HomeMy WebLinkAboutPools Inspection 9999 Cinnamon Springs R Town of South Windsor — Health DepartmentRF
+O 1540 Sullivan Avenue, South Windsor, CT 06074 L'��VFO
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Phone: 860-644-2611 ext. 248 Fax: 860-644-7280 MqY
PUBLIC SWIMMING POOL REGISTRATION FORMSOUr 202014
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FACILITY NAME:_ /nrl��n�
ADDRESS: Clnod 41 60
PHONE: 'R6 6S7 — F9el EMAIL:
OWNER/ASSOCIATION
REPRESENTATIVE: AV�✓��//� //, ��-j �Gr� e.1/
ADDRESS:_ '
PHONE: EMAIL:
MANAGER(if different from owner):
ADDRESS:
PHONE NUMBER: EMAIL:
POOL
OPERATOR: / /
ADDRESS '/4(�
PHONE NUMBER ��� Z�� "r`�2 / EMAIL
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FACILITY INFORMATION:
Check all that apply:
Indoor Pool Outdoor Pool Wading Pool Whirlpool/Spa
Dates Pool is Open: From ,S`!Z-2 to
Pool Capacity: /%, d v U a,26
Pool Make-up Water Source: Public Private
Disinfectant Used:
The unde agrees to comply with Section 19-13-B33b of the Connecticut Public Health Code:
ature of Applicant Tlt a Date
*Please return completed registration form to the South Windsor Health Department. Pool inspection requests must be scheduled 2 weeks
prior to anticipated pool opening date.
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0 Routine Inspection A Indoor Pool
Town of South Windsor—Health Department
A Re-inspection I Outdoor Pool
c 1540 Sullivan Avenue,S.Windsor,CT 06074 A Complaint A Wading Pool
Phone: 860-644-2511 x248 Fax: 860-644-7280 A Other: A Whirlpool/Spa
ALY?R4;t:.
Public Swimming Pool Inspection Report
Name of Facility: CIrw\c rl .. Sxr;,�.c�s Inspection Date: S aO I1
Address: Cyr 5 Phone:
Items marked with an X indicate non-compliance wi CT Public Wealth Code(Section 19-13-B33b). Violations must be corrected by the listed compliance date.
a-4 Life Saving Equipment b-12 Vacuuming
N/ Ring buoy <15" inner diameter,attached to Pool vacuumed to maintain cleanliness
/ 50ft length of%" line
Life pole/shepard's crook with blunted ends, a b-13 Accessibility to Pool Area
minimum of 12ft in length Putdoor pools surrounded by barrier(>4ft)
b-1 Pool Construction Outdoor pool entry gates self-closing and self
latching
Pool inn ggood repair
b-2 pory Personnel Pool access restricted when pool is closed
Knowledgeable pool supervisor onsite b-14 Lifeguards
List of personnel provided to Health Dept. Warning signs if no lifeguard on duty(letters
>4" high)
b-4 Pool Water Clarity Warning signs visible from all entry 6" secchi disk at pool bottom visible g 8 ns points in
b-5 Pool Water Disinfection pool area
- Automatic Feeder Used
b-15first Aid Kit
Kit filled, ready for use, materials current
b-5, b-6 Teestst Kit
> mg/Liter Free Chlorine Amer. Red Cross 24-unit first aid kit or equiv.
s Emergency Telephone
DPD Test Kit onsite (for disinfectant and pH) b-16
b-6 Poo Water pH Telephone readily available in pool area
l Value between 7.2 and 7.8 b-17 Signs
b-7 Records and Testing "All persons shall bathe with water and soap
V Residual disinfectant&pH tested prior to daily before entering pool""Anyone having a communicable disease shall
opening not use the pool"
Daily pool testing records kept / prohibited"
"Spitting,or blowing the nose in the pool is
b-8 Decks, Dressing,Toilet&Shower Rooms ✓
Clean, ood repair well ventilated "Running, boisterous or rough play is
0.5%chlorine cleaning solution for floors prohibited"
.Shower water 90—105 degrees F b-18 Emergency Communications
Adequate toilet facilities Directions to nearest telephone and first-aid kit
b-9 Equipment rooms/areas&Equipment posted at entrance
r Maintained in good repair, clean/sanitary Telephone numbers (print>.25")of police,fire,
Skimmers,gutters, strainer baskets clean and in hospital and EMS
good repair b-19 Registration
Drain grates compliant VName of owner or owner's agent, address and
b-10 Deck Equipment location on file a
Handrails provided on steps, stepholes,and c-1 Depth Markers
ladders Markers on rim at min and max depth and
Equipment properly secured points of slope change
b-11 Pool Chemical Storage Markers visible from pool deck and from within
Stored in a cool,dry, clean,well-ventilated area pool
Containers stored tightly closed
Public Swimming Pool Inspection Report
2
c-2 lifeguard stands Comments:
�R Lifeguard stand raised at least Oft X Cyr Ynknkl,.S
' Lifeguard stand located pool side adjacent to
deep end low "�� C�b�� 5.0
c-4 Sign
"No diving is permitted off the deck into
shallow areas of the pool"
Additional Requirements for Public Spas: Vk t �
e-1 Pool Water Disinfection Jk4
Free available chlorine residual >1.0 mg/Liter
when spa in use ti 5
e-2 Pool Water Temperature
Water temperature shall not exceed 104
degrees F
e-3 Depth Markers
Minimum 2 markers located on rim or
adjacent to pool
e-4 Precaution Signs
"Elderly persons and those suffering from
Heart Disease,Diabetes, High or Low Blood
Pressure, shall not enter the spa"
"Unsupervised use by children is prohibited"
"Do not use while under the influence of
alcohol/drugs"
"Do not use alone"
"Observe a reasonable time limit(preferably
less than 15 min.): long exposures may result
in nausea, dizziness,or fainting"
e-5 Oils, Body Lotions,and Soaps
Oils, body lotions&soaps must be removed
prior to spa use
Pool Supervisor: Vh Date:Z Z
(Print Nam
gnature)
Health Inspector: Title: v• �- � oar
(Signature)
DATE OF COMPLIANCE: Na7,, t Re-inspection Required: 0 YES •NO
S.Windsor—April 2011