HomeMy WebLinkAboutThe Gates at Highland Apartments Cil ENVIRONMENTAL HEALTH
Nair
a. . • Catawba County Government Center
catawba counI1. 25 Government Drive I P.O. Box 389 I Newton, NC 28658
, Ltiili.. !:. „ Phone: (828) 465.8270 I Fax: (828) 465-8216
Email: EHAdmin0LCafowhnCountyNC.ctr,t,
Application for Public Swimming Pool re it. .1 154,340
1:-.. - Pool Information ) I) DOISaCO i i0
Name of public swimming pool: //1f a a le,j c--I i-Ii:54 /a,"1 i Q ic-i/„lP A"
Street address: / l ! 0 /5 i/! SE 7)Y AI a...
City: t0. o State: 1 v ZIP: °���
Type of public swimming poo l Jy Swimming pool nWadin pool S a Other describe
k Date constructed or remodeled: Before May I, 1993 niter May I, 1993 D D/rir.1l I s AS
Dates of operation: Opening dote: Maki j • I/ !a Closingdate: AM1
1..' „
�'"t � � _Opening A cGitStiA-1
Hours of operation: time: `"► Can Closing time: /200 l not(,
vw>,tt:z, Antali 1 y&u/ fg;:t old Oa' l
Name of owner: poll r,i *11w0 Owner email: pattipo,Q1'p l�vs .c
Mailing address: PO /5 D X a 3 LQ5
City: #7.0(.0- State: NC ZIP:a gliQ.DI
Contact Person: ( iinekl p _ce mood! Phone#: (U J`0' 7/7, 5---
IUpet.afui: OJt, •
I. Pool operator. kail M ��Phone #: P ( ✓ T2(/ 739
//y �Street address: /l / 1 ' Pfit S 7 r rr'v -ill bi--/
City: J7/('Jt'.Cf3fState:NC ZIP: c9t (0 t1
i
Pool operator trained by: FINational Swimming Pool Foundation (Certificate#: l irL5 L a 1 7
[Other(please specify) a-t I Yin t Ise
"Q" 5 gjto3
Application Submitted by: / / 4 le, Owner Operator
Signature of Applicant: L / a-4 ,L Date: t-7//3/2Q
Purpose General Statute 13011•282 requires the Commission Health Services to adopt ulet governing public swimming pools.the rultsin ISA NCAC I SA.2500 sequit c the owner or operatoi to apply annually
for an operation permit for each public swimming pool. this form is to allow owner or operators of pudsc swimming pooh to apply for permits.Prepotation:the information requested on leis Form is to be
completed bythe pool owner or a designated representative of the owner.the completed appialloa is wbmttcd to the local health department for the county in w4odh the public swimming pool is located. A
separate appliwlion must be completed For each public swimming pool.Copies- Original ts be maintained at the local health deportment.Disposition: Please refer le Records Retention and Disposition
Schedule lot(crusty/District Health Depo'tmenh whidh are pubhohod by North Carolina Demon of Historical Resources. Reader:Additional forms may be ordered from: Division of Environmental Health,
Deism two ofEovirenmcnt and Natural Rests cc', 16J0 Mail Service Center,Raleigh,NC21699.1632.((oarc152 01.00)
DLNN 3961(Rcvised4/03) Enviconmenial Menhir Scums Section(Review 4/06)
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OF t. * .` fool Drain Safety(1(i111 Compliance Data
PERMIT C•ANNo•i 1W ISSI FU IF FY)RSl IS t`C'(illPL1;Ii:
1`t:haratc li,rni is rc. tirrii h'r cad!pn,nitifi!s ,n st.9ii
'Same of Pont_._rh e_... ..xtLs ._____ •
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t ttdress M. L } V ) „r __e o . 1 `�-e z'ol
.=OR\1 (":0\II'LI.11O\ \ Ncp irate I'tlul 1)Iaitt ti.tltt% ( itt i•i:_li,_,. Data iot'to must be completed untl submitted
for t'aclt intik itlual void at a facility inciu(lintt spas,Watling voids, .ifutl r►lltttrr_I)ools.
~ I. Pump I hrrr Pump \Liunl I )t r; \t f. \I..d t tt
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2. Drain Sump \leisurenienls I his is!lie area under Ih Ilw,r lll:nit., ii IIL'lil huiii stt:nln rt! n 1!. ,1 lit 1.Iltos,drillll tsp.er one lime to Ineasnre
tCltel.i. here iI mtinp14.... i„.."' , then proceed lu ni i .eeln,r I
Sumo.liilt.': R1,1111.I- tii,itil 1110:.'s..ir.tnict.r: ( Ii sst;u•r-r- i9t1.i;-- `, inch;.
5i1)U1 minimum Jett;it - tatile•• 1)1.,at,:I4.71 .00ttr1 ltl ,�I,: 'UIli1 ___J
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3. Drain(;n►er((irate Data
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1)id.;.lin'tt.i,1,, ::rates instaIL.,l' rY\A(1 ji,,().i:) I•.\1)112 l I I 1l I \ I 1 _
3. I?rtu:iliier ( tier'.
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•.-- I tlualiicr Iillnt \Linul taur.•r Pe.it_ x,,;- . n1;at.l a SC.' t`' '0 i 1: .i • J`,ram ,
kir.,. I•tlualiier lining nrt'nnuii Ilo.i raiine f CI ,q�tt„.
ikttc cquslikrcos,r _rities irri:ti!etl' rt•17r� �,,;;1`}}%..s..t„• __ . . l-\19RA-1 IO\ I).i IF:: ?.2,..1
uulil Release Si..icnl i's1 RS) 5\Itti required it dual&hail;}are Cir:.r ill.;!) + Ie t ,'a ecnier„r{`limit ha.it.ili_Iedrain li lilt
I ttrkltble cot,er or.lull;)
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\,it `=lcinlii Init:in i+uu'Oi(
l','ti1Ji11.0 0)1,0 on 1:1C1IG{ll iiih..1 Insiallctl hetitit lit;\ I,20111 OR
.scir:vin,i;i::. ,el-{iltchin in,:ti"er des);n,•tl !i,is opened tt iili at fuui i-a t;Nil,l!:! lire. i,,,lal!;J alter\Ian I. 20if1
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Am.• CATAWBA COUNTY
o G 100A SOUTIIWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
PHONE:828.465.8399
Wednesday,July 13,2022
8 42 sM www.catawbacountync.gov
PAYOR: The Gates at Highland Apartments
The Gates at Highland Apartments
PAYMENTS
TRANSACTION NUMBER: TRC-43353375-13-07-2022
PAYMENT DATE: 07/13/2022
PAYMENT TYPE: Credit Card
292393940
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
07-22-409069 110-580200-663000 Pool Inspection Fee-Seasonal $150.00
TOTAL PAYMENTS: $150.00
FL1-07-2022-1 7563 6
CASE TYPE: Food&Lodging Institutions WORK CLASS: 50-Seasonal Swimming Pool
SITE ADDRESS: 1710 8TH ST DR NE,HICKORY NC 28601
Applicant THE GATES AT HIGHLAND APARTMENTS, 1710 8TH ST DR NE,HICKORY NC 28601
B:8282347364
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 07/13/2022 16:59 Page of 1