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HomeMy WebLinkAboutThe Abbey 500033 Pool App 06 17 16.tif N.C. Department of Environment and Natural Resources Division of Environmental Health /:% _0066o89 APPLICATION FOR PUBLIC SWIMMING POOL OPERATION PERMIT POOL INFORMATION: ((�� 1 J ;2011500033 1'� Name of public swimming pool: bb e-o A 1 Ro Mc.- -PS Street address of pool location: g0 91:k A UL Dr City: l-4;C4oc County: C4144JD/a Type of public swimming pool: (check one) ❑✓ Swimming pool n Wading pool ❑ Spa ❑ Other (describe) Date constructed or remodeled: (check one) Z.1 Before May 1, 1993 / ❑/- May 1, 1993 or later / _ Dates of operation: opening date (7�,,�0//1� closing date 1�©/,�//CS Hours of operation: opening time dt-Nio•J closing time 6(.t Oh OWNER INFORMATIIOON Il 1 (� L I (� Name of owner: ; ' k(2- O\ft) 1 69er 1 •'(ctS i £ dc_ \ 1��UUb03 Mailing address: 3 6V 91L AO 4- be N-)Es' Contact person: j,LlYvin-(.�. E.1-�"p(Re Telephone: Sag'3a-2 mo2' tVS OPERATOR (On-Site Manager) INFORMATION:O I Name of pool operator: QL`,`,�\ l^N'\ p Address: 1194 2.;c9.3 a ../t-". &k .d4,7 /Os_, _zfl e z Telephone Number: 'c:Zer, 0276 40,2g Pool operator trained by: (check one) 4 National Swimming Pool Foundation (Certificate Number: ) Other (please specify) ML 01\) 61/#La‘,2o/G APPLICATION SUBMIITTEE/D�_B,,�YJ:p Owner or operator: lZ✓��,/�/oLQeX Pin: iv, P L A'\ 32 Signa / e Typed or printed me Date: �i" / Xw Purpose:General Statute 130A-282 requires the Commission for 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 the 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) Q (Pool Drain Safety Compliance Data Name of Pool 1 7 q���'� A iJ(��c±M<' ks/� ` lye/ ,� / Address 3c o l _ vc_ 1\J. '� 3 L /7, C/�ltj A)C-.1 ,21-6 / Pump System Flow ' / Pump Manufacturer Model Number Maximum Pump Flow(manufacturer's specifications) gallons per minute Maximum Pumping System Flow is reduced to gpm based ono Measured Total Dynamic Head loss of feet; Calculated Total Dynamic Head loss of feet; Magnetic flow meter reading of 1pm; Automatic flow limiting valve factory set at gpm (Provide supporting evidence for flow reduction) Drain Sump Measurements Sump width:round inches diameter; rectangle _inches X inches Sump minimum depth inches . Diameter of outlet pipe to pump inches Distance of top(inside)of outlet pipe from bottom of cover/grate inches Drain Cover/grate Data / Number of drains on same pumping system / Distance between drains(on centers) Cover/grate manufacturer f r n�// -a r'9-RA C ,model v,N) 171 1( ∎Q�t E te Maximum flow rating of cover/grate gpm(floor); C gpm(wall)/ / Date drain cover/grates installed: W479?o/� Expiration date: C�//f/X 0 Number of operable skimmer equalizers Equalizer fitting Manufacturer model . Equalizer fitting maximum flow rating ' Date equalizer cover/grates installes: Expiration date Full name of pers ro ding this information Signature, cz4 i if Date G/ "17-4 For i structions please visit the Pool Drain Safety Compliance Website at http://ehs.ncpublichealth.com/faf/pti/drainsafety.htm To:4658276 Paoe:2 2 JUN-18-E016 05:24 From: ISCOVINS Rev F Ell � � °® InetallO aton, Operation, &IParts ti 4• • WGX1048E—Used for Floor/horizontal or wall/vertical applications. Listed as W$1048E, Submerged Suction Outlet,Flow rating as tested per ASME A112.19.8-2007 Is floor/horizontal 125 m and wall/vertical 72 mend Is noted on cover, • G1 E1— s a special case used to replace S 1048 1 in the field. Submerged Suction Outlet,Flow rating tested per ASME A112.19.8-2007 15 floodhorizontel 125 gpm gpm and wall/vertical 72 gpm and Is noted on cover e Part rumber is WGX1030Z2AM 15/16 long • and is used with sumps that have metal inserts. . _ _ ��� l WG1048AVPAK2/WG1049AVPAK2 Vi ., r.� ars. a Par number Is WGX1030Z2A 1-1/2 long � ,`y !% i�� and is used with sumps without metal inserts. • r� � �' SP1048AVPAK2/SP1049AVPAK2 • cn .6.00.-- . �; Part number is WGX103021AM 1-1/4 long and Is used with sumps/frames that have metal Inserts. _ y` ~ WG1051AYPAK2/WG1052AvpAK2/ ._a . q -- �• �� f WG1153AVPAK2l — Ol WG11a4AVPAK2/WG1030AVPAK2 Part Number W G1425Z3 screws are used on Sumps That require WG1048E1 covers. >--' . --� Part numDer is WGX7030Z1A 1-1/4 ton "t - �" •" •... and IC IifcA Wlh e.i...ne..I...9........� • N-18-2016 05: 11 From: To:4658276 Paee: 1'1 ® ISWG1o48COC Rev D [01 CERTIFICATION OF COMPLI NCE Contains: WG1o48E, WG1o48EBLK, WGio48i GR, or WGio48EDGR Description: 8" Round Suction Outlet Cover Ratings: Floor: ra Wall: a GPM Open Area: 8,s sa-!n Certified to Comply with Section 1404 of the Virginia Graeme B:ker Act (VGB) Pool & Spa Safety Act codified at 16 CFR part 1450, Initial Certification May 2011. Manufactured: After September to, 2009, by a Division of Hay and Industries, Inc. at K4-A, 214028 Block K4- A, Export Processing Zone Wuxi New District Pangs Province PRC 214028, China; or at One Hayward Industrial Drive, Clemmons, NC 27012. Certified by Hayward Pool Products, 62o Division Street, Elizab:th, Nl 07207, Phone 908-355-7995 Contact at www.havwardnet.com Record Custodian is Customer Service at www.haywardnet.com Hayward Pool Products P.O. Box sioo Clemmons,NC 27012-51o., Phone: 336-712.990o http: ww a ward-. .ol.com . . literatur- :inround • _ .d Date of Mfr: The Lot Number shown on the product label contai s the Year& Month of manufacture. The first number represents the year (ex 1 = 2011) and the seco d character the month (A=)an, B-Feb, H=Aug, I is skipped, J=Sep, etc) Tested to: ANSI/APSP 16 (ANSI/ASME 112.19.8-2007 (addendu 0-20o9)) per Section 1404 of the Virginia Graeme Baker Act (VGB) Pool & Spa Safety Act. Tested •y NSF International, 789 Dixboro Road, Ann Arbor, MI 48113, Phone 734.769-8010 in April 2011. Fertificate at: htto://info.nsLorg/Certified/Pools/Listings.asp?Company=26•o&Standard=ASME1oo8 Date of Installation: Suction outlet components have a finite life, the cover/grate shiuld be inspected frequently and replaced at least every? years or If found 15t e damaged;-• o e , cracked, missing, or riersecurely" attached. Hayward Pool Products acknowledges that it is a federal crime to knowingly and willingly make materially false, fictitious, or fraudulent statements, representa lions, or omissions on this certification, 6" SPACING BETWEEN MOUNTING HOLES \p1+1. 119 T USE ON FOLLOWING SERIES: \ .00 0�0a /15 WG10 IAV PAK2 SP I030AVPAK2 T10000000 \ -?. WGIO•:AVPAK2 SP104eAVPAK2 4 " • 000000 • '. WG1O 9AVPAK2 SP1049AVPAK2 073/4" 0000000 t _`-'. ■ •0000..0000••" @ WGIO.I AVPAK2 SP1051AVPAK2 SUCTION OUTLET ''iCU• 0000•x+0000^ 0 m WG10.2AV PAK2 SP1052AVPAK2 COVER WG104EE :=2t!...0000••00p0.__ :� 0000000 WG10-3AVPAK2 SPIOS4AVPAK2 ti." 000000 Well-3AVPAK2 SP1053AVPAK2 p:0•000. \ - WG11-3AY PAK2 SP1153AV PAK2 WG11-.AVPAK2 SP1154AVPAK2 a Warning— Suction Entrapment Hazard. Suction in suction outlets and/or suction outlet covers which are installed n a small area and/or below the surrounding surface can cause severe injury or death due to body entrapment hazard. To reduce the risk of body entrapment, installation of the field fabricated su ps must be such that the top of the mounted cover is a minimum of 11/2" above the finished pool surface over an area larger than 4o"on a diagonal. CATAWBA COUNTY 100A SOUTHWEST BLVD i~ NEWTON,NORTH CAROLINA 28658 RECEIPT ed>m PHONE: 828.465.8399 1±f U ° v�®ei Friday, June 17, 2016 842 sn+ www.catawbacountync.gov PAYOR: Prime Coatings LLC Prime Coatings LLC PAYMENTS TRANSACTION NUMBER: TRC-693904-17-06-2016 PAYMENT DATE: 06/17/2016 PAYMENT TYPE: Check 1805 Phillip Owen Lail Jr NCDL 7715015 exp 3/27/18 dob 3/27/70 INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329586 Pool Inspection Fee - Seasonal 5150.00 TOTAL PAYMENTS : $150.00 FLI-0000089 CASE TYPE: Food K. Lodging Institutions WORK CLASS: 50 - Seasonal Swimming Pool SITE ADDRESS: 380 9TH AV DR NE RD, HICKORY NC Applicant THE ABBEY, PO BOX 961, GRANITE FALLS NC 28630 F:NONE NONE Manager THE ABBEY, C/O SHERRILL'S CROSSING PO BOX 961, GRANITE FALLS NC 28630 8:4412229 Paid By PRIME COATINGS LLC, 609 2ND ST NE, HICKORY NC 28601 B:8288551136 **NO PEOPLESOFT ACCOUNT ASSIGNED ** Pool Operator MARTYN PROPERTIES LLC/ABBEY APTS-OPER ACCT, PO BOX 3874, HICKORY NC 2860: receipt 06/17/2016 14:59 Page 1 of 1 JUN-18-2016 05:36 From: To:828g65^x276 Rase:3/3 �� ^,'4.1 r ry_,` °' :, • a t }� p 9- r‘...‘,.g .'r� 4't_ "4,"" '5.. -+ °^ � x h •'� ^tw4 9- _ p 'I jfYryRfi}�I I�,m� t - !t ' r _ s" M1 , /y 11-;7 .x a � tthPt�it \' `.�r:-`�x F'+°,'a�?y .»-.'-..-. x�..a n �#":h�•"-="f.. av"fi3 4 -�e `-. ;A�Il+..`s+` a°r��+i .y' 4'.-.\r 2• a�y zL• ,,,,.:L..,"4,:;$14-14 E j p 5..'� . Y+tr A n�f °'7> tyy ens `„-, t . , is- s yi, `5 ti Ph, h "_--,! 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