6 DEWEY DRIVE POOL INSPECTION 5-25-2022 41
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
98 WASHINGTON STREET,3RD FLOOR pPublicHedth
TEL. (978) 741-1800
KIMBERLEY DRISCOLL health�?,salem.com
DAN7ID GREIJNBAUM,RS
MAYOR HE,uLTH Ac 1.N'f
SWIMMING POOLINSPECTION REPORT
-P -n en
NAME. '7 DATE: I TIME IN:
f9
ADDRESS: PHON ME OUT:,,
CERTIFIED POOL OPERAT U
Regulations 105 CMR 435.000 :Min im 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
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 00 Q/ $O+ �' �'
/< • Special Purpose Pools(Spas)—Once every half hour
Maximum design filtration for filters:
• High rate sand filter— 15 gpm/ft2 -20 gpm/ft2(NSF filters)
• DE filters—2 gpm/ft2
• Cartridge filters—0.375 gpm/ft2
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
V/ 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
cjperation of 12urification a ui ment
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
x 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
SWLMMING POOL INSPECTION REPORT
Regulations 105 CMR 435.000
Minimum Standards for Swimming Pools, State Sanitary Code,Chapter V ll
NAME:- R GyC 'n , PCr k Co/1 G(O S DATE: < S
Remarks,Results and Actions:
Tvl)e: T e: Ty pe:
Free Free Free
Chlorine Chlorine Chlorine
Combined Combined Combined
Chlorine Chlorine Chlorine
Bromine Bromine Bromine
H pH pH
Alkalinit i Alkalinit v Alkalinity'
Calcium Calcium Calcium
Type: Hardness Hardness Hardness Type:
Type
Pool Pool Pool
Volume �f�f� 000 Volume R Volume g
n Sand Sand DE
Filter Type DE Filter Type DE Filter Type Cartridge
Cartridge Cartridge
Filter Size ft' 3FF Filter Size ft2 Filter Size ft2
Minimum Minimum Minimum
Flow Rate up m Flow Rate gpm Flow Rate gpm
Maximum Maximum Maximum
Flow Rate gpm 13 o 5 Pv-% Flow Rate m Flow Rate gpm
Actual Actual Actual
Flow Rate m �' 5 P"� Flow Rate gpm Flow Rate gpin
Cam. c-cA r n n ed I fc, 6 L' hi! n r �.tD
&' 1n'L�
5 C:
rr e s r+C e
Passed Inspection: Yes A.4 o d Re-Inspection Date: S - 6 -d A
Inspector's Signature:
Person In Charge: