HomeMy WebLinkAboutHoliday Inn Express & Suites 500071 05 23 22 G) ENVIRONMENTAL HEALTH
Catawba County Government Center
c a t awb a county 25 Government Drive I P.O. Box 389 I Newton, NC 28658
public health Phone: (828) 465-8270 I Fax: (828) 465-8276
MAKING.LIVING.LETTER.
Email: EHAdmin@CatawbaCountyNC.gov
t I - Ot00 i58
Application for Public Swimming Pool Permit
ipao lets 5061) 7 (
Pool Information _
1
�Name of public swimming pool: l k V C)\--- l A— 1,I'1 P., ._-Ip S S
Street address: \O `I I 0-IR (S+ ly 1 C
City:\Oi'1, \A_Q-A" State: r IC-• ZIP: La 13
Type of public swimming pool wimming pool IiWading pool nSpa 7O6er (describe)
Date constructed or remodeled:nBefore May I, 1993 I1After May I, 1993 RECEIVED
Oates of operation: Opening date: 'a—) • D,D, Closing date: I Ll '�1 ' 9) _Opening
Hours of operation: time: "1 • 00 I!iy1 Closing time: 1 \ , -Dern • 2 0 2022
Owner Information rr � cl,au,,,,.0,4C-0-h-WOMAthil:
�y�)Ennvironmental Health
Name of owner: ! P.,((t ( �.t. I - �=��' t J ''1<d1OVP f` C c
Mailing address: 1 D—1 I (151-k St • KU) .
City: C DO a .-Ar State:NC ZIP: ate 13
Contact Person: \,�i(^ PVi.-QL4 . Phone#: i a b `L1 J_—7 o—i D
Operator(On-Site Manager)Information l
Pool operator.g\lS`r%� P'( —I{�_. Phone#: q �C `-)b-) 0
Street address: lO _\ \ - CSA - r w
City: C (\Q•A--e-Ar State:NC ZIP: C L. 13
Pool operator trained by: Didronal Swimming Pool Foundation (Certificate#: C)2l.o X. t I V )
❑Other(please specify)
Application Submitted by: `. OY\•C-A--- R IiOwner erator
Signature of Applicant:)--- ‘(\Q—rL-}`32 : 5• (t• oe.0 )
Purpose General Statute 130A•282 requires the Commission Health Services to a dopt rules governing public swimming pools.The rules i n 1 SA NCAC 1 SA.2 500 require the owner or operator to apply annually
for an operation permit for each public swimming pool.This form is to akw owners or operators of public swimming pools to apply for pernits.Preparation:The informaion requested on this form is to be
completed by the pool owner or o designated representative of the owner.The completed applafon is submitted to the local health department for the county ih which the public swimming pool is located.A
separate application must be completed for each pubic 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 punished by North Carolina Division of Historical Resources. Reorder:Additional Forms maybe ordered hem:Division of Environmental Health,
Departmental 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(Review4/06)
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Instructions for Completion and Submission of Pool Drain Safety Compliance Data Form
Please review the instructions below to ensure the Pool Drain Safety Compliance Data form is properly completed and
submitted with all information required. All submissions will be need to be approved and verified by the Health
Department prior to the issuance of an operation permit for the pool in accordance with Rule .2539(c).
POOLS WITH MULTIPLE PUMPING SYSTEMS MUST SUBMIT A FORM FOR EACH PUMPING SYSTEM.
1. PUMP FLOW—Enter the maximum flow from the manufacturer's pump performance curve.
Pump curves can be found online at http://ehs.ncpublichealth.com/faf/pti/drainsafety.htm and
http://charmeck.org/mecklenburg/county/HealthDepartment/EnvironmentalHealth/PublicSwimmingPools/Pages/defa
ult.aspx\
2. DRAIN SUMP MEASUREMENTS—Measurements are needed to determine the size of the cover/grate and to
assure the sump is deep and wide enough to meet the requirements in the cover/grate manufacturer's specifications.
Information on documenting the size of the drain sump can be found at:
http://ehs.ncpublichealth.com/fafpti/drainsafety.htm
3. DRAIN COVER/GRATE DATA—Enter the manufacturer, model, lifespan expiration date and maximum flow for
the main drain cover(s).Various approved covers can be found under VGB Approved Drain Covers and Equalizer
Covers listed at the following website:
http://charmeck.org/mecklenburg/county/HealthDepartment/EnvironmentalHealth/PublicSwimmingPools/Pages/defa
ult.aspx\or at the drain cover manufacturer's website.
4. EQUALIZER COVERS—Enter the number of operable equalizer line covers, the manufacturer,model, lifespan
expiration date and maximum flow for the equalizer covers. Various approved covers can be found under VGB
Approved Drain Covers and Equalizer Covers listed at the following website:
http://charmeck.org/mecklenburg/county/HealthDepartment/EnvironmentalHealth/PublicSwimmingPools/Pages/defa
ult.aspx\or at the equalizer cover manufacturer's website. If all equalizer lines are disabled or pool has no equalizer
lines, please indicate and provide details on the form.
5. SAFETY VACUUM RELEASE SYSTEM(SVRS)—SVRS is required if dual drains are closer than 3 feet on
center or pump has a single drain with a blockable cover or blockable sump. Enter the manufacturer of the safety
vacuum release system(SVRS). If using another secondary method of preventing bather entrapment allowed in Rule
.2539(b),please attach documentation.
6. VACUUM LINE—If vacuum line ports are present in the pool,please indicate the type of cover(s)on the form.
FORM COMPLETION—A separate Pool Drain Safety Compliance Data form must be completed and submitted
for each individual pool at a facility including spas,wading pools, and other pools.
The Health Department understands that the required information and/or measurements may be beyond the scope
of owners or operators. In those cases, it is recommended that you contact a Registered Design Professional
(Professional Engineer or Licensed Architect) or a knowledgeable pool professional to assist you in completing the
form.
y�y'A CATAWBA COUNTY
71 t I
100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
I 7 PHONE:828.465.8399
Monday,May 23,2022
I842 sM www.catawbacountync.gov
PAYOR:
HOLIDAY INN EXPRESS CONOVER LLC,
PAYMENTS
TRANSACTION NUMBER: TRC-40360712-23-05-2022
PAYMENT DATE: 05/23/2022
PAYMENT TYPE: Check ap039192
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
05-22-406787 110-580200-663000 Pool Inspection Fee-Seasonal $150.00
TOTAL PAYMENTS: $150.00
FLI-0000158
CASE TYPE: Food&Lodging Institutions WORK CLASS: 50-Seasonal Swimming Pool
SITE ADDRESS: 104 10TH ST NW,CONOVER NC
Owner LEROY LAIL-PIEDMONT CENTER ASSOC,LLC, 104 10TH ST NW,CONOVER NC 28613
B:8284657070
Paid By HOLIDAY INN EXPRESS CONOVER LLC,2258 HWY 70 SE,HICKORY NC 28602
**NO PEOPLESOFT ACCOUNT ASSIGNED**
Pool Operator JAMES DUNN, 104 10TH ST NW,CONOVER NC 28613
B:8284657070
receipt 05/23/2022 10:40 Page 1 of 1