]f gr )cr `''.,La Ramdin RSAREHS salern:com :, }.<rr; r'� ' 14mberle Driscoll v �{. r'� >n� .� ,�.� gnr#4 s ,. ;: k i t� �"` M� R� 'zMa or '�^" �•"'t`� ?8 I}� a��"K•0.' 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S ;,Y l # } G w j P014.-371 License -r+L 5vifXrt +v �, �r r , ` k .','stn ; °P' p' yr'..+� �4 'r� y ,mSs# t 4- Date of:Pnnt '.4 i � r� �-�:' 'f+y` F ,n; '+k A Of" vz` „.East�Coast Pro ernes LLC <` + Granted To ## P lr At, i'a ;5/221201,4 .r :,, YY , a a,.. ♦+: s �4�r; , '2` x1Y#,d9 w5 uexsti,+M xW' .7 ' T lw"SFn`Ya ^5zv m ,i,`m4 t3 "' .,°nfi✓ �w} 5 ,*`€n'• „ ,2, i t t x , 'd ,+i q. ,r.A,.*& " Ail'. `Y yY-s `a,�k�vt'f s-�,� `six ` F°tx Ips:�s4�i��' yrre i, .r� prn` '.fir}r' f g 4 "a; �v tt• YFx`!tlz,V{,,e` 't"kr -.P t 4 ,•.'Si' n 4;.,. 'Address•,'.6.EastCoast ' < .r>4r,;,.. r • 'Salem - :'t.. �<µ a 01970 'c' 7 '�',.r 5/22/2014 ,, aw ; r - 391 t' ;-Highlafld'AY@ Ste ,ytPe�miCExpires k.. 'z5 kit, a, a *+'t"C,+ Y " .. r� .?., "w t .`.' u - k ^e ; •,.in R ui + , l.#•iN 'S °A 'sE. - y # ra * a w;•+,e. +?- <, xp+ ' - Kab ,M �k�' :vet-�.dt , • ,w6! yxhk' >?fi rswre`-'°t :a�y';?.�x i.. 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('/ b" y. t f.:• 4 t4 '" 4 "' i{ Y 11 `L 5 { ss 9 wr,. reJl!c "'y* +• teaa v 4 eA' r•,, i..ur(;S Y�:e`f v i' A t k S`s% ; IY M i"x 'Y' }:"`x k "-4• :� ' 'q s ' --•: s "n s z r'i y Restrictions - rr .�r w e s..A :'Y $*r 'ak r rvs .+r h. >, ' �^ ria + 5t a ,s a '. # a'"' z sw-az 4,� k ," ty..;,x h v s tx ,• 1' � LateFee ':.x T a g", �'•,:'''` Cdr T..r'.»:tl ' s'�'h °v �.aq °? }� •,?u.'.#` hrj$OPa..,£O.x+O� ,µ ,qr,,�:.+3 r�t+r°.+1T�( ' ii a-'.+i 4mk�,5,+gy im ,snv xv„tN.e.a5Zr+a3� •g.`i�'.v.bws t s:, ,+s*?x,:ts. 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Yy ' , ^a<° "� e k L""Ar r@VOlted Or suspended ak , g + e s a c < + IF U,vN n. # r 't ➢ r ��1 �' �'[ 'f"Y a t ,x:„ e �h z, tu•s P, °"e}4 s, r '. �`r'a�2w x s:d r • x3u �a.. 1 *W } ay �, .i'i & `4 4 : _ E m 4.> x sr �yr# rC rt r a v . �,• rP u, ' + 4- t i Ik e CITY OF SALEM, MASSACHUSETTS BOARD OF H8AETH 120 WASHINGTON S1REE'r,4" F1,OOR KIMBERLEY DRISCOLL Tri (978)741-1800 ' FAx(978)745-0343 MAYOR LRAN[DIN(aDsALEM.COM LARRY RAMDIN,RS/RE IS,CHO,CP-FS HEALTH AGENT 2014 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL end of Indian Hill Lane, Salem NAME OF APPLICANT Highland Condo at Salem Trust TEL# 978-741-2003 MAILING ADDRESS 400 Highland Avenue, Salem MA 01970 CERTIFIED POOL OPERATOR Name: Andrew J.Anselmo Cert#: 01-182673 TEL#978-852-4001 DATES OF OPERATION(if not annual): Memorial Day to Labor Day DAYS & HOURS OF OPERATION: 7 days a week— l OAM—9 PM TYPE OF POOL Public Semi-Public x Special Purpose FEE: $210.00 for year round poolF,$1406.!()�for seasonal$40.00 Non-Profit (Please pay total with one check pto 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 file �I state tax retu s an I paid all state taxes required under the law. 5/05/14 Federal Id Number: 04-6568871 /Signa ue Date SS#or Federal Identification Number Revised 5/23/11 poolappI l.doc Check#Date �� i - w t"+ - �� c .- �,; .`N ":' � ±• a w' W k %A '} u it .. x�r . f�s N:�" .� g x`�j,'a ,'; �, 't S �. e.+ 'k r � tl° x 'am'. J% � " w '-� � .�, '� $#. ,:. � r .3�y rw•�5° .. � �'9 �� .. `" q � &W F u a k sk, x £' .',; �. O, °'. # '"' ', r '* C � t ':rav ;• , � r� Sv� '. �a , ��+ r + �1�:L^' m�t ��. +q% p °�,� $f.. ,+a rSdx � ty 3 tF Al,Xn A,`Y.e � .T v,•. 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': ` {z r �T� Oy Dy k, '' 3 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4TM FLOOR TEL.(979)745-1800 KIMBERLEY DRISCOLL FAx(979)745-0343 MAYOR lramdin_.salem.com LARRY RAMDIN,RS/REHS,CHO,CP-FS HEALTH AGENT ,_APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL end of INDIAN HILL LANE, SALEM LOCATION OF POOL_ HIGHLAND CONDOMINIUM NAME OF APPLICANT AT SALEM TRUST TEL# o 7 a 7 n 1 u n 3 MAILING ADDRESS EAST COAST PROPERTIES, 400 HIGHLAND AVE. , SALEM MA CERTIFIED POOL OPERATOR 01 -182673 Name: and T Ansal:mo Cert#: TEL# 978-857_4001 DATES OF OPERATION(if not annual): MEMORIAL DAY to LABOR DAY DAYS &HOURS OF OPERATION: 7 days a week – 10 AM – 9 PM TYPE OF POOL Public Semi-Public XX 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 MGL Chapter 63C, ee�ion 49a, I certify under the pains and penalties of perjury that I,to my best knowledge and belief, have filed to tax returns and and a state taxes required—der the law. t x0113 01-/- Si na re Date SS#or Federal Identification Number Rev' ed IV f poo appl fldm Me X_#Date f d " CITY OF SALEM, MASSACHUSETTS dJ BOARD OF HE�ILTH 120 WASHINGTON STREET,4"'FLOOR KTEL. (978) 741-1800 IMBERLEY DRISCOLL Fax(978) 745-0343 MAYOR lramdin@salem.com LARRY RANIDIN,RS/RFI IS,Cf 10,CP-F5 Hj. IMxi-i AGENT Swimmine Pool Inspection Report Pool: 14)W)4—*n t';%~ Date: Address Phone: Operator: Max Bathing Load: 1n accordance with 105 CMR 435.00 Minimum Standards for Swimming Pools:State Sanitary Code Chapter V __�//A�nnual Permit Posted 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 Emer. ommunication: phone at pool tone instructions t/ Emergency numbers hone in unlocked area r/Safe Equip: for each 2000,sq. feet > escue tube or ring buoy(with rope) L-/ Backboard with collar and straps First ld: Equipment area V35) I"band-aids ✓f�10)3x3 gauze 2)5x9 surgipads 12)antiseptic wipes (1)8x10 Surgi (2)2"soft roller bandages 7 Scissors _,42)3"Soft roller bandages ,LTweezers1) '/z roll hypoallergenic tape escue blanket ce packs ask Pocket m _sterile isotonic eyewash Disinfection Chlorine -2,0 pH 7.2-7.8 Residual free 1-3, Combined 0-0.2 _Bromine _pH 7.2-7.8 Residual 2-6 (ppm)(mg/l) Re cor Kept: — Watertests �C�emicalsUsed ✓ Backwashing ✓Attendance ours of operation Depth Markings Sidewalk and inside pool Diving Boards rigidly constructed,properly anchored,braced for heaviest load,no splinters or c l cracks,non-slip surface,not over 10' above water level and at least 13' unobstructed headroom N19 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: ' a.a�a S ne- T'), Received by: 4 Inspected by:C _ _ I 4 ? C1'1Y OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR �1211C��Aflflth rrr,cni.v<<•mmc.rrna . TEL. (978)741-1800 FAX(978)745-034.3 KIMBERL EY DRISCOU, lt-a_Ln dinA a saletri,com 1,1RRY RANiD1N,IiS/at3I-ts,G 70,(T-I'S MAYOR 14FAI;l l l A(;I NT Swimming Pool Inspection Report Poo1: �,C'e,11,�- C�1e7 Date: 1 a, _ Addressyy Phone: Operator: 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 prohibited,no glass. Lifeguards: Present _Certification —Red/orange suit _"Guard"printed on jersey _Sun block avail. Voice Amplifier Elevated seat Enter. Communication: phone at pool —Phone instructions _Emergency numbers Phone in unlocked area _V Safety Equip: for each 2000,sq.feet _Rescue tube or ring buoy(with rope) Backboard with collar and straps _First�id:Equipment area ✓ (3 5) 1"band-ands _f(10)30 gauze V(2)5x9 surgipads (12)antiseptic wipes Z6)8x10 Surgi ✓(2)2"soft roller bandages _/Scissors v(2)3"Soft roller bandages Tweezers (1)Y:roll hypoallergenic tape Rescue blanket ice packs ,/Pocket mask =sterile isotonic eyewash } 1`i2 L✓j'pyt7rP t/ _Disinfection / _Chlorine S-S C _pH 7.2—7.8 Residual free 1-3,Combined 0-0.2 _Bromine `j, 1}( _pH 7.2—7.8 Residual 2.6 (ppm)(mg") Records Kept: _Water tests _Chemicals Used _Backwashing __Attendance __Hours of operation Depth Markings Sidewalk and inside pool Diving Boards rigidly constructed,properly anchored,braced for heaviest load,no splinters or c N� 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: Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Swimming Pool Seasonal Permit DATE PRINTED: 05/24/2011 ESTABLISHMENT NAME: Highland Condo Pool File Number:BHF-2004-000197 East Coast Properties 400 Highland Ave Ste. 11 Salem, MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes SWRVIMING POOL- BHP-2011-0442 May 28,2011 Sep 6,2011 $140.00 SEASONAL Total Fees: $140.00 PERMIT EXPIRES ISeptember6, 2011 Board of Health e f� Page 1 I1- ` ° CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4'ro FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR DGREENBAUM@SALEM.COM DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL INDIAN HILL LANE, SALEM MA HIGHLAND CONDOMINIUM AT NAME OF APPLICANT SALEM TRUST TEL# 978-741-2003 MAILINGADDRESS 400 HIGHLAND AVE. , STE 11 , SLAEM MA 09170 CERTIFIED POOL OPERATOR 01 182673 Name: ANDREW J. ANSELMO Cert#: TEL# 978-852-4001 MEMORIAL DAY to LABOR DAY DATES OF OPERATION (if not annual): DAYS & HOURS OF OPERATION: 10 AM — 8 PM — 7 days a week TYPE OF POOL Public Semi-Public xxx 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. Pu nt to MGL Chap 63C, ection 49a,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fed ate tax ret sand pa' all state taxes required under the law. / 5 11 11 04 6568871 Ai na re Date SS#or Federal Identification Number Revised 10/6/10 poolappI I.doc Check# Date East Coast Ptopertias, LLC 40p Hghleh0 Avenue,ft.1 t selem.MA 01970 RM 741.20U Ee�ipeeDl.CMn ,.� _� I i I "�a_4 ,��}�scpQyca ?aye�i;7�tzia-.� r S w��,9urayq baBNf(»F?4�P' �' {ltf il� 1R{ rti;Dixr. CSXiS roi carpi +*+ua kisl�v;�9z+ca3/2w� I " CITY OF SALEM, MASSACHUSETTS BOARD OF HEAI:.Tii 120 WASHINGTON STREET,4...FLOOR TEL. (978) 741-1800 ' K1M13LRLEY llRISCOLL FAX(978) 745-0343 MAYOR lramdin@salem.com LARRY RAMDIN,RS/RGI[S,CHO,CP-FS HFAIxiiA(;UNI Swimming Pool Inspection Report Pool: O W)Le 1, e,>*g>z�s Date: ! ' 27- ) ) Address Phone: Operator: Max Bathing Load: In accordance with 105 CMR 435.00 Minimum Standards for Swimming Pools;State Sanitary Code Chapter V. v--�Gnual Permit Posted r-Health and Showers signs Posted X—Health: no sick employees, no sick bathers, bathers take showers, spitting prohibited,no glass. 144 Lifeguards: Present _Certification _Red/orange suit _"Guard"printed on jersey —Sun block avail. _Voice Amplifier _Elevated seat 4�l;mer.Communication: phone at pool ✓Phone instructions Emergency numbers V--Mone in unlocked area Safety Equip: for each 2000,sq. feet _✓Rescue tube or ring buoy(with rope) v Backboard with collar and straps first Aid: Equipment area ✓V5) 1"band-aids 0)30 gauze V750 surgipads y(t2)antiseptic wipes e-(1)WO Surgi r_(2)2"soft roller bandages ✓3t:issors L-12)3" Soft roller bandages _✓-Neczers ) '/2 roll hypoallergenic tape + %,cue blanket �e packs 'Pocket mask _P;�_Sierile isotonic eyewash Disinfection v '�Chlorine_Z•Y ✓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) ✓ Records Kept: _✓'Water tests ✓Chemicals Used =Backwashing v—Attendance --Rours of operation ✓�Depth Markings Sidewalk and inside pool J1!�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 p) 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:! Q11�--r-tJ71 W - CITY OF SALEM BOARD OF HEALTH — 120 WASEZEGMW STREET 4TH FLOOR, SALEM, MA 01970 1_ _)A rnJ Poor,INSPl;cx)MO_N REPM Pool: ��E,y�tTate: Address: Phone: Operator: Max. bathing load: In accordance with 105 CMR 433.000 Minimum Standards for Swimming Fools,- State Sanitary Code: Chapter V. ✓ - ANNUAL PERMIT POSTED - HEALTII and SHOWER SIGNS POSTED ✓ -HEALTH: no sick employees, no sick bathers, bathers take showers,spitting prohibited, no gds. A -LIFEGUARDS: Present _-certification _- red/orange suit _- "guard" printed on jersey _ sunblock avail. _- voice amplifier -elevated seat -EMER COMMUNICATION: phone at pool -phone instructions emergency numbers _-phone in unlocked area -SAFETY EQUIP.: for each 2000 sq. feet - rescue tube or ring buoy (with rope) backboard with collar and straps �- FIRST AIL '' equipment area 1/ -(35) 1" bandaids ,/-(10) 30 gauze ✓-(2) 5"x 9" surgipads __V-(I) 8x10 surgi ✓ -(2) 2" soft roller bandages ✓ - scissors 42) 3" soft roller bandages V- tweezers -(I) 1/2" roll of hyperallergenic tape �Vl 1ot�`S ✓ - rescue blanket - ice packs _Z-(12) antiseptic wipes�\�� - pocket mask -(I) sterile isotonic eye wash - DISINFECTION - chlorine pH 7.2 - 7.8 Residualsfree 1-3, combined 0 0-2 - bromine pH 7.2 - 7.8 Residual- 2-6 (PPM) (M3/1) __ ----�--- --RECORDS-I:epf-- `T.1-- --- — ��Yn - Water tests ✓ chemicals used 1f- backwashing attendance hours of operation DEPTH MARKINGS: sidewalk and inside pool - DIVING BOARDS: rigidly constructed, properly anchored, braced for heaviest load, no splinters or cracks, non-shp surface, not over 10' above water level and atleast 13' �Ay unobstructed headroom. BATHHOUSE: sepcnic drrssrng and sanitary facilitics for tach sox -adjacent to pool, well-hghled_drained, vwtilarcd, impervious eonstruenon,one shower and one toilet per 80 bathers,hot and cold water,soap providedno common cups, towels, combs pool adcouatcly r.ncloscd approval cinnking water facilitics received by:_ inspected by Commonwealth of Massachusetts City of Salem lip Board of Health 120 Washington Street,4th Floor Kimberley Driscoll SALEM,MA 01970 Mayor Swimming Pool Seasonal Permit DATE PRINTED: 05/18/2010 ESTABLISHMENT NAME: Highland Condo Pool File Number:BHF-2004-000197 East Coast Properties 400 Highland Ave Ste. 11 Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes SWIMMING POOL- BHP-2010-0422 May 28,2010 Sep 6,2010 $140.00 SEASONAL Total Fees: $140.00 PERMIT EXPIRES ISeptember6, 2010 Board of Health ,Page 1 4�s CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASI-BNGTON STREET,4-FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR DGRI::ENBAUM(el)SALEM.COM DAV1D GREENBAUM, ACIING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL end of INDIAN HILL LANE NAME OF APPLICANT HIGHLAND CONDO AT SALEM TEL# 978-741-2003 MAILING ADDRESS 400 HIGHLAND AVENUE, SALEM MA 01970 CERTIFIED POOL OPERATOR 0 I- 1:P4/093 Name: ANDREW J. ANSELMO Cert#: TEL# 978-852-4001 DATES OF OPERATION (if not annual): MEMORIAL DAY to LABOR DAY DAYS & HOURS OF OPERATION: 9AM - 8 PM MONDAY thru SUNDAY TYPE OF POOL Public Semi-Public - XX 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 mustbereissued'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 C 63C,Section 49a, I certify under the pains and penalties of perjury that 1,to my best knowledge and belief,have e all state tax eturns d paid all state taxes required under the law. ,////0 S' lure Date SS#or Federal Identification Number Revised 8/14/07 poolapp.wpd Check# Date -� Prom:978 745 9684 05121/2009 14:52 #269 P.001/005 I EAST COAST PROPERTIES 400 Highland Avenue,Ste. I I Salem MAO 1970 978-741-2003:FAX 978-745-9684 E-mail:EostCoostPro@ool.com f Real Estate&Property Management j t FAX DAVID GREENBAUM n To: I From. Yt "±% . Fax: 978-745-0343 Pages: 3 i Phone: 978-741-1800 3 Date: 5121109 1 _- Re: HIGHLANDILORING HILLS POOLS 1 Cc: ' COMMENTS: j Aiidched are copies of the paperwork regarding the pools of Highland Condominium, end of Indian Hill Lane and Loring Hills Condominium, 6 Loring Hills Avenue. I I I I } , i i i , I 1 1 1 I i I i 1 I � i I I I 1 I I 1 I 1 1 1 I 1 1 I � I I I I 1 I i 1 I I I I E,(om:978 745 9684 05/21/2009 14:53 #269 P.002/005 FAMILY POOLS & PATIO, INC. 70 South Broadway Lawrence, MA 01843 978-688-8307 To Whom It May Concern: This is a letter to verify that the pool at Highland Condo on 400 Highland Ave Salem MA is compliant with the Virginia Graeme- Baker Pool and Spa safety act. On 5/18/09 a Pentair Intelliflo pump with built in suction vac release system was installed on the pool. On 5/16/09 compliant drain covers were installed with the ANSI/ASME Al 12.19.8M stamp on them verifying that they are compliant on the single drain. Any questions please call Family Pools 978-688-8307 x 14. Thank You Bill Gianopoulos Family Pools ��il�Owner Ftrom:978 745 9684 05/21/2009 14:53 #269 P.003/005 I Hayward Industrial Drive jQHAYWAR1YPooiPr0dUCtS Clemmons,NC27012 A Hayward Industrms,Inc.Company 336-712-9900 www.haywardnetccom CERTIFICATION OF COMPLIANCE Contains: WGIO48E Description: 8" Round Suction Outlet Cover Ratings: Floor: 125 GPM Wall: 72 GPM Open Area: 8.I sq-in Certified to Comply with Section 1404 of the Virginia Graeme Baker Act(VGB)Pool&Spa Safety Act Test Results can be obtained from:www.Havwardnet.com and/or h"p://www.nsf.orpjcenified/Pool Manufactured: Between October 2008 and December 2008,by Hayward Pool Products in Jiangsu Province, China and Clemmons,NC Divisions of Hayward Industries, Inc. 620 Division Street,Elizabeth, NJ 07207, Phone 908-355-7995 Date of Mfr:The Lot Number shown on the product label contains the Year&Month of manufacture. The first number represents the year(ex 8=2008)and the second character the month(A=Jan, B=Feb, H=Aug, I is skipped,J=Sep,etc) Tested to ANSI/ASME 112.19.8-2007(addendum 8a-2008)per Section 1404 of the Virginia Graeme Baker Act(VGB)Pool&Spa Safety Act. Certified by NSF International, 789 N. Dixboro, Road,Ann Arbor,MI. 48105 1(800)-NSF-MARK. Date of Installation: S'( (,1 0e ISWGIO48COC FAIAA I lS4 poo� 'r 6,. SPACING BETWEEN MOUNTING HOLES USED ON FOLLOWING SERIES: 00 00 WGI030AVPAK2 SP1030AVPAK2 0000000 WG1048AVPAK2 SP1048AVPAK2 000000 X73/4" .R 0000000 WG1049AVPAK2 SP1049AVPAK2 000000000 WG1051AYPAK2 SP1051AVPAK2 SUCTION OUTLET 0000 0000 COVER WG1048E 0000 WG7052AVPAK2 SP1052AVPAK2 000 0 000000 WG1053AVPAK2 SP1053AVPAK2 000000 WG1054AVPAK2 SP1054AVPAK2 00 000 WGI153AVPAK2 SP1153AVPAK2 WG1154AVPAK2 SP1154AVPAK2 GqDLDUNE HAYWA UPooi Prod" O -ne---so-uu'rce.---'Every---..phot.—_ M S CITY OF SALEM, MgSSACHUSETTS yI — B(,)-ARD OF" HF�LTH 1` 120 WASHINGTON STREET,4"'FLOOR. TEL. (978)741-1800 KIMBERLLY DRiSCOId, F,AR(978) 745-0343 MAYOR IMANCtNIr�sA]12,1a,00IN-4. ]AN la;f MANCI N I ACTING Ht?At:rH Act=.NT Swimming Pool Inspection Report nate: 51at joa Phone: C1R8 'ILt 1 2.003 Max Bathing Load: In accordance with 105 CMR 435.00 Minimum Standards for Swimming Pools:Slate Sanitary Code Chapter 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 Red/orange suit _"Guard"printed on jersey Sun block avail. Voice Amplifier Elevated seat Emer.Communication: phone at pool _Phone instructions _Emergency numbers _Phone in unlocked area Safet Equip: for each 2000,sq. feet Rescue tube or ring buoy(with rope) Backboard with collar and straps First Aid: Equipment areea x(35) 1"band-aids _jZ(10)30 gauze (2)5x4 surgipads (12)antiseptic wipes (1)8x10 Surgi V(2)2"soft roller bandages Scissors 1/:(2)3"Soft roller bandages Tweezers (1)%,roll hypoallergenic tape Rescue blanket ✓ ice packs Pocket mask sterile isotonic eyewash Disinfection Chlorine li 5h JPH 7.2-7.8 Residual free 1-3,Combined 0-0.2 Bromine _pH 7.2-7.8 Residual 2-6 (ppm)(mg/1) Records Kept: Water tests ✓Chemicals Used -v Backwashing N Attendance �Hours of operation okDepth 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 01160_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: met 6 VP t aj G_a r Received b nspected by: —.— i Commonwealth of Massachusetts « ° City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 DATE PRINTED: 05/20/2008 ESTABLISHMENT NAME: Highland Condo Pool File Number:BHF-2004-000197 East Coast Properties 400 Highland Ave Ste. 11 Salem MA 61970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes SWIMMING POOL- BHP-2008-0459 May 20,2008 Dec 31,2008 $140.00 DATES OF OPERATION: SEASONAL Memorial Day-Labor Day HOURS OF OPERATION:10:00 am to 9:00 pm 7 days a week/SEMI-PUBLIC Total Fees: $140.00 PERMIT EXPIRES December 31,2008 Board of Health i�— Page 1 ° CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGI'ON STREET,4'°'FLOOR TEL.(978)741-1800 RECEIVEDK IMBERLEY DRISCOLL FAx(978)745-0343 MAYOR JSCGFI uSALENLCOM MAY - 9 2008 JOANNE SCOTT, CM'OF S;iLEM HEALTH AGENT BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL end of INDIAN HILL LANE, SALEM NAMEOFAPPLICANT HIGHLAND CONDOMINIUM AT TEL# 978-741-2003 SALEM TRUST MAILINGADDRESS �00 HIGHLAND AVENUE, SALEM MA 01970 CERTIFIED POOL OPERATOR 91-182673 Name: ANDREW J. ANSELMO Cert . TEL# 978--852-6001 DATES OF OPERATION (ifnotannual): MEMORIAL DAY TO LABOR DAY DAYS &HOURS OF OPERATION: 7 DAYS A WEEK —10 AM — 9 PM TYPE OF POOL Public Semi-Public X 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. Io 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 Chap" C,Section 49a,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have e all state tax recut s an paid all state taxes required under the law. s ag"vz 1 at Date SS#or Fe ral I entification Number Revised 8/14/07 poolapp.wpd Check# Date t Commonwealth of Massachusetts s ; City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Swimming Pool Seasonal Permit DATE PRINTED: 05/25/2012 ESTABLISHMENT NAME: Highland Condo Pool Fite Number:BHF-2004-000197 - East Coast Properties 400 Highland Ave Ste. 11 Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes SWIMMING POOL- BHP-2012-0442 May 25,2012 Sep 29,2012 $140.00 SEASONAL Total Fees: $140.00 PERMIT EXPIRES ISeptember29, 2012 Board of Health Page 1 9 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4m FLOOR KTEL(978)741-1800 IMBERLEY DRISCOLL FAx(978)745-0343 MAYOR lramdin e salem.com LARRY RAMDIN,RS/REHS,CHO,CP-FS HEALTH AGENT 2012 21x1 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATIONOFPOOL Pori of TmT)TDN HTii I,ANE NAMEOFAPPLICANT HIGHLAND CONDO AT SALEM TEL# 978 741 2003 TRUST MAU,ING ADDRESS non HIGHLAND AVENUE SALEM MA 01979 CERTIFIED POOL OPERATOR 01 -182673 Name: ANDREW J ANSELMD Cert#: TEL# 978 741 2003 DATES OF OPERATION(if not annual): MEMORIAL DAY TO LABOR DAY DAYS &HOURS OF OPERATION: 7 days a week — 10 AM — 9 PM 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 CI e 1,3C,Section 49a,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have all state tax r urns tpaid all state taxes required y�u�/nder the law. /1L_/�0.4-6S68271 S' n lure Date S#or Federal Identification Number Revised 5/23/11 poolappl Ldoc Check#Date