HomeMy WebLinkAboutSpa Athletic Club Women's Spa App 550005 01 12 23 ii . .--9 E J MiE t L IlEALThi
Catawba County Government Center
catawba county 25 Government Drive I P.O. Box 389 I *ievrton, NC 2865<s
public health APhone: (828)465 82 0 ( I uic (828) 465 8276
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Application for P b1ic Swimming Pool Permit
i 1� , V/ 3 �'Sbb�. J A N 1 2 2023
Name of public swimming pool:, >�✓ p„,,eif1T,Vd?2'
J? � ��� Environmental Health
Street address: 9Pt2 � L ,,. Ladies
City: *64-X7State:,, I ZIP:
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type of public swimming pool Swimming pool 4Yadin aol I'Spa j 1011ter (describe) ? -1 ! ivew 3
Dole constructed or remodeled:ngefore May 11993 her May lr 1993
Dotes of operation: Opening date: / Closing dote: . l Opening
Hours of operation: time: °®J Mtn J Closing time: __
_virtssi:Infr,,sr atwn. ...".
Name of owner: j--/fr463P.t. X fal fe weer email: lacf272-aeg— R. t
Mailing address: _ , -_/&,_ o -/tit' 4/66)
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City:____ , 662V State:NC ZIP: e W
Contact Person: oro/ �,� I-Ot Phone#: • F2 `a�%51
Operator(Ot1•'Site.yh ramose:)information
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Pool operator: l�/�( f �' Phone#: I/1iciE7e': 0,./i
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Street address: - MC
City: Stale: NC ZIP:
Pool operator trained by: I National Swimming Pool oundetion(Certificate i!
Other lease specify)--, /7 u ef-/, 4V�� 73 .r
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Application Submitted by: ` 4 'Owner HOperotor
Signature of Applicant: Date:' z '
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Purpose General 5Fatute1304.282requires the Commission Health nicectoadoptrulesgoveeniiigpublic swimming park.The rulest°ISANCAC 1502500 reqolre th owner or operator to apply£uutully
for an operation permit far each public swimming pool.this fo is to afow owners or operators of public swimming pooh la apply for permits.Preparation:The Information requested on Ns lanais to he
wnpletedhythe pool owner or a desigmted representative oldie owner.The rompleted application Is submitted In the load health sleparnnent for duo county In AA the public swimming pool fs located.A
separate application must ha completed far each puh,Gc swimming pool.Copies:Original to ha maintained at the local health departwenir Disposition:Please refer to Records Retention and Disposition
Schedule for County/District Hecht Departments which are published by North Carolina Division at Historical Resources_Reorder:Additional Forms maybe aged from:Divirion at Environmental Wit,PepanmautoflovironmantondHoluhlResound,1630MailScrviraCemcr,Raleigh,NC27699.1632,(Courier 52.01.00i 1 5
DERR3961(Rovlsed4/03) Covironmentel lied Services Saida(Revh:wd/06i
r L Completed form must
pool Drain Safety(VGB)Compliance Data
PERMIT CANNOT BE ISSUED IF FORM IS INCOMPLETE be submitted with
A se crateform is required for each pumping system. application
Name of Pool 4/(e/...."-ite
277(/
Address 9/76 �- /I ,. /17‘.1."." zliy-W ZI:(7‘,L.5-;/
FORM COMPLETIOI4—A separate fool 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. Pump FIcF+ II1(AP �Purnp Manufacturer / ,`�, ,� lodel# 77/V/14-1 5-27( Horsepower ti 45
Maximum Pump Flow. Maximum flow rate from pump curve: 711 gpm. (Provide supporting evidence if flow 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)
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Sump shape:Round-width:,/ inches diameter; OR Square- inches X inches
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Sump minimum depth 6 inches Diameter of outlet pipe in sump 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 Distance between drains(on centers) ', 9
c
Cover/grate manufacturer �XA eppo# ,model, i .Lifespan: r if 55 -
Maximum flow rating of cover/grate gpm(floor). /9 gpm(wall)
Date drain cover/grates installed: 4 #/ /R
i j,, � EXPIRATION DATE:E:
4. Equalizer Covers / �
Number of operable skimmer equalizers OR 1-lave the equalizers been disabled') YE ;NO
Equalizer fitting Manufacturer ,model .Lifespan
Equalizer fitting maximum flow rating
Date equalizer cover/grates installed: _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 suinp.
Safety Vacuum Release System manufacturer-
Vacuum line-Choose One
No vacuum line in pool OR
_Protective coverr..ot}vae.uum lines installed before May 1,2010 OR
Self-closirjg self-Ja hing/bv;er designed to be opened with a tool on vacuum lines installed after May 1,2010
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Full name o person ro•idin t ishormation i Lb°7 - kW-
---_. Date ,/6 ". 69
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NCDHHS V / —
4,
Revised I0/2016
C
A CATAWBA COUNTY
a 100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
O ' PHONE:828.465.8399
Thursday,January 12,2023
8 4 2 5M www.catawbacountync.gov
PAYOR: SPA FITNESS CENTER INC
SPA FITNESS CENTER INC
PAYMENTS
TRANSACTION NUMBER: TRC-55307828-12-01-2023
PAYMENT DATE: 01/12/2023
PAYMENT TYPE: Check 13841
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
01-23-416831 110-580200-663000 Pool Inspection Fee-Year Round S200.00
TOTAL PAYMENTS: $200.00
FLI-0000200
CASE TYPE: Food&Lodging Institutions WORK CLASS: 55-Ycar-Round Spa
SITE ADDRESS: 920 2ND AV NW DR,HICKORY NC
Manager SPA FITNESS CENTER INC,920 2ND AV NW,I IICKORY NC 28601
**NO PEOPLESOF'1 ACCOUNT ASSIGNED**
OTHER-IMPORTED SPA ATI ILETIC CLUB,920 2ND AV NW,I IICKORY NC 28601
F:NONE NONE
Pool Operator SPA ATHLETIC CLUB,920 2ND AVE NW,I IICKORY NC 28601
C:8283285949
receipt 01/12/2023 13:50 Page 1 of 1