HomeMy WebLinkAbout600 Sandstone Drive (2) 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: FL14
ADDRESS: � j -Y�,cs11 �SF.t�1 I _�1►n�4a, �� �(4�`7�{
PHONE . EMAIL:
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OWNER/ASSOCIATION l _
REPRESENTATIVE: 1 r"
ADDRESStCC
PHONE. (fin-5g -aAF5 LI LJ(Q EMAIL: / �,�Lo ., >Fc� �� t v►
MANAGER(if different from owner):
ADDRESS:
PHONE NUMBER: EMAIL
POOL ?
OPERATOR:-, 4'
ADDRESS_jh anv l �I• 0,2 D
PHONE NUMBER a (Q�; a0� ^ ga� EMAIL QhI�S �, D�Y1
FACILITY INFORMATION: I
Check all that apply:
Indoor Pool Outdoor Pool ! Wading Pool Whirlpool/Spa
Dates Pool is Open: From c�/ � _ to A off(
l
Pool Capacity
Pool Make-up Water Source: Public Private
Disinfectant Used:
The undersigned agrees to comply with Section 19-13-B33b of the Connecticut Public Health Code:
re of Ap licant Title Da
Qu; r r7(S 3'-(d
"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.
Routine Inspection 21noor Pool
�y, � Town of South Windsor—Health Department
�. � A Re-inspection Itdoor Pool
1540 Sullivan Avenue,S.Windsor,CT 06074
/ A Complaint A Wading Pool
Phone: 860-337-6182 Fax: 860-644-1930 A Other. A Whirlpool/Spa
Public Swimming Pool Inspection Report
Name of Facility: qu=m t a(10_. Inspection Date: Z J J OV
Address: Phone:
Items marked with an X indicate non-compliance with CT Public Health Code(Section 19-13-633b). 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)
� Outdoor pool entry gates self-closing and self-
b-1 Pool Construction
Pool in good repair latching
Pool access restricted when pool is closed
b-2 Supervisory Personnel
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)
/ Warning signs visible from all entry points in
6" secchi disk at pool bottom visible
b-5 Pool Water Disinfection J 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 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
b-17 Signs
Value between 7.2 and 7.8
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 —7
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"
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 J _ hospital and EMS
good repair b-19 Registration
Drain grates compliant f Name of owner or owner's agent, address and
b-10 Deck Equipment v location on file
J 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:
Vv Lifeguard stand raised at least 4ft Filter Type:
Lifeguard stand located pool side adjacent to
y:)- 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/" er
when spa in use Free Chlorine Total: ___-D
e-2 ool Water Temperature
ter temperature shall not ex ed 104 pH: `d
deg es F
e-3 Depth arkers \Cr �E`� k�6,cC--n
Minimu markers loc ed on rim or
adjacent to ool
e-4 Precaution Si s
"Elderly person nd those suffering from
Heart Disease. iab.es, High or Low Blood
Pressure, sh I note er the spa"
"Unsuper sed use by akiildren is prohibited"
"Do no se while under a influence of
alco I/drugs"
"D not use alone"
bserve a reasonable time lime (preferably
less than 15 min.): long exposures ay result
in nausea, dizziness, or fainting"
e-5 Oils, Body Lotions, and Soaps
Oils, body lotions&soaps must be rem
o ed
prior to spa use
Pool Supervisor: JC �I��;l Date:
(pn t N rne)
(Signature)
Health Inspector: ��— Title: rf4S
(Signature)
DATE OF COMPLIANCE: \ Re-inspection Required: 0 YES 4/NO
S Windsor—April 2011