HomeMy WebLinkAboutHuntington Park Apts App 500039 05 13 16.PDF N.C. Department of Environmental and Natural Resources
Division of Environmental Health
APPLICATION FOR SWIMMING POOL OPERATION PERMIT
POOL INFORMATION: k Name of public swimming pool: Ron i i� 4-c n ha r /� A) 9 n r7<.'n e n 1 5
Street address of pool location: /•Z O 7
City: County: �• c o y IV.0 . re,
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 I, 1993 or later `
Dates of operation: opening date s/a `d//Ce closing date 5 / °1 / )1
Hours of operation: opening time /0/069 ,9n closing time __.`) ! o o P•117
OWNER INFORMATION:
Name of owner: I JAIT/AtC-ro eJ 7¢K L //C
Mailing address: /201 21 sr $ w NE lbexne 1, NC 2g(401
Contact person: )6'411 (ERA/Am AF Telephone: gag. 324 . 4 786
OPERATOR(On-Site Manager)INFORMATION:
IS
Name of pool operator: e/4 GJ- S v n S
Address: 41& 09 C'rys/e / St. C/4 e tno, e /!>_C v28o /D
Telephone number: u 3 /0 — a 7
Pool operator trained by: (check one) ❑ National Swimming Pool Foundation
(Certificate Number: 95-4 5 9 oll
!f(1 Other(please specify) St to o P /✓.r{11 C, ra)I^^c
(Rey i'. r, r•
APPLICATION SUB TT D Y:
Owner or operator: 4�i / �• ' ^' °
Signature Typed or printed name
Date: i.//2 to /!o
Purpose General Statute 130A-282 requires the Commission Health Services to adopt rules governing public swimming pools.The rules in 15A
NCAC I8A.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)
S In)Cam D2.AIN *"iiO?E: iF ANY DRAIN COVENS,
Si`vMMER EQUALIZER COVEN(_t MW/cR
WITH Sri 4QiLE PUMP(S)WERE CHANGED Cur SNCE IfiST
Pool Drain Safety Compliance Data YEAR PLEASE FILL OUT THIS FORM Aumkr.i
/�
W Ih THE APPLICATION**
Name of Pool PLIMTING-roa M'T V. AARPAR-TK2NTS (HAW—Poo a
Address 1201 21&-r Ave NE NtCSOZ4, NC 2E601
Pump System Flow
Pump Manufacturer- NT AIe. Model Number (,HALL E1J faER
Maximum Pump Flow(manufacturer's specifications) I 40 gallons per minute
Maximum Pumping System Flow is reduced to _gpm based on:
Measured Total Dynamic Head loss of feet;
Calculated Total Dynamic Head loss of feet;
Magnetic flow meter reading of gpm;
Automatic flow limiting valve factory set at gpm
(Provide supporting evidence for flow reduction)
Drain Sump Measurements
Sump width: round inches diameter; rectangle � 2' inches X 17- inches
I
Sump minimum depth inches Diameter of outlet pipe to pump
2 �� inches
Distance of top(inside)of outlet pipe from bottom of cover/grate O inches
Drain Cover/grate Data
Number of drains on same pumping svct I _ Distance between drains (on centers)
Cover/grate manuf ac:,,....
A5 `t ' ��" , model V4 1/ a
Maximum flow rating of cover/grate 36 l gpm (floor); _ gpm(wall)
Date drain cover/grates installed: /Ylct7 �'� / :2 (2 /6' Expiration date:
Number of operable skimmer equalizers
Equalizer fitting Manufacturer A7In? fek model it HPAXX (a)
Equalizer fitting maximum flow rating 2 LI 9 p fn
Expiration date
Date equalizer cover/grates installer: m Li 00/E E
p
x et I /
Full name of person providing this information Ale /Iy : S / M M G n S
Signature Date . t7 9z .;27-W
For instructions please visit the Pool Drain Safety Compliance Website at:
http://ehs.ncpublichealth.com/faf/pti/drainsafety.htm
y'A CATAWBA COUNTY
LTA / � 100A SOUTHWEST BLVD
1 _ NEWTON, NORTH CAROLINA 28658 RECEIPT
�I�!i;.w Gnape PHONE: 828.465.8399
U� ': Goas. Friday, May 13, 2016
/842 sM www.catawbacountync.gov
PAYOR: Huntington Park Apartments LLC/Brantley Properties Inc
Huntington Park Apartments LLC/Brantley Properties Inc
PAYMENTS
TRANSACTION NUMBER: TRC-671846-13-05-2016
PAYMENT DATE : 05/13/2016
PAYMENT TYPE: Check 1474
INVOICE NUMBER FEE NAME FEE AMOUNT
05-16-328323 Pool Inspection Fee - Seasonal $150.00
TOTAL PAYMENTS : $150.00
FLI-0000095
CASE TYPE: Food& Lodging Institutions WORK CLASS: 50 - Seasonal Swimming Pool
SITE ADDRESS: 1207 2I ST AV NE, HICKORY NC
Applicant DEFAULT APPLICANT„
Manager BRANTLEY PROPERTIES INC., (HUNTINGTON PARK APARTMENTS LL PO BOX 9886, GI
27429
OTI-IER-IMPORTED HUNTINGTON PARK APARTMENTS, PO BOX 9886, GREENSBORO NC 27429
F:NONE NONE
Paid By HUNTINGTON PARK APARTMENTS LLC /BRANTLEY PROPERTIES INC, 826 N ELM ST SI
GREENSBORO NC 27401
** NO PEOPLESOFT ACCOUNT ASSIGNED **
receipt 05/13/2016 10.16 Page 1 of 1