HomeMy WebLinkAboutLR Pool App 530050 11 03 22 i . iv- '� ENVIRONMENTAL HEALTH
'or f Catawba County Government Center
Catawba county • 25 Government Drive I P.O. Box 389 I Newton, NC 28658
public health__ Phone: (828)465-8270 I Fax: (828)465-8276
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Email: EHAdministrativeAssistants@CatawbaCountyNC.gov
Application for Public Swimming Pool Permit
Pool Information (� "� — 0000 O L(
Name of public swimming pool: ,�.-tr ram' /p C/�1�1,G�/=' • i'' I ►✓• : O 1 0 �-(�
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Type of public swiannieg p Swimming pool EWading pool ❑Spa ❑Other (describe)
Date constructed or remodeled:O.:fore May I, 1993 [JMter May 1, 1993
Dates of operation: Oppeaiog date: dosing date: Opening
Flom of operation: time: )Q,*rvn — $;30//1✓•j Closing time:
Owner Information�
Name of owner. NU �� +�g 7Y1�— l//t'71�'�= Owner email:
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Mailing addr : 7,57 . , c/i.e JY 2/ed
thy: //',/!�'''" State:NC ZIP: oe��p�J..--
�'� ', Phone#: � — 3( ' —? 11
Contact Person: /�— ��-4�-
Operator(On-bite Manager)Informati
Pool operator. �'—iQZc.� Phone#: r�-y 31 O - ��9 �.
Street address: L1i' 2I /Y L� tV C y,,,,....
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City: /1 z .,. ct . >_ NC ZIP: �z�
Pool operator trained by: ,i ,`Swiumb*. Peel Foeedeton(certificate#
I ��) - ` 617/
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Pool Drain Safety Compliance u tta
r PERMIT CANNOT BE ISSUED IF FORM IS INCOMPLETE
A separate form is required for each pump including circulation,jet or feature.
Name of Pool / A ►``l"— IPLIA.R_, (//91-L1/)-.4 ) ID#
1. Pump Flow 4,-,k/.7
[��/Yg /8-3 biHorsepower /17
Pump Manufacturerl!
Model#
Maximum Pump Flow at highest speed FROM PUMP CURVE: J 1 gpm. Pump use: irculatio 'jet/feature(circle one)
Has pump been serviced(disconnected from power for any reason)or changed out in last 12 months? YES/NO
Flow meter manufacturer Flow meter reading GPM
2. Drain Sump Measurements Is drain cover sumpless? YES/NO
Sump manufacturer and model OR: Field built sump(circle if yes)
Diameter of pipe entering sump inches. Pipe enters througlLlSl�vr/SIDE of sump(Must circle one)
?It-inches.
/
Distance between highest point of outlet pipe and top edge of sump /10�y inches.Sump dimensions /7-/Y
3. Drain Cover Data—MUST BE INSTALLED/ PER MANUFACTURER'S INSTRUCTIONS-Attach Instructions to form.
Number of main drains on each pump OL Distance between main drains(on centers) /5 feet inches
Cover/grate manufacturer /77.41-77.11/1--4 ,model it.,)4 /V r' , vGBA approval 2008/2017(circle one)
Flow rating from instructions: X/ gP
m Cover(s)located on pool:1 /wall(circle one)
Date installed / /7 Lifespan Y,' EXPIRATION DATE /7/7- -----_
4. Equalizer Covers
Number of operable skimmer equalizers Have the equalizers been permanently disabled? YES/NO
•
Equalizer fitting Manufacturer ,Model ,Lifespan
Bulkhead adaptor Manufacturer .Model ,Date Installed
Diameter of equalizer pipe Cover is located on(circle where mounted):Floor/wall
Equalizer fitting maximum flow rating_ Rpm.
•
Date equalizer cover/grates installed EXPIRATION DATE:
afe Va' , (S
`-'elease System VRS)—Safety Vacuum Release System manufacturer/model#-
a ..equired to demonstrate effectiveness during permitting inspection.Date last tested
.se One
'l e in pool OR Protective cover on vacuum lines installed before May 1,2010,OR
If-latching cover designed to e o ned wi a ol n lines installed after g62 5/4-Z/
May
ayyy 1,20102
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#,A C CATAWBA COUNTY
6: 100A SOUTHWEST BLVD
` NEWTON,NORTH CAROLINA 28658 RECEIPT
�.�� PHONE:828.465.8399
��►� Thursday, November 3,2022
18 4 2 sM www.catawbacountync.gov
PAYOR: LENOIR RHYNE UNIVERSITY
LENOIR RHYNE UNIVERSITY
PAYMENTS
TRANSACTION NUMBER: TRC-50407224-03-11-2022
PAYMENT DATE: 11/03/2022
PAYMENT TYPE: Credit Card
297083443
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
11-22-414217 110-580200-663000 Pool Inspection Fee-Year Round $200.00
TOTAL PAYMENTS: $200.00
FLI-0000184
CASE TYPE: Food&Lodging Institutions WORK CLASS: 53-Year-Round Swimming Pool
SITE ADDRESS: 751 STASAVICH PL NE DR,HICKORY NC
Applicant LENOIR RHYNE UNIVERSITY,PO BOX 7164,HICKORY NC 28603-
Owner LENOIR RHYNE UNIVERSITY,PO BOX 7164,HICKORY NC 28603-
**NO PEOPLESOFT ACCOUNT ASSIGNED**
Pool Operator PAUL SCHIFFEL,751 STASAVICH PL NE,HICKORY NC 28601
B:8283287427C:8283103924
receipt 11/03/2022 09:15 Page I of I