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Home My WebLink About50 Andrews Way 0". Town of South Windsor — Health Department 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address 1530 Sullivan Ave., South Windsor, CT 06074—Office Address Phone Number: (860) 337-6173, Fax Number: (860) 644-1930 PUBLIC SWIMMING POOL REGISTRATION FORM FACILITY NAME: / !%� '�C.' C_ ✓Z�C�r1LJ �-y1 �; `� 'J ADDRESS: !�D , PHONE: ��i1� .??I— �c,0 1 EMAIL ci OWNER/ASSOCIATION REPRESENTATIVE: — — r ADDRESS: 1`(S lc�rl �c n s�—:2e �� n�'- �� t�1i V PHONE: EMAIL: MANAGER(if different from owner): rr ,_lam ADDRESS: 5G i PHONE NUMBER: EMAIL: i Cc - -,iC •,)e - r c._5. POOL ' !OPERATOR: I!i(L 91.�� k, G S% c�- ADDRESS PHONE NUMBER EMAIL FACILITY INFORMATION: Check all that apply: Indoor Pool Outdoor Pool Wading Pool Whirlpool/Spa Dates Pool is Open: From /' ;r I�> to i T/ %. �`/if, Lt c Pool Capacity: Pool Make-up Water Source: Public �/ Private Disinfectant Used: r/, ,i;4 The undersigned agrees to comply with Section 19-13-1333b of the Connecticut Public Health Code: Signature of Applicant Title Date sr T-R V3 11JDqtbj-D, 1,—S RECEIVED "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 JUN n 7 '101a Rwl� I o0 < l q 3 SOU Ttj WNDSOR HEW-' DEPT. i�� 1 G�t.l '�1V1►l��Uc �T�;� W'S r� /`o Routine Inspection (i Idoor Pool 1. �� Town of South Windsor—Health Department 0 Re-inspection KOuldoor Pool 1540 Sullivan Avenue,S.Windsor,CT 06074 0 Complaint A Wading Pool Phone: 860-337-6182 Fax: 860-644-1930 0 Other: 0 Whirlpool/Spa Public Swimming Pool Inspection Report 11 Name of Facility: 1 1AA@6 Inspection Date:_ l_L� Address: JN �/,(IDS L)PLA 4 Phone: Items marked with an X indicate non-compliance with Cr Public Health Code(Section 19-13-B33b). 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 VI 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 01 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 Vz >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 Kit filled, ready for use, materials current >0.8 mg/liter Free Chlorine Amer. Red Cross 24-unit first aid kit or equiv. b-5, b-6 Test Kits DPD Test Kit onsite (for disinfectant and pH) b-16 Emergency Telephone Telephone readily available in pool area b-6 Pool Water pH Value between 7.2 and 7.8 b-1 Signs "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 "Spitting, or blowing the nose in the pool is b-8 Decks, Dressing,Toilet&Shower Rooms (� prohibited" vT 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 hospital and EMS good repair b-19 Registration Drain grates compliant / Name of owner or owner's agent, address and b-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 l/ pool Containers stored tightly closed Public Swimming Pool Inspection Report 2 c-2 Lifeguard stands Comments: ` Lifeguard stand raised at least 4ft Filter Type �' G Lifeguard stand located pool side adjacent to l� deep end Filter Size: IUU kA . 1, c-4 Sign vie "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): -1 Pool Water Disinfection Filtration rate (gpm/sf): Free available chlorine residual >1.0 m iter when spa in use Free Chlorine Total: r 2 e-2 Pool Water Temperature Water temperature shall not a eed 104 pH degrees F e-3 Nepth Markers Mi 'mum 2 markers loc ed on rim or adja nt to pool e-4 Precau ' n Signs "Elderly p sons d those suffering from Heart Diseas D'abetes, High or Low Blood Pressure, sha tenter the spa" "Unsupervig4d us y children is prohibited" "Do not a while un er the influence of alcohol rugs" "Do t use alone" /nnausea, erve a reasonable time Nit (preferably han 15 min.): long exposure ay result dizziness, or fainting" e-5 Oils, Body Lotions,and Soaps Oils, body lotions&soaps must be remove prior to spa use Pool Supervisor .Je.575 �'� �oc�i•_ Date: (Print Name) ( l e Health Inspector: 10110 A. Title: (SiKnatLire) DATE OF COMPLIANCE: �V�(� Re-inspection Required: 0 YES NO S Windsor—April 2011