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Home My WebLink AboutCrowne Plaza Pool App 530008 12 14 22 , (/ 'i) ENVIRONMENTAL HEALTH Catawba County Government Censer 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 ■ague.LIVING.Spore. Email: EHAdmin@CatawbaCountyNC.gov Application for Public Swimming Pool Permit -b 0 b1 Pool Information t i/ r�v 1% 5 3 00v$ Name of public swimming pool: e_gnli.�"(\ .kZ..CA_ V(v Street address: S Lt,�( )\,C QeJ P y) �� F� City: tr'[l,e State: °(� ZIP: g �.& Type of public swimming pool Swimming pool []Wading pool riSpa []Other (descrle) Date constructed or remodeled:1gefore May I, 1993 [ Afteerr�May I, 1993 .�1 Dates of operation: Opening date: ( ) 1 `)— Closing date: t Qc"`�-1]pening Hours of operation: tie: loCAim Closing time: I C) m RECEIVED Owner Information DEC T 4 2022 Name of owner: . C`!\C,, t „,4v Owner email: Hco a� u3 7 ) s L -\ e lo/ Environmental Health Maili�gaddressr City: Pf,OA State:NC ZIP: ,.) a Contact Personl j t i„,-(..A—k_./5 Phone#: $COI —, qc3—WC) Operator(On-Site Manager)Information Pool operator. n� \Oj�v� Phone#: Street address: 1'TS t 1`Y `L` n City: c State:NC ZIP: acare, aR Pool operator trained by: 1, )National Swimming Pool Foundation (Certificate#:_. 5 3 7)'' /C) - ) la Other(please specify) (�Cn c "�i�1\1\ ..t ccjl 5 �c.k_ `r 1S Application Submitted by:_ .j. ` e Ltt., .ems []Owner rilOperator Signature of Applicant: _ ----441...../= - " Date:_ d'5--^a� Purpose GeneralStalte130A•282requirestheCommissionHealthServicestoadoptrules1.verningpublicswimmingpools.therulesin ISA NCAC I SA.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 poets to apply for rennin.Preparatiam The information requested an this form Is to be competed bythe pool owner or a designated representative of the owner.The completed gspimiaa is submitted to the local health dcparhneat for the county in wlidr the public swimming pool is located.A separate conflation roust be completed for each pubic swimming pooL Copies:Original to be mainlined at the local health department.Dispesitiom Please refer to Records Retentionond Disposition Schedule for County/District Health Departments winds are nishshed by North Carolina Division of Historical Resources. Reorder:Additional Forms may be ordered ham: Dirision of rmviroamental Health, Deportmeatoffaviroamentand Henrd Resources,1630 Mail Service Canter,Raleigh,NC 27699 1632,(Conner52.01-00) D1IIR 3961(Revised 4/03) Fink canard Health Services Section(Review 4/06) Completed form Pool Drain Safety(VGB)Compliance Data must be submitted PERMIT CANNOT BE ISSUED IF FORM IS INCOMPLETE A separate form is required for each pumping system. with application Name of Pool Qç.)uç\t, ckCC tU` r Address l� D 5- IJC�Il�IJ` `U(1L_J�� s1r l i ��!c (QC, l Ot 0 wC 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. 1. Punt ow J r- r�` � �? Pump Manufacturer /-![,tu �(Ck Model#e.�'�,�J p[i�/1�J1.O l Horsepower I { Maximum Pump Flow. Maximum flow rate front pump curve: gpm. (Provide supporting evidence if flow reduction) 2. Drain Sumo Measurements s 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 hen proceed to next section) Sump shape:Round- width: 9' inches diameter; OR Square- /inchesX�� inches Sump minimum depth inches Diameter of outlet pipe in sump ! -a inches Distance of top(inside)of outlet pipe from bottom of cover/grate inches Sump manufacturer and model#if available 3. Drain Cover/Grate Data Number of drains on each pump I Distance between drains(on centers) Cover/grate manufacturerixrektf ,A model Syxl ) ,Lifespan: Maximum flow rating of cover/grate } gpm(floor); gpm(wall) Date drain cover/grates installed: /c i i$/ * EXPIRATION DATE: / 2 1!5 1 4. Equalizer Covers Number of operable skimmer equalizers 07 OR Have the equalizers been disabled? YES! Equalizer fitting Manufacturer ,model Li ti-t) €itL Lifespan 5 rcAx3 Equalizer fitting maximum flow rating 5-19 Date equalizer cover/grates installed: -� J EXPIRATION DATE: 5. Safety Vacuum Release System(SVRS)-SVRS required if dual drains are closer than 3 feet on center or pump has a single drain with blockable cover or sump. I , Safety Vacuum Release System manufacturer- net-- \i ~' zoo() Vacua e-Choose One No vacuum line in pool OR Protective cover on vacuum lines installed before May 1,2010 OR Self-closing,self-latching cover designed to be opened with a tool on vacuum lines installed after May 1,2010 Full name of person p vidin his info ation Signature Date 1 Z- L— Z L NCDHHS Revised 10/2016 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. I. 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.nepublichealth.com/faf/pti/drainsafety.htm I 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/mecklenburv/county/HealthDepartment/Environmen talHealth/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. .�4'A • CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT ‘"-I PHONE:828.465.8399 Wednesday,December 14,2022 .18 4 Z SM www.catawbacountync.gov PAYOR: Crowne Plaza of Hickory Crowne Plaza of Hickory PAYMENTS TRANSACTION NUMBER: TRC-53248784-14-12-2022 PAYMENT DATE: 12/14/2022 PAYMENT TYPE: Check 087795 received by mail INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 12-22-415910 110-580200-663000 Pool Inspection Fee-Year Round $200.00 TOTAL PAYMENTS: $200.00 FLI-0000183 CASE TYPE: Food&Lodging Institutions WORK CLASS: 53-Year-Round Swimming Pool SITE ADDRESS: 1385 LENOIR RHYNE BLVD SE DR,I IICKORY NC Establishment HOLIDAY INN SELECT DBA CROWNE PLAZA, 1385 LENOIR RHYNE BLVD SE,HICKORY NC 28602 F:NONE Owner PIEDMONT CENTER ASSOCIATES,2250 US HWY 70 SE SUITE 101, I IICKORY NC 28602 B:8283231000 Paid By CROWNE PLAZA OF HICKORY,2258 1IWY 70 SE,HICKORY NC 28602 B:8283231000 **NO PEOPLESOFT ACCOUNT ASSIGNED** Pool Operator LARRY ANDERSON, 1385 LENOIR RHYNE BLVD SE,HICKORY NC 28602 C:8283123970 receipt 12/14/2022 13:20 Page 1 of 1