HomeMy WebLinkAboutDays Inn 500094 App 03 21 16.TIF •�• APPLICATION POR PUBLIC SWIMMING POOL OPERATION PERMIT I - )Z /3
•:•%v POOL INFORMATION: ��� Poo■om Name of public swimming pool: `✓7`4) l p
Street address of pool location: �� �I O cet I c�Q \I\I
co: CEO (L County: ( C �'d( ilk
Type of public awimming pool: (check one) „IgN. Stvinuning pool
❑ Wading pool
❑ Spa
❑ Other(describe)
Date constructed or remodeled; (check one) ❑ Before May 1, 1993
M ❑ May 1, 1993 or later
Dates of operation: opening date V ` \QL closing date 3
Hours of operation: opening time tCO Am closing tins \C1(30 9 in
OWNER INFORMATION ,, ` \ C�j(�
Name of owner: _ � . 0 .SUI`n C1a
Mailing address: `1\O '�"`�c�(ycOce 0-54-‘ / I
Contact person. C-`C- �- ” Telephone: C c `���—
OPERATOR(On-Site Mana` )INFORMAWN:
Name of pool operator: \Y '�`� �G� ���
Address: c�"�1 , \A
Telephone Number; [PJ q) Lk@ " —9r --)
Pool operator trained by: (check one) ❑ National Swimming Pool Foundation ��\\
(Certificate Number:0 C *( )
❑ Other @lease specify) -
APPLICATION TTED BX:/ em n
/4P( \ c.� u
Owner or operator: Zed or printed name
Signature
Date. tor1 •-\ c-) 4
Purpmc:Ocnpal Smtute 130&282 roquimt the Commission for Health 5ctvlecs to adopt erica gorcmlag public awlmming pools. The n la In ISA
NCAC 18A.25QO equht the otmct or ape'otoc to apply minuet fat en opctation pot fm each public swimming pool. This form is to allow
Timers of operators or public swimming pools to apply for pemlb. Ptepoation:ma la mis ion rrqueted on Mk fu'm Is to bo completed by the
pool own&or adaigneUt representativo of the ownm Tho completedsppitcetku'io sulunttmd to the bat health de ilment for the munq In whkh
the pohlleawimming pool is located. A Ecpveta application nwatbe camplalyd for Beth pubae swlauntag Dmml• Copies:Odelnel to ha malnluincd al
the local health published b g Disposition:Please refer to Records cal R ion end Dupree:: o Sdiedulu for Ceunlybeistr ct Ha Divi ion of
which ere published by the North Carolina eatanoe of Historical Resources.Rcotd&: Addition form may 76 oil 632, Condor52-01 o0)
Environmcatel Health, DeparlmmtofEmlronnKOtsnd NabiS Resources,l630Mall3ervice Gusher, ash, t
DENR39f11(revised 1103)
Eavlronmenla1Hralth Seev 9etaan(Review u0d)
"NOTE: IF ANY DRAIN COVERS,
•ti SKIMMER EQUAEiZECt;i 4VER(Sj FN /CR
x PUMP1S WERE CHANGED OUT SINCE LAST
tir7- Pool Drain Safety Compliance Data YEAR FEEASE Eli L CU?nk1S WPM ALONG
■ WITH WE APFRIC , PU'Ns '
. . Pi"
Name of Poo • _ll __ ^
Address • �, Y: .ooC I / S AU.i °A. I SS.
Pump System Flow nn'' '' ((��
Pump Manufacturer Attie 'i • ,( o�elNumber�#1 ��-' 11~
Maximum Pump Flow(manufacturer's specifications) gallons per minute
Maximum Pumping System Flow is reduced to bp gpm based on:
Measured Total Dynamic Head loss of feet;
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Calculated Total Dynamic Head loss.of l/ feet; V.
Magnetic flow meter reading of gpm;
L cL_ ' ClL 0 C
aj�v_ Q-3.
Automatic flow limiting valve factory set at epm
(Provide supporting evidence for flow reduction)
Drain Sump Measurements
II
Sump width:round (D inches diameter; rectangle inches X inches
Sump minimum depth 0U inches Diameter of outlet pipe to pump o(/ inches
fir /
Distance of top(inside)of outlet pipe from bottom of cover/grate I�t inches
Drain Cover/grate Data
` Lf/
Number of drains on same pumping system a _ Distance between drabs(on centers) '�-!
Cover/grate manufacturer \l t--`th�n 11 ,model �i1 J 1\ (L
Maximum flow rating of cover/grate gpm(floor); gpm(wall)
Date drain cover/grates installed: Expiration dater . -
Number of operable skimmer equalizers a -
Equalizer fitting Manufacturer i can model_ IC �b
.Aft ��t L1-7001
Equalizer fitting maximum flow rating
fat I
Date equalizer cover/grates installes: Expiration date
Full name of person providing this information
Signature jam./G Date 3 (5 -I I°
For instructions please visit the Pool Drain Safety Compliance Website an
http://ehs.ncpublichealth.comffafipti/drainsafety.htm
Y'A CATAWBA COUNTY
G 100A SOUTHWEST BLVD
l~ NEWTON, NORTH CAROLINA 28658 RECEIPT
6 PHONE: 828.465.8399
U\ d> Monday, March 21, 2016
\1842 sM www.catawbacountync.gov
PAYOR: DAYS INN POOL
DAYS INN POOL
PAYMENTS
TRANSACTION NUMBER: TRC-641324-21-03-2016
PAYMENT DATE : 03/21/2016
PAYMENT TYPE: Credit Card
Payment by Phone from Sheila
INVOICE NUMBER FEE NAME FEE AMOUNT
03-16-326322 Pool Inspection Fee - Seasonal $150.00
TOTAL PAYMENTS : $150.00
FLI-0001275
CASE TYPE: Food & Lodging Institutions WORK CLASS: 50- Seasonal Swimming Pool
SITE ADDRESS: 1710 FAIRGROVE CHURCH RD SE, CONOVER NC
Manager JAI JALARAM HICKORY, LLC, 1710 FAIRGROVE CHURCH RD, CONOVER NC 28613
F:NONE
OTHER-IMPORTED DAYS INN POOL, 1710 FAIRGROVE CHURCH RD, CONOVER NC 28613
F:NONE NONE
**NO PEOPLESOFT ACCOUNT ASSIGNED **
Pool Operator RICK PATEL. 1710 FAIRGROVE CHURCH RD SE, HICKORY NC 28613
B:8284652378
receipt 03/21/2016 12:08 Page 1 of 1