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Home My WebLink AboutColony Square App 500032 05 06 16.TIF N.C. Department of Environmental and Natural Resources Division of Environmental Health APPLICATION FOR SWIMMING POOL OPERATION PERMIT POOL INFORMATION: /f Name of public swimming pool: £i/CD.v j (5i'L1 tcHLC Street address of pool location: 61:92 3/ /Qvar /f/, A7/Cks2 y e7Wz0 City: County: C)9747-1.0 &4 / Type of public swimming pool(check one) [' Swimming pool ❑ Wading pool ❑ Spa ❑ Other(describe) • Date constructed or remodeled: (check one) ❑ Before May 1, 1993 ❑ May 1, 1993 or later p Dates of operation: opening date 576//(o closing date / ?dl/L Hours of operation: opening time :1%OO closing time 8 :00 OWNER INFORMATION: Name of owner: O to Ai/� ' (Q u rna Mailing address: (038 4//h 4/ c 6b,J HJ'G/cog/ Nd/ _,24e) Contact person: >lsAVN'4 72eRNv,6 c. Telephone: g3 x" 3 3X'3`/3 4, OPERATOR(On-Site Manager)INFORMATION: Name of pool operator: J7S,rr;Nis id— J aNk / 72 nFl r/ Address: S/796 gR-unt&cud/ S G/Mf2Cl vrWC i nnF/O Telephone number: gag-31,-/g4. Pool operator trained by: (check one) National Swimming Pool Foundation eQ ✓/ (Certificate Number: 0/fJ-4Q/03 8 01591 ❑ Other(please specify) APPLICATION SUBMITTED BY: //'(��1f/ J Owner or operator: ttl!4�„p4"7( idele rrtR/XJ Re6.440 il, Nt l4em4A gi4ature Typed or printed name Date: 5/4// ' Purpose General Statute 130A-282 requires the Commission Health Services to adopt rules governing public swimming pools.The rules in 15A NCAC 18A.2500 require the owner or operator to apply annually for an operation permit for each public swimming pool.This form is to allow owners or operators of public swimming pools to apply for permits.Preparation:The information requested on this form is to be completed by the pool owner or a designated representative of the owner.The completed application is submitted to the local health department for the county in which the public swimming pool is located.A separate application must be completed for each public swimming pool.Copies:Original to be maintained at the local health department.Disposition:Please refer to Records Retention and Disposition Schedule for County/District Health Departments which are published by North Carolina Division of Historical Resources.Reorder.Additional Forms may be ordered from:Division of Environmental Health,Department of Environment and Natural Resources, 1630 Mail Service Center,Raleigh,NC 27699-1632,(Courier 52- 01-00) DENR 3961(Revised 4/03) Environmental Health Services Section(Review 4/06) Pool Drain Safety Compliance Data Name of Pool 4 4 59,./24_0. Address 936 / `t4 ,/i4V 1/2{4 CJ Pump System Flow J `, Pump Manufacturer Model Number 6,00t16-..X-,;1-6) Maximum Pump Flow(manufacturer's specifications) /j 2. gallons per minute Maximum Pumping System Flow is reduced to 33 j; )—gpm based on: Measured Total Dynamic Head loss of �S,1f feet; Calculated Total Dynamic Head loss of 7. 'it feet; Magnetic flow meter reading of is gpm; Automatic flow limiting valve factory set at gpm Provide supporting evidence for flow reduction) Drain Sump Measurements 11;ump width:round j inches diameter; rectangle inches X inches ;ump minimum depth it inches Diameter of outlet pipe to pump / inches distance of top(inside)of outlet pipe from bottom of cover/grate // inches 'rain Cover/grate Data umber of drains on same pumping system / Distance between drains(on centers) over/grate manufacturer N ti 0 ,model CL) &icit?A V aximum flow rating of cover/grate /a.,j gpm(floor); '71 gpm(wall) ate drain cover/grates installed: 57/j/ /I Expiration date: 5-./1 I/_ I amber of operable skimmer equalizers (3 ualizer fitting Manufacturer model :at% tip Xi:X , ualizer fitting maximum flow rating 1/` to equalizer cover/grates installes: 57 /f` ! 14. Expiration date 57/L I/ / j I name of person providing this information J/C!_,C' -1 /%-;a.�,;/c eD„M au nature 24/,,� f� tj {nJ /A1 IL,4,�J Date II For instructions please visit the Pool Drain Safety Compliance Website at http://ehs.ncpublichealth.comifafiptildrainsafety.htm '�A CATAWBA COUNTY J 100A SOUTHWEST BLVD �� NEWTON,NORTH CAROLINA 28658 RECEIPT U �, v�►°v,� G PHONE: 828.465.8399 \ 6,71 Friday, May 6, 2016 1842 sM www.catawbacountync.gov PAYOR: COLONY SQUARE COLONY SQUARE PAYMENTS TRANSACTION NUMBER: TRC-668093-06-05-2016 PAYMENT DATE : 05/06/2016 PAYMENT TYPE: Check 1770 INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328103 Pool Inspection Fee - Seasonal $150.00 TOTAL PAYMENTS : $150.00 FLI-0000088 CASE TYPE: Food&Lodging Institutions WORK CLASS: 50- Seasonal Swimming Pool SITE ADDRESS: 891 21ST AV NE ST, HICKORY NC Manager COLONY SQUARE, 891 21ST AV NE, HICKORY NC 28601 ** NO PEOPLESOFTACCOUNTASSIGNED ** Pool Operator REGGIE'S POOL& MAIN'T& SUPPLIES, 4796 RIVER BEND RD, CLAREMONT NC 28610 C:8283121861 receipt 05/06/2016 15:07 Page 1 of