HomeMy WebLinkAbout2985 Ellington Road (2) Town of South Windsor — Health Department
1540 Sullivan Ave., South Windsor, CT 06074-Mailing Address
O Y A = 1530 Sullivan Ave., South Windsor, CT 06074-Office Address
.= Phone Number: (860) 337-6173, Fax Number: (860) 644-1930
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PUBLIC SWIMMING POOL REGISTRATION FORM
FACILITY NAME: 14 w +1�v/`
ADDRESS
PHONE: ?'(L . �t$"�� EMAIL:_ SLv47-C mill e Qrn/}I%.., Cc+,*j
®VIfRMASSOCIATION
REPRESENTATIVE: M I L- f'D*4f f
ADDRESS —� I F, C- ;tM t, lz✓
PHONE: EMAIL:
MANAGER(if different from owner):
ADDRESS
PHONE NUMBER: EMAIL:
POOL � ( i
OPERATOR: IV +C ��+�e L1 t
ADDRESS I ��� It� �%(.. 4. W��� 1 Sc�'-4 N LlJ iPX c
PHONE NUMBER L' ��" l C EMAIL /1(1f 3L t C i t �. C C A%
FACILITY INFORMATION:
Check all that apply:
Indoor Pool Outdoor Pool_i Wading Pool K i Whirlpool/Spa
Dates Pool is Open From 124 I is to yl 31 IV
Pool Capacity: �[X'o ou
Pool Make-up Water Source: Public_, Private AV
Disinfectant Used: tjy-t' e
The undersigned agrees to omply th Section 19-13-B33b of the Connecticut Public Health Code:
Signature of lica ,'_,('1 0 Title DateJ
'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.
Of South �outine Inspection 0 Indoor Pool
SouthwInC�SOr—Health Department
•� ^ 0 Re-inspection 94 door Pool
1540 Sullivan Avenue,S.Windsor,CT 06074 0 Complaint @ ading Pool
=:�'�� •�
'•.,,, - Phone: 860-337-6182 Fax: 860-644-1930 0 Other: 0 Whirlpool/Spa
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Public Swimming Pool Inspection Report
Name of Facility: c 1*� '�,�{�� C 7CXN-,s is Inspection Date: s ; 1 4� ! 4
Address: � ��> Fu I QA Phone:
Items marked with an X indicate non-compliance with CT Public Health Code(Section 19-13-1333b). Violations must be corrected by the listed compliance date.
a-4 Life Saving Equipment b-12 Vacuuming
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 Outdoor pools surrounded by barrier (>4ft)
b-1 Pool Construction Outdoor pool entry gates self-closing and self-
Pool in good repair latching
b-2 Supervisory 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
b-4 Pool Water Clarity
>4" high)
6" secchi disk at pool bottom visible Warning signs visible from all entry points in
b-5 Pool Water Disinfection pool area
b-15 First Aid Kit
Automatic Feeder Used I� " �d>0.8 mg/liter Free Chlorine c(--?�- 'Z Kit filled, ready for use, materials current
-5, Test Kit
Amer. Red Cross 24-unit first aid kit or equiv.
b b- s DPD Test Kit onsite (for disinfectant and pH) b-16 Emergency Telephone
_Telephone readily available in pool area
b-6 Pool Water pH `"� t.� b-17 Signs
Value between 7.2 and 7.8 , �. "All persons shall bathe with water and soap
b-7 Records and Testing before entering pool"
Residual disinfectant & pH tested prior to daily "Anyone having a communicable disease shall
opening not use the pool"
Daily pool testing records kept Decks, Dressing,Toilet&Shower Rooms "Spitting, or blowing the nose in the pool is
-8 ,J Clean, good repair, well ventilated prohibited""
Running, boisterous or rough play is
0.5%chlorine cleaning solution for floors _Ij 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
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
J Drain grates compliant Name of owner or owner's agent, address and
10 Deck Equipment location on file
Handrails provided on steps, step holes, 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:
Lifeguard stand raised at least 4ft Filter Type
/ Lifeguard stand located pool side adjacent to
J deep end Filter Size:
c-4 Sign
J "No diving is permitted off the deck into Flow Gauge (gpm).
shallow areas of the pool"
Additional Requirements for Public Spas: TO rate (vol./flowrate x 60):
e-1 Pool Water Disinfection Filtration rate (gpm/sf):
Free available chlorine residual >1.0 mg/liter
when spa in use Free Chlorine Total: 2-
e- Pool Water Temperature _
Water temperature shall no xceed 104 pH: �� -IG+P
degrees F
e-3 Depth Markers
'mum r o 2 markecated on rim or
adja nt to pool
e-4 Precau ' n Si s
"Elderly p ns and those suffering from J
Heart Dis S Diabetes, High or Low Blood
Pressu shall t enter the spa"
"un pervised us by children is prohibited"
not use while u der the influence of
alcohol/drugs"
"Do not use alone"
"Observe a reasonable tim limit (preferably
less than 15 min.): long expo ures may result
in nausea, dizziness,or fainting'
e-S Oils, Body Lotions,and Soaps
Oils, body lotions&soaps must be removed
prior to spa use
rM _
Pool Supervisor: f ' —� �S`N Date:
E,,a )
5
(Signature)
Health Inspector: Title:
Is;g 1—
DATE OF COMPLIANCE: Re-inspection Required: 0 YES EYNO
S Windsor-April 2011