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HomeMy WebLinkAboutWaterford Place App 530073 08 25 16.TIF ELI— CCODiaa N.C. Department of Environmental and Natural Resources �-{���W/'� �'y1 Division of Environmental Health —lT 330 APPLICATION FOR SWIMMING POOL OPERATION PERMIT POOL INFORMATION: �( Name of public swimming pool: icofer-�Ord I hcQL 4ritYto Street address of pool location: " 'DOO N• (el•L4er 'S+ City: County: fhcwry (aim. 6i 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 Dates of operation: opening date Y YOLIf G closing date Hours of operation: opening time Lj 9 :00 A.M closing time q • OD f.VM1- OWNER INFORMATION: Name of owner: y\o 1 er-ro rd Place tQYT Weds Mailing address: 11000 • N• // cer cLryNc ^ g(oO1 Contact person: je5S(cO HeDuser Telephone: 3.23--&51-608. o OPERATOR (On-Site Manager)nINFORMATION: Name of pool operator: CAlers SIW oszc K Address: 3gwle GIS abmjpe Telephone number: Z2/>- 302 9-0O O b Pool operator trained by: (check one) ❑ National Swimming Pool Foundation (Certificate Number: Other (please specO) POD I raceSSe }- APPLICATION SUBMITTED BY: Or2r p r # 397 r (002012. Owner or operator: Signature Typed or printed name Date: Purpose General Star Etc 130A-282 requires the Commission Health Services to adopt rules governing public swimming pools.The rules in ISA 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 nwst 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) • ��j 11�� (� Pool Drain Safety Compliance�jData V Name of Pool Y ale rd ThIGCf �`f/ieat$ /� Address yo©° N C..en-ter Si- / i74�yy N( iC.8(Qo Pump System Flow IIMP ^, , , neYr Pump Manufacturer I eI r-bA.r Model Number /t D t0 u/ Maximum Pump Flow(manufacturer's specifications) 91-/ 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) 3 • Drain Sump Measurements I Sump width:round 7 2 inches diameter; rectangle inches X inches Sump minimum depth 5 /2 inches Diameter of outlet pipe to pump // 'f inches Distance of top(inside)of outlet pipe from bottom of cover/grate ,3 /Y inches Drain Cover/grate Data p' , I/ /J Number of drains on same pumping system �(, Distance between drains(on centers) S O /2 / ,model W(' In 8E /rsFa��d 3/a3 �'? Coverlgratemanufacturer �'(j�lI,OQY'Ol 'rf y z 7y rUS Maximum flow rating of cover/grate /2, 6 gpm(floor); gpm(wall) ��pp / 3 br7 ►:to L'"�3 Date drain cover/grates installed: Qqt� 3/2 /,0 Expiration date~ 302 Number of operable skimmer equalizers 2 \ / r (j({�// {�N�model !iii 7 o- o3)CV 7(-Star /,lilt Equalizer fitting Manufacturer \j( Equalizer fitting maximum flow rating /0 t0 (� f P I 0 Date equalizer cover/grates installer: 31 AS `/0 Expiration date /3 Ms // Full name of person providing this information JOSS f� _API h f{oe.LS f 1 Signature / � Cilgt7isV Iq((.4(,1 i Date Jr/Z f{/Y CFor instructions please visit the Pool Drain Safety Compliance Website at httrliehsocpublichealth.com/faf/pti/drainsafety.htm 4'A CATAWBA COUNTY fIOOA SOUTHWEST BLVD mm 11 NEWTON, NORTH CAROLINA 28658 RECEIPT g rkii PHONE: 828.465.8399 vdw C Thursday, August 25, 2016 /842 sm www.catawbacoungmc.gov PAYOR: WATERFORD PLACE APARTMENTS WATERFORD PLACE APARTMENTS PAYMENTS TRANSACTION NUMBER: TRC-800369-25-08-2016 PAYMENT DATE : 08/25/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332037 Pool Inspection Fee -Year Round 5200.00 TOTAL PAYMENTS : $200.00 FLI-0000198 CASE TYPE: Food& Lodging Institutions WORK CLASS: 53 - Year-Round Swimming Po! SITE ADDRESS: 4000 N CENTER ST DR, HICKORY NC Manager WATERFORD PLACE APARTMENTS, 4000 N CENTER ST,HICKORY NC 28601 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Pool Operator ALEKS SIWOSZEK,4000 N CENTER ST, HICKORY NC 28601 B:8285140002 receipt 08/25/2016 14.38 Page I of 1