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Home My WebLink AboutAdrian L Shuford Pool App 530057 02 07 23 " '' ENVIRONMENTAL HEALTH t Catawba County Government Center c a t aw b a county 25 Government Drive I P.O. Box 389 I Newton, NC 28658 public health Phone: (828) 465-8270 I Fax: (828) 465-8276 MAKING.LIVING.BI111R. Email: EHAdministrativeAssistants@CatawbaCountyNC.gov Application for Public Swimming Pool Permit Pool Information -ODbV r6S Nameofpublicswimmingpool: Shuford YMCA Pool j) ��]% 5300.0 Street address: 1104 Conover Blvd E. City: Conover State: NC ZIP: 28613 Type of public swimming pool Swimming pool ❑Wading pool ❑Spa ❑Other (describe) Date constructed or remodeled: efore May I, 1993 EAfter May 1, 1993 Dates of operation: Opening date-01/01/2023 Closing date: 12/31/2023 Opening Hours of operation: time: 5a Closing time: 9P Owner Information Name of owner: YMCA of Catawba Valley Owner email: logant@ymcacv.org Mailing address: 1104 Conover Blvd E. City: Conover State: NC ZIP: 28613 Contact Person: Logan Taylor Phone#:828-493-0435 Operator(On-Site Manager)Information Pool operator: Logan Taylor Phone#: 828-493-0435 Street address: 1104 Conover Blvd E. City:Conover State:NC ZIP: 28613 Pool operator trained by: PKItional Swimming Pool Foundation(Certificate#: 58P9V7W ❑Other(please specify) Application Submitted by:Logan Taylor El Owner Q'bperator Signature of Applicant: '4,)—e Date: 2/6/2023 Purpose General Statute 130A-282 requires the Commission Health Servicesto adopt rules governing public swimming pools.The rulesin 15A NCAC 15A.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 pools to apply for permits.Preparation:The information requested on this form is to be completed by the pool owner or a designated representative of the owner.The completed application is submitted to the local health department for the county in which the public swimming pool is located.A separate application must be completed for each pubrlc swimming pool.Copies:Original to be maintained at the local health department.Disposition:Please refer to Records Retention and Disposition Schedule for County/District Health Departments which are pubished by North Carolina Division of Historical Resources. Reorder.Additional Forms may be ordered from:Division of Environmental Health, Department of Environment and Natural Resources,1630 Mail Service Center,Raleigh,NC 27699.1632,(Courier 52-01.00) DENR 3961(Revised 4/03) Environmental Health Services Sedion(Review 4/06) Pool Drain Safety Compliance Data PERMIT CANNOT BE ISSUED IF FORM IS INCOMPLETE A separate form is required for each pump including circulation,jet or feature. Name of Pool 5kif Aro( yitiel} roe, ID# 1. Pump Flow Pump Manufacturer Per,114,.\e"" Model# a!iz k-7S O Horsepower 7 Maximum Pump Flow at highest speed FROM PUMP CURVE: s io gpm. Pump use: 04E0 /jet/feature(circle one) Has pump been serviced(disconnected from power for any reason)or changed out in last 12 months? YES/ dt� Flow meter manufacturer 6[ve ► ./1,i_ Flow meter reading L) .0 GPM 2. Drain Sump Measurements Is drain cover sumpless? YES/NO Sump manufacturer and model OR: ield built s p(circle if yes) Diameter of pipe entering sump 1 inches. Pipe enters through tTI ireli /SIDE of sump(Must circle one) Distance between highest point of outlet pipe and top edge of sump 7 inches.Sump dimensions /$XI t 3. Drain Cover Data-MUST BE INSTALLED PER MANUFACTURER'S INSTRUCTIONS-Attach Instructions to form. Number of main drains on each pump 13 Distance between main drains(on centers) I D feet inches Cover/grate manufacturer it tat. S 11ne ,model U//}V)g ta.4 7 ,VGBA approval 2008/CD(circle one) Flow rating from instructions: 6).v gpm Cover(s)located on pool: /wall(circle one) Date installed o3�,A) Lifespan S 'r EXPIRATION DATE 0341fr 4. Equalizer Covers Number of operable skimmer equalizers ' Have the equalizers been permanently disabled? YES/NO Equalizer fitting Manufacturer 9 ,Model e ,Lifespan Ar Bulkhead adaptor Manufacturer 4 .Model " ,Date Installed Of Diameter of equalizer pipe Y Cover is located on(circle where mounted):Floor/wall Equalizer fitting maximum flow rating 5i gpm. Date equalizer cover/grates installed_ EXPIRATION DATE: 5. Safety Vacuum Release System(SVRS)-Safety Vacuum Release System manufacturer/model#- You will be required to demonstrate effectiveness during permitting inspection.Date last tested 6. Vacuum Line 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 providing this information 1-050,,,` 1.-Nytpre- Phone number: UZ b-- tVy3_oy7s- Signature i�� Date Q 2-1E7(0/23 NCDI-II-IS Revised 4/1/2022 for immediate use. 414'A CATAWBA COUNTY QI - f� ,z , RECEIPTa„j NEWTON,NORTH CAROLINA LINA 28658 PHONE:828.465.8399 V1-3 ' Tuesday,February 7,2023 18 2 sM www.catawbacountync.gov PAYOR: YMCA OF CATAWBA VALLEY YMCA OF CATAWBA VALLEY(Taylor,Logan) PAYMENTS TRANSACTION NUMBER: TRC-57165429-07-02-2023 PAYMENT DATE: 02/07/2023 PAYMENT TYPE: Credit Card 300855385 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 02-23-417964 110-580200-663000 Pool Inspection Fee-Year Round $200.00 TOTAL PAYMENTS: $200.00 FLI-0000185 CASE TYPE: Food&Lodging Institutions WORK CLASS: 53-Year-Round Swimming Pool SITE ADDRESS: 1104 CONOVER BLVD E,CONOVER NC Owner YMCA OF CATAWBA VALLEY, 1104 CONOVER BLVD E,CONOVER NC 28613 B:8284646130C:8284930435 LOGANT@YMCACV.ORG **NO PEOPLESOFT ACCOUNT ASSIGNED** Pool Operator LOGAN TAYLOR,5525 BRIDGEWATER DR,GRANITE FALLS NC 28630 C:8284930435 receipt 02/07/2023 14:42 Page 1 of 1