Board of Health 

Permit To Operate A Swimming Pool  

In accordance with the provisions of Chapter 111, Section 127A of the Massachusetts General Laws, and 105 CMR 435.000: Minimum 
Standards for Swimming Pools established by the Massachusetts Department of Public Health, this permit is hereby issued to:  ____________________________________________( Pool Operator/Owner) for the operation of___________________________________(Public, Semi-Public, or Special Purpose Pool)  at _________________________________(address)
Method of water treatment is 
Bathing load not to exceed    bathers 
If required by Board of Health, number of lifeguards required when pool is open: __________________________   
This permit is valid until: (date)________________________ 

  _________________________________  

    _________________________________  

  

Date issued          ________________ _________________ 
POST CONSPICUOUSLY IN POOL AREA     

A Certified Pool Operator (CPO) is responsible for 
           supervision of this pool.  The name of the CPO is on   
           file with the BOH and pool owner.