Princeton Crossing Pool Inspection 5-20-2019 1F ' CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
'120 WASHINGTON STREET,4".FLOOR PubliCHeak
Prevent.Promote.Protect.
TEL. (978) 741-1800 FAx(978) 745-0343
KIMBERLEY DRISCOLL lramdin Casalcm.com.
LARRY RANDrN,Rs/REI-is,c.Fio,cP-.F
MAYOR HEALTH AGENT
SWIMMING POOL INSPECTION REPORT
NAME: el 1,0 C EL LC 1 Vn DATE: 5.a0 19 TIME IN:
ADDRESS: is M i Po4w ors PHONE: TIME OUT:
CERTIFIED POOL OPERATOR: _6(ced Ne tJl o
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
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
rece tacle
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 w
• Special Purpose Pools (Spas)—Once every half hour CI=
Maximum design filtration for filters:
• High rate sand filter— 15 gpm/ftz -20 gpm/ft2(NSF filters)
• DE filters—2 gpm/ft2
• 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
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
SWIMMING POOL INSPECTION REPORT ,
Regulations 105 CMR 435.000
Minimum Standards for Swimming Pools, State Sanitary Code, Chapter V
NAME'— f+�w Lg ' j��; _ DATE'
Regulation Compliance r
Number Yes I 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
N4swimming 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 letterinE. Lifeguards shall direct their attention to area assi Lned
435.24 Safety Equipment—One ring Buoy for each 2000 ftz,One rescue tuband rescue hook Lifeguan
staffed pools shall have readily available a backboard with.stra s
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
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 sidewalk
of pool at all distance up to tenyards) _
435.32 ry r Water Quality Maintenance—Special purpose pools shall be drained, cleaned and refilled a
I v 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 E General Sanitation—All pools, bathhouses and grounds shall be maintained in good repair, safe
and sanitaty manner.
Remarks,Results and Action Taken:
Swimming; Pool Wading/Kiddie Pool Spa Type: Type:
Free Free Free Free Free
Chlorine Chlorine Chlorine Chlorine Chlorine
Combined Combined Combined Combined Combined
Chlorine Chlorine Chlorine Chlorine Chlorine
Bromine Bromine Bromine Bromine Bromine
H PH pH PH pH
Alkalinil-v Alkalinity Alkalinii► Alkalinh►� Alkalinit►
Calcium Calcium Calcium Calcium Calcium
Hardness Hardness Hardness Hardness Hardness
SWIMMING POOL INSPECTION REPORT
Regulations 105 CAM 435.000
Minimum Standards for Swimming Pools, State Sanitary Code, Chapter V
NAME: DATE:
Remarks,Results and Actions:
Type: Type: Type:
Free Free Free
Chlorine Chlorine Chlorine
Combined Combined Combined
Chlorine Chlorine Chlorine
Bromine Bromine Bromine
H J)H H
Alkalinity Alkalinit v Alkalinif.
Type: Calcium Calcium Calcium
Type
Hardness Hardness Hardness Type'
Pool Pool Pool
Volume g Volume g Volume
Sand Sand Sand DE
Filter Type DE Filter Type DE Filter Type Cartridge
Cartridge Cartridge
Filter Size ftz Filter Size ftZ Filter Size ft2
Minimum Minimum Minimum
Flow Rate a m Flow Rate g m Flow Rate,-,pm
Maximum Maximum Maximum
Flow Rate gpm Flow Rate gpm Flow Rate gpm
Actual Actual Actual
Flow Rate > >m Flow Rate gpm Flow Rate gpm
Passed Inspection: Yes []No ❑ Re-Inspection Date:
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'ILL.(978)741-1800
KIMBERLEY D.RISCOLL hmlthP'sakem.com D,kv1D GRELzNBAUJIM
MAYOR F RAI TF-I AGENT
APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL
LOCATION OF POOL
NAME OF APPLICANT
MAILING ADDRESS ,Z ��-/
v -
EMAIL ADDRESS
CERTIFIED POOL OPERATOR L
Namewq(1-C/ egm✓�v Cert#: TEL#
DATES OF OPERATION(if not annual): " � ( /;/
DAYS &HOURS OF OPERATION:
TYPE OF POOL
Public
Semi-Public
Special Purpose
Surface Area _sf Volume--&�2 gallons Bather Load
FEE: $210.00 for year-round pools $140.00 for seasonal $40.00 Non-Profit
(Please pay total with one check payable to the City of Salem)
This permit is not transferable and must be reissued upon change of ownership.
In accordance cfi the 1itate Sanitary Code,before any renovations,improvements,or Equipment changes are made,all plans
for such mus a submi led to and approved by the Salem Board of Health.
Pursuant MGL Ch ter 63C,Section 49a,I certify under the pains and penalties ofperjury that I,to my best knowledge and belief,
ve$ all state returns and paid all state taxes requiredO
he law.
�a DateSS#or Federal Identification Number
This section for office use only
Check# 1 Date Amount__ b n