Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 202 - RULES RELATING TO PUBLIC SWIMMING POOLS AND SPAS › Appendix 144-202-E - DHHS PUBLIC POOL OR SPA REGISTRATION FORM

Current through 2024-29, July 17, 2024
1.
Owner/Operator of
				Pool:________________________________________________________________
2.
Establishment:________________________________________________________________________
3.
Location: Street
				________________________________Town or
				City:___________________________
4.
Owner Mailing
				Address:________________________________________________________________
Town ___________________________________State ______ ZIP Code
				_______________________
Telephone: ________________________________ E-mail:
				  ___________________________________
5.
Location of Pool/Spa: Indoor [ ]
				Outdoor [ ]
6.
Capacity in Gallons :_________________
7.
Dimensions for In-Ground Pool:
				Length ______FT. Width _______FT. Surface Area :______
				FT2
Greatest Depth :________FT. Minimum Depth :________FT.
				  Maximum Bottom Slope __________ %
Dimensions for Above Ground Pool: Round : Depth
				  __________ FT Diameter ____________ FT
Greatest Depth :________FT. Minimum Depth :________FT.
				  Maximum Bottom Slope __________ %
Square or Rectangular: Length _________FT. Width
				  _________FT. Surface Area :________ FT2
Greatest Depth :________FT. Minimum Depth :________FT.
				  Maximum Bottom Slope __________ %
8.
Dimensions for Spa: Depth
				_______________ FT Diameter ________________ FT
9.
Recirculation Pump Capacity:
				__________ GPM
10.
Turnover Rate in Hours: _____HRS.
11.
Type of Filter (Check One)
Sand Filter [ ] High Rate Sand Filter [ ]
Diatomaceous Earth [ ] Cartridge Filter [
				  ]
Other, specify:
				  _______________________________________________
Loading rate: Recirculation Rate _________ GPM/SQ. FT.
				  Filter Area _____________ SQ. Ft.
12.
Method of Filter Backwash
				Disposal:_____________________________________
If other than public sewer, provide an HHE-200 Form
				  (Subsurface Wastewater Disposal System Application).
13.
Diameter of Recirculation Piping
				_____________ (inches)
14.
Number of Skimmers:____________ (1 PER 500 SQUARE FEET
				required.)
15.
Size
				of Gutter:_________ (REQUIRED IF POOL SURFACE AREA IS GREATER THAN 1,600 SQUARE
				FEET)
16.
Height of
				Board (if any) :________ Depth of water 12 feet beyond end of board
				:______________
REQUIRED: 8 FEET, 6 INCHES FOR 2-FOOT BOARD HEIGHT OR
				  LESS; 10 FEET FOR 1 METER BOARD HEIGHT OR LESS.
Purification
				  Equipment:_________________________________________________________________
Amount of Chemicals Used per Day, in
				  pounds:
Chlorine:__________ Alum:____________ Soda Ash:
				  __________ Other: _______________________
17.
Fresh Water Supply
				Source______________________________
18.
Average Bathing Load per
				day:___________________________
Number of Showers _____ Location
				  :_____________________
Number of Toilets:_______ Urinals _____
				  Location:__________________
SIGNATURE:______________________________
				  DATE:___________________
Public Swimming Pool and Spa Registration
				  Instructions
When submitting an application for review of a public
				  swimming pool to the Department, the applicant and/or designer must include the
				  following for a complete application:
(1) A completed Department Swimming Pool
				Registration Form.
(2) Plan(s) of
				the pool showing depths, area, piping, and safety features, complying with the
				ANSI/National Spa and Pool Institute's Minimum Standards for Public Swimming
				Pools. If plans for existing in-ground pools are not available, complete the
				sample pool diagram page. For above ground pools, omit the plan, but be sure to
				include the dimensions in the application form.
(3) Plans and/or manufacturer's
				specifications for pumps and filtering equipment.
(4) A complete HHE-200 (Subsurface Wastewater
				Disposal System Application) if a separate building for showers and/or toilets
				are associated with the pool or spa
OR
if the pool backwash
				discharges to a subsurface system. For existing systems installed after 1974,
				check with your Town Office, or apply for a record search. Systems older than
				1974 have no records, and a new design is necessary.
(5) A review fee of $15.00 is required. A
				check or money order must be made payable to the "Treasurer of State" and
				submitted.
(6) A pre-operational
				inspection is required. The Department must be notified at least 15 days in
				advance of placing the pool or spa in operation to allow for inspection and
				approval.
Upon receipt of all of the above, we will review your
				  request. Please allow a minimum of 30 working days for the review.
If you have any comments or questions, please feel free to
				  contact us.
Plan Review
Subsurface
							 Wastewater Unit - DWP Division of Environmental Health Maine Center for Disease
							 Control & Prevention Department of Health and Human Services 286 Water
							 Street, 3rd Floor Augusta, ME 04333
(207) 287-5672
Inspection & Operation
Health Inspection Program Division of Environmental Health Maine Center for
							 Disease Control & Prevention Department of Health and Human Services 286
							 Water Street, 3rd Floor Augusta, ME
							 04333
(207) 287-5671
IN-GROUND SWIMMING POOLS
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