B o a r d o f H e a l t h April 3, 2018 2018 Public Recreational Bathing License Application Dear Pool Owner: Enclosed you will find an application for the 2018 Public Recreational Bathing License and a preoperational checklist. The completed forms and appropriate fee should be returned 21 days prior to scheduling a pre-operational inspection. The Licensing fees are $500 for year-round and $300 for seasonal facilities. Pre-operational inspections are required for all seasonal pools. Appointments can be schedule by contacting the Health Department at 609-936-8400. The Public Recreational Bathing Code, Chapter IX, N.J.A.C. 8:26 was readopted with changes effective January 16, 2018. Management and Operators should review the code as soon as possible and take steps to achieve compliance prior to scheduling an inspection. A copy of the regulations is available at the link below. Bacteriological Lab Results Water Clarity and Chemical Parameters Main Drain Certification and Documentation Annual Electrical Certificate of Compliance Valid Electrical Bonding and Grounding Aquatic Facility Plan Certifications for a Trained Pool Operator and Lifeguard Owners and operators are also encouraged to review their facility s compliance with the American Disabilities Act (ADA) pool entry requirements. This law is enforced by the US Department of Justice. Guidance materials are available at http://www.state.nj.us/health/eoh/cehsweb/adapools.shtml I encourage you to contact our office as early as possible to schedule pre-operational inspections. If you have any questions in regards to the above, please do not hesitate to contact the Health Department at 609-936-8400. Sincerely, Jill M. Swanson Health Officer
TOWNSHIP OF ROBBINSVILLE DEPARTMENT OF HEALTH 2298 ROUTE 33 ROBBINSVILLE, NJ 08691 Phone 609-259-3600 ext. 124 Fax: 609-259-3645 www.robbinsville.net PUBLIC RECREATIONAL BATHING PLACE LICENSE APPLICATION Name of Facility Onsite Phone Number Location Name of Owner(s), Corporation, or Registered Agent Address State Zip Phone Pool Management Company Name (If N/A please check box ) Address Phone Emergency Phone Name of trained operator (CPO) Contact Dates of Pool Operation to Hours of Pool Operation to Bonding and Grounding Certification Electrical Inspection Date Date Testing Lab: Phone: The undersigned owner, representative, or manager agrees to operate this facility in compliance with the standards set forth in the New Jersey Sanitary Code, Chapter IX, Public Recreational Bathing, N.J.A.C. 8:26. The undersigned also certifies that this facility has not been altered from its approved design without the required review and approval of the Health Department and/or the Construction Code Official. Changes to the pool structure, the recirculation equipment or flow of water, and modifications of the disinfection system are alterations which require plan review and approval from the local health authority. Name (Print) Signature of Owner Date FEE SCHEDULES: Please enclose the license fee made payable to the Township of Robbinsville: $300.00 6 Month License Seasonal $500.00 12 Month License Year-Round --------------------------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY: LICENSE # ISSUED: PAID $ CHECK #: CASH:
New Jersey Department of Health Consumer, Environmental and Occupational Health Service CHECKLIST FOR PUBLIC RECREATIONAL BATHING FACILITIES Municipality Local Health Authority Date Name of Public Recreational Bathing Facility Dates of Operation Type of PRB Facility PRB Facility Location Phone Number Special Exempt Yes No Both Owners Name and Address Phone Number Certified Laboratory Phone Number Date of Last Sample Trained Pool Operator Email Address Phone Number TPO Certification No. and Exp. Date Lifeguard Certifications Current Pro CPR Certifications Current Aquatics Facility Plan Water Sample(s) Results Sanitary Surveys (8:26-7.15) Emergency Phone Numbers Pool/Natural Waters Rules Sign No Diving Signs Caution Chemical Sign No Smoking Sign (Chem. Room) Depth Markings Codes: X-Compliant P-Pending N/A-Not Applicable PAPERWORK Log Book GENERAL LAYOUT Bonding and Grounding (5-year cert.) Bonding and Grounding (Town) CB-20 completed and submitted MSDS sheets for all chemicals Physical Hazards inspection No Lifeguard on Duty Sign Adult Supervision Sign Special Exempt Signs Spa Clock Spa Rules Diving Rules Entrance(s) Secure Cliff Jumps < 15 Floats and Fixed Platforms Permitted with LHA Approval Diving stands, boards, ladders, stairs, all equipment maintained Water slides conform to CPSC and approved by LHA and/or NJDCA Rope drops, cliff jumping, and aquatic play equipment meet N.J.A.C. 5:14A-12 Surface area (Pool sq ) Volume (Pool) Equipment for continuous disinfect all types pool water and meet 8:26-3.22 Pool chemicals stored, handled and used per manufacturer's instructions Anti-entrapment drain covers installed, all documentation on site Pool Floor (Clean and Visible) Turnover Rate(s) (Pool) Pump Maximum Flow Rate(Pool) CEOH-1 NOV 12-1-
Name of Public Recreational Bathing Facility CHECKLIST FOR PUBLIC RECREATIONAL BATHING FACILITIES (Continued) Facility Phone Guard (Uniform/Whistle) DPD Test Kit First Aid Kit Rescue Tube(s)/LG Backboard Straps Head Immobilizer Shepherd Hooks Reaching Poles/Assist Safety Rope and Floats Ring Buoys Thermometer Goggles and Gloves Emergency numbers posted Codes: X-Compliant P-Pending N/A-Not Applicable EQUIPMENT Vacuum Equipment Skimmer Net # of Returns Sight glass Entrapment Issues Spa Requirements Wading Pool Requirements Circulation System Flow Meters Continual Disinfection Device Secure Fencing Self Close/Self Latching Gates Diving Boards Water Clarity Lifeguard platforms or stands Paddle Rescue Device Emergency care room (500+) Bathrooms (Cleaned and Stocked) Separate BR facilities (each sex) Sanitary facilities maintained and constructed of impervious materials Floors have slip-resistant surface Suitable receptacles provided for paper towels and waste materials Soap dispenser provided, hot and cold water GENERAL SANITATION AND MAINTENANCE Only unbreakable mirrors provided Sanitary sewage and filter backwash waters handled properly Solid waste stored in watertight containers with tight-fitting lids Potable water supply source and of safe and sanitary quality All buildings rodent and insect proofed Premises maintained to prevent the breeding and harborage of vermin CHEMICALS / DISINFECTANTS (POOLS) Free Chlorine (10 ppm max) ph (7.2 7.8) Total Chlorine (ppm) Combined Chlorine (<.2) Other Disinfectant Total Alkalinity (60 180 ppm) Calcium Hardness (ppm) Cyanuric Acid (10-100ppm) Outdoor CEOH-1 NOV 12-2-
Name of Public Recreational Bathing Facility CHECKLIST FOR PUBLIC RECREATIONAL BATHING FACILITIES (Continued) Codes: X-Compliant P-Pending N/A-Not Applicable SUPERVISION Operations supervised by an adult Aquatics Facility plan executed Standard first aid and Pro CPR All lifeguards identifiable Pools have TPO,TPO onsite weekly Lifeguards equipped with a whistle Adequate number of Lifeguards Emergency Drills documented BATHING WATER QUALITY Pool water approved water source Pool chemistry monitored (2 hrs) Water samples collected weekly Deaths/serious injuries reported 1 st sample failed warning signs 2 nd sample failure closure signs COMMENTS I verify that the statements made in this form are true and accurate and this Public Recreational Bathing facility meets the requirements of N.J.A.C. 8:26 et seq., I understand that all the information provided, if falsified, can be used against me in court, by the authorities. Signature of Owner/TPO Title or Position CEOH-1 NOV 12-3-
TOWNSHIP OF ROBBINSVILLE DEPARTMENT OF HEALTH 2298 Route 33 Robbinsville, NJ 08691 Phone 609-259-3600 ext.120 Fax: 609-259-3645 www.robbinsville.net Notice to Pool Owners Renovations, Repair, Replacements Please be advised that the owners of public pools are responsible for obtaining any permits and/or approvals required for renovation, repairs, or replacement work performed at the facility. Construction Permits Pursuant to the Uniform Construction Code, any work that is not listed as ordinary maintenance under the UCC, requires a permit from the Construction Department. If you have questions about a specific project and applicable permits, contact the Construction Department at 609-259-3600. Health Authority Approval Approvals are required whenever a facility proposes to alter a bathing facility. Alter is defined as any modification, or relocation of any structure or equipment, or diversion and change of water flow patterns in an existing public recreational bathing place such that the design, configuration and/or operating characteristics are different from the original design, configuration and/or operating characteristics. The term does not include normal maintenance, repair, or replacement of previously approved equipment. [NJAC 8:36-1.3] Applications should be submitted to the Health Department. Please call for additional information; 609-936-8400. Rev. 3/17