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SP/Spa Inspection Form
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SP/Spa Inspection Form
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May 26, 2016 - Public Swimming Pool Inspection Report. Public Health Datyon-Montgomery County. Health District: Name of
Health District:
Public Swimming Pool Inspection Report Name of Facility:
Public Health Datyon-Montgomery County
Type visit
Type pool
Setting
[ X ] Standard
[ X ] Pool
[ X ] Wading pool
[
] Zero Entry
[
] Spray ground
Special feature (SF)
[
] Re-inspection
[
] SPA
[
] School
[
] Govt
[
] MHP
360 ZENGEL DRIVE
[
] Complaint
[
] SUP
[
] Indoor
[ X ] Outdoor
[
] Camp
City:
[
] Epi Investigation
[
] Apartment/Condo
[
] Hotel/Motel
CENTERVILLE OH 45459
[
] Consulation
[
] Other
PLEASANT HILL Address:
Insp Date (mm/dd/yy) 05/23/2016 Surface Area (sf)
100 [
[
]
Flow measure reading (gpm)
]
Insp Time
Travel Time
30
Required turnover rate (min) [ie 30]
ID no.
Volume (gallons)
[ [ [ [ [
] Kiddie Slide ] Playground slide ] Rec Slide ] Water Slide ] Fountain
[
] Other
License no.
6146
2016030
Required flow min:(gpm) [Volume/TRate]
12000
Check if in violation of the Ohio Administrative Code 3701-31-04 (A-E); NA= Not Applicable
[X]
Max allow. filter flow: (gpm) [filter label]
141
[
]
Max allow. flow: SF pump capacity (gpm)
[
]
Max allow. flow: Jet pump capacity (gpm)
Critical violations (3701-31-04(B)(1)(a-l)
[
]
(a) Outlet covers installed/secured/ in compliance
[
]
(d) Circulation/Disinfection system operating properly
[
]
(g) Water clarity; (can see pool bottom)
[
]
(j) Pool treated after RWI
[
]
(b) SVRS devices functioning
[
]
(e) Automatic chemical controller functioning properly
[
]
(h) Natural or artificial light sufficient
[
]
(k) Proper use/storage of chemicals
[
]
(c) Disinfection residual as required
[
]
(f) Lifeguards on duty
[
]
(j) Fecal accident treated properly
[
]
(l) No Electrical hazards present
Water Quality 3701-31-04 C, D (check all that apply)
[
] Calcium Hypochlorite
[ X ] Sodium Hypochlorite
[
] Bromine
[
]
(D)(6)Total Chlorine-Cl2 (ppm)
3.0
[
] (C)(2) pH (7.2 - 7.8)
[
] Di-Chloro
[
[
] Salt
[
]
(D)(6)Free Chlorine-Cl2 (ppm) [>= 1; 2]
3.0
[
] (C)(3)Alkalinity (ppm) [min 60]
80
[
]
(D)(6)Combined - Cl2/ (ppm) [
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