Facility Information
{[PNAME]}
Email
Address
Facility Name
Phone #
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
(978) 538-5926  
https://peabody-ma.gov/
Facility Type
Specify Address where the pool is located.
Application Type
ZIP
City
State
  • Contacts
  • Pool Information
  • Pool Information cont.
  • Lifeguards
  • Request for Variance
  • Attachments, Fees & Certifications
Business Owner/Applicant
Address
City
Name
ZIP
Email
Who is the primary contact person for this project? e.g. the property owner, a project supervisor or site foreman.
Manager
Phone #
Phone #
Address
Organization Name
Name
Address 2
Phone #
Name
State
Applicant is Operator?
Email
Email
ZIP
Emergency Contact
Certified Pool Operator
City
State
Date Season Ends
Wednesday
Operation
Width (ft)
Filter Type
Date Season Starts
Volume (gal)
Type of Pool
Bather Load
Depth (ft)
Friday
Saturday
Length (ft)
# of Main Drains
Sunday
Source of Water
Non-Swimming Area (5 feet or less in Depth) (Sq. Ft.)
Pump Size
Water Filtration and Filtration Systems
Pool Name
Pool Size
Expected Opening Date
Thursday
Diving Area (if applicable) (Sq. Ft.)
Sanitizer
Swimming Area (Over 5 feet in Depth)
(Sq. Ft.)
Tuesday
Days and Hours of Operation
If Other
Total Filter Area
Pump Rating (GPM)
# of Skimmers
Monday
Pool Information

Kindly Read and Answer the Following Before Proceeding 

105 CMR 435.00

105 CMR 435.23: (1) The operator shall provide one or more lifeguards 16 years of age or older if the Board of Health determines that they are necessary for the safe use of the swimming or wading pool. The Board, when determining whether there is a need for one or more lifeguards and the number of on-duty lifeguards to be present at the pool at any one time, shall take into account the size, shape and capacity of the swimming or wading pool. As a guideline, it is suggested that one lifeguard be provided for each 25 bathers.

Do you have Lifeguards?
Lifeguards
Access Restrictions
Other Safeguards
Describe/Explain
Describe/Explain
Signage Present
Expiration Date
Fencing
Describe/Explain
Request For Variance

105 CMR 435.46: (b) the applicant has proved that the same degree of protection required under 105 CMR 435.00 can be achieved without strict application of the particular provision.

Describe/Explain
Describe/Explain
Surveillance and Alarm Systems
Pool Monitors
Issue Date
Describe/Explain
Most Recent Certification Held by On-Site Pool Manager
Emergency Communication Equipment and Procedures
Type Full Name :
Sign With Hand
Preferred Payment Method
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.
Pay By Credit Card
In order to receive your permit, you must first pay the above Application Fee.

If you'd like to pay now by Credit Card, click the Submit & Pay Now button below.

Total Fee
or
If you need to make your payment by mail or in person, our office is located at:

{[CNAME]}
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}, (978) 538-5926 

In order to obtain a {[PNAME]} permit, you must provide
  • Copy of current CPO certificate.
  • Current Lifeguards Certifications (If Applicable)
    • Application Fee $100
    Renewal Late Fees $50.00 will be charged if not paid by May 31st
    Pay Later
    Signature
    Application Fee
    Attachments
    Certification