HomeMy WebLinkAboutHuntington Park App 500039 06 01 22 ENVIRONMENTAL HEALTH
r Catawba County Government Center
c a t a w b a l-. i. 25 Government Drive I P.O. Box 389 ( Newton, NC 28658
Phone: (828) 465-8270 I Fax: (828) 465.8276
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sail: 1H11;f1 : :ItawhaCo.“1 Fig cir,
tion for Public SwimmingPool'P t ��L}�L��
Appl><ca en
nit
I� DC 60003
Narneofpublkswimmingpool: flV1/1 n f h P,4 A 5W-- -,41-,►t ( /1 N po0'1
Street address: /2o7 2,1 s7 Ave /
City: ��L�Co / State: NC ZIP: z0p-Kdl
Type of public swnaisg pool Swimming pool nWading pool nSpa 70ther (gastrin)
Date constructed or remodeled:V:gaforej I, 1993 [After Hoy I, 1993
Dates of operation: Opening date: V ll c/ 3ra" Closing date:/3 3r - . ZO2"Zopecing
/
Hours of operation: time: /0:00 �M Closing time: •16d ern
O�Jtt.r Iit fr:YIT1.1ti n /y� !_
Name of owner: .ski Y /'/'✓1 V C F1it Owner email:i 1 t/tti//i?Aa.1 G� '. Co/►'1
Mailing address:f vi 61 L1-)efs U trt t v'QJS ity ex.N O1 SJ Q 10 (
City: kt,W0oO State:NC ZIP: NJ') 0 ?011
Contact Person: Cil t ftgfl rls—, ( 10 T\IJ Phone#: !1 2 g _ J Z y-- (--(7 �o
Oc raitrio (Url- ..!eti,t .. E3) irlICJilii.1.1,1ri
Pool operator. C,4c,Lci1rl '}6Y►pf Phone#: q/2'7 ' "7 r°2'
Street address: "! 1-3/ I t I S 1 S W f 111.C.kG /J C. Z. �Q 2
City: n UC 6r ,' State:NC ZIP: Z b C O Z
Pool operator trained hy: Rational Swimming Pool Foundation(Certificate#: Pool £e f'0W1
Other(please specify)
Application Submitted by: (k11 (kl_I,, Jo tuX [ 'Owner 1 Operator
Signature of Applicaat: f V Date: t3/ .-51/21
Plop's General SMuh 130A•262 regokes die(Minh r ion Ho.114 Service I.adept rules(ovarian,Public swimr lia'peel s.Therdesla ISA HCAf 1 SA.2 SOO rryulre to moor or operator I.apply woody
for on*swedes penalt for earh peblir swimming peal This lone is to slow*rams or epaalan simian twiaains pools la rpPly for panic.Pnparagen:The Information rapeseed on des fora line M
uapleI.d hyte polemic.or declension representative 011ie.weer.ana roaphated gglaloa is whwaeed to the loci Mawr department(or Is minty ha which do public twlawlae pool h lnamd.A
mouth,appllatlee must he tomploted for anti pat swimming peal Capin:arl,ind to M meiatmioad ai the local health department.Disposition:Pease refer to Retails RotemNea aed Diapesleae
S4u.dde hr Caunry/District Haa16 Deparlmerb which we salmi by Nedr Carona.Division of Historical Res.wae. Roeder:Adithnel hors wry ha ordered hew:Dideioe of Earirewannhl Smith,
Dgar6motofEnvinosaetand 1111111111 beuunes,1630 Mail Soak((err*,Runtish,NC 27699.1632,(Cornier 52.01.00)
0 0113961(Rsvised4/03) hair.eaermal N eahh Shakes Sadism(Raiew 4/04)
Completed form
Pool Drain Safety(VGB)Compliance Data must be submitted
PERMIT CANNOT BE ISSUED[F FORM IS INCOMPLETE
A separate limn is required fin-each pumping system. with application
Name of Pool t4(/vitt rt.Or% Payk. Apark44Ntr
Address I1°1 2(rt AYt hl E 1.0 1 Cl'hQ(h PQ•J
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.
Putt_ n Flow 4.1.,
I1 /1 ' Model v la G,
Pump Manufacturer ` Horsepower
Maximum Pump Flow. Maxinuun low rate from nnmroo come: gpm. (Provide supporting evidence if Row reduction)
2. Drain Sump Measurements This is the area under the floor drains,if field built sump may need to remove drain cover one time to measure.
(Check here if sumpless ,then proceed to next section)Sump shape:Round-width: inches diameter: OR Square- (2- inches a l Z inches
Sump minimum depth inches Diameter of outlet pipe in sump - 1- f 2 inches
Distance of top(inside)of outlet pipe from leutiont of cover-grate O incites
Sump manufacturer and model#if available
3. Drain Cover/Grate Data
Number of drains on each pump Distance between drains(on centers)
Cover'grate ntauulitcturer A ug t/0.Sillr .model WA V 11, .Lilespan: G iQS
Maximum flow rating ofcoven'grate 3 6 I gpm(floor); gpm(wall) ' Cv
Date drain cover/grates installed: Nay a-y 6 ZO Z� EXPIRATION DATE: 1 b Cam`' .--\°
7. Euualizer Covers O
Number of operable skimmer equalizers OR Have the equalisers been disabled? CI'NO 6 3 / ZO r/ O
Equalizer fitting Manufaclitrer ,model .I.ilespan
L:yualizer titling nutsintunt flow rating
Date equalizer cover.grates installed: EXPIRATION DATE:
5. Safer'Vacuum Release System(SVRS)-SVRS required if dual drains are closer than 3 feet on center or pump has a single drain with
blockahle cover or stoup.
Safety Vacuum Release System manufacturer- v.(n.J
Vacuum line-Choose One
V No vacuum line in pool OR
Protective cover on vacuum lines installed betOre May I,2011)OR
Self-closing,self-latching corer designed to be opened ssith a tool on vacuum lines installed idler May I.201(1
]'till name of person providing this information Ckri4f i .- 4.JGVt .,S
Signature Date 5/...7'/ Zo ZL
Newt iis
Revised 10/2016
�$A CATAWBA COUNTY
E'�' � 100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
k)711ED
PHONE:828.465.8399
Wednesday,June 1,2022
j841, sM www.catawbacountync.gov
PAYOR: Eskay Management
Eskay Management(Schecter,Yehuda)
PAYMENTS
TRANSACTION NUMBER: TRC-40902377-01-06-2022
PAYMENT DATE: 06/01/2022
PAYMENT TYPE: Credit Card
290697288
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
06-22-407197 110-580200-663000 Pool Inspection Fee-Seasonal $150.0o
TOTAL PAYMENTS: $150.00
FLI-0000095
CASE TYPE: Food&Lodging Institutions WORK CLASS: 50-Seasonal Swimming Pool
SITE ADDRESS: 1207 21ST AV NE,HICKORY NC
Manager CARLISLE RESIDENTAIL PROPERTIES,826 N ELM ST,GREENSBORO NC 27401
B:3364580828
Manager COMMUNITY MANAGER HUNTINGTON PARK, 1207 21 ST AVE NE,HICKORY NC 28601
Paid By ESKAY MANAGEMENT, 15 AMERICAAV,LAKEWOOD NJ 08701
**NO PEOPLESOFT ACCOUNT ASSIGNED**
Paid By HUNTINGTON PARK APARTMENTS LLC/BRANTLEY PROPERTIES INC,826 N ELM ST SUITE 200,
GREENSBORO NC 27401
Pool Operator KELLY SIMMONS,4609 CRYSTAL ST,CLAREMONT NC 28610
H:8283104927
receipt 06/01/2022 15:11 Page 1 of 1