HomeMy Public PortalAboutPoolTOWN OF BREWSTER
2198 MAIN STREET
BREWSTER, MA 02631
PHONE: (508) 896-3701 EXT 1120
FAX: (508) 896-4538
BRHEALTH@BREWSTER-MA.GOV
WWW.BREWSTER-MA.GOV
OFFICE OF
HEALTH DEPARTMENT
APPLICATION FOR PERMIT TO OPERATE A PUBLIC/SEMI-PUBLIC SWIMMING, WADING OR
SPECIAL PURPOSE POOL
The undersigned hereby applies for a permit to operate a swimming, wading or special purpose pool in
accordance with the State Sanitary Code: Chapter V, 105 CMR 435.000: Minimum Standards for Swimming
Pools.
Name of facility:
Address of facility:
Facility phone #:
Mailing address (if different than facilit y):
Name and Title of Applicant:
Name, Address & Phone # & Email address of owner:
Name of Certified Pool Operator:
(Must provide copy of current CPO certificate)
Type of Pool: Swimming ( ) Wading ( ) Special Purpose ( )
Days and hours of operation:
Year Round ( ) Seasonal ( )
Expected opening date:
Pool Size: Length: Width: Depth:
Volume (gallons):
Swimming area (over 5 feet in depth) (Sq. Ft.):
Non-swimming area (5 feet or less in depth) (Sq. Ft.):
Diving area (if applicable) (Sq. Ft.):
Bather load:
Water Filtration and Filtrations Systems:
Source of water:
Number of main drains:
Number of skimmers:
Pump size and rating (GPM):
Filter type and total filter area:
Sanitizer: (check one) Chlorine ( ) Bromine ( )
Fee: $110.00 per pool
Signature of applicant: Date: