HomeMy WebLinkAboutTwin Circle Drive Apr, 12. 2018 1 : 14PM G+W Management No• 1874 P.
w 0" Town of South Windsor — Health Department
`°w s`'` 1540 Sullivan Ave,, South Windsor, Cr 06074- Mailing Address
�p 1530 Sullivan Ave., South Windsor, CT 06074-Office Address
Phone Number: (860) 337-6173, Fax Number: (860) 644-1930
USOfl'CD.:
PUBLIC SWIMMING POOL REGISTRATION FORM
FACILITY NAME:_Rfu Y wcx)� 0_0y}1' ir'1um '_4,s.C(X
ADDRESS 101' 1Q012 TL/U1Vl C(rCle, 7Y\14C SQU-�V\ V\AV\jd& t . C I (x0C)'1
PHONE:9U0 - 71 y - (_0-1 2S EMAIL: -Knu Gt U W rnC',lnCl IPMP n1 00A
OWNER/ASSOCIATION
REPRESENTATIVE: tC \S
ADDRESS:_ 708 'T(���`�1 Cl'rC�e �Yl DUI -�1n.Vy��RC Uft 0
PHONE:_ _EMAIL:_�(� �� bret�ouct��jil-L��
MANAGER(if different from owner);
ADDRESS. (' ` �X �S 1 c) WC,1 tP 1r 2)U�(\, �-T o LO-.(qS
PHONE NUMBER: G 3 EMAIL:-t'n o q\NYAC
POOL
OPERATOR: fV LIOL
ADDRESS S()Lp -AA)j\'C� CtV .t-e P'n�'e ,�S(>�,(�'12 �(1�S�Y, cy moO�`�
PHONE NUMBER 0 - L{3Z - 1 S l2 _ EMAIL M(Dn-4e. 10 ll (O'J Co-y- X)C-�
FACILITY INFORMATION:
Check all that apply:
Indoor Pool Outdoor Pool Wading Pool Whirlpool/Spa
Dates Pool is Open From Z y to
Pool Capacity: 0 QCQ
Pool Make-up Water Source: Public_ Private
Disinfectant Used: C h 1c-tn Y-\.Q-
The undersigned agrees to comply with Section 19-13-B33b of the Connecticut Public Health Code:
ff _
Si ature of Applic t Title Dad
4CEIVE6
APR 11 ?018
"Please return completed registration form to the South Windsor Health Department. Pgf3 j""t,tequeW must be scheduled 2 weeks
prior to anticipated pool opening date. HEALTH L
I
-' Town of South Windsor—Health Department �utine Inspection A Indoor Pool
0 Re-inspection I6utdoor Pool
1540 Sullivan Avenue,S.Windsor,CT 06074 0 Complaint 0 Wading Pool
=� H= P g
Phone: 860-337-6182 Fax: 860-644-1930 0 Other: 0 Whirlpool/Spa
Public Swimming Pool Inspection Report 4 `
Name of Faci 'ty: VO Inspection Date:
Address: "rCk, ��, Phone: 6.4J —
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
✓ 50ft length of%" line Pool vacuumed to maintain cleanliness
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-
t� latching
Pool in good repair
b-2 Supervisory Personnel Pool access restricted when pool is closed
�/ Knowledgeable pool supervisor onsite b-14 Lifeguards
Warning signs if no lifeguard on duty(letters
List of personnel provided to Health Dept.
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
✓ >0.8 mg/liter Free Chlorine Kit filled, ready for use, materials current
b-5, b-6 Test Kits ✓ Amer. Red Cross 24-unit first aid kit or equiv.
DPD Test Kit onsite (for disinfectant and pH) b-16 Emergency Telephone
b-6 Pool Water pH Telephone readily available in pool area
V' Value between 7.2 and 7.8 b-17 Signs
b-7 Records and Testing "All persons shall bathe with water and soap
before entering pool
/ Residual disinfectant & pH tested prior to daily "Anyone having a communicable disease shall
✓ opening
Daily pool testing records kept not use the pool"
.r "Spitting, or blowing the nose in the pool is
b-8 Decks, Dressing,Toilet&Shower Rooms
prohibited
Clean, good 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
Maintained in good repair, clean/sanitary
Telephone numbers (print>.25 ) of police,fire,
Skimmers,gutters, strainer baskets clean and in VXhospital and EMS
good repair b-19 Registration
Drain grates compliant Name of owner or owner's agent, address and
b-10 Deck Equipment t/ 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 Oft �� 2
Filter Type:
Lifeguard stand located pool side adjacent to
deep end Filter Size:
c-4 Sign"No diving is permitted off the deck into Flow Gauge (gpm): L QQ
_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:
e-2 Pool Water Temperature
Water temperature shall not exceed,04 pH
"-degrees F
e-3 De h Markers _ l P
Mini m 2 markers locate on rim or
adjacent pool
e-4 Precaution ns /
"Elderly perso a those suffering from
Heart Disease,o b es, High or Low Blood
Pressure, sh note er the spa"
"UnsuperyXed use by Nklclren is prohibited"
"D/no se while under t influence of
alrugs"
"Dse alone" \
' bserve a reasonable time limit ( eferably
less than 15 min.): long exposures ma 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 I� �'LG-o ��k->�A Date: -S f
(Print Name)
(Si
Health Inspector: Title: hV. Ct,wn '}
(Signature)
DATE OF COMPLIANCE: Re-inspection Required: 6 YES._�NO
S Windsor—April 1011