HomeMy WebLinkAboutBrandywine Pool App 500012 03 15 23 ENVIRONMENTAL HEALTH
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@CatuwbaCountyNC.gov
Application for Public Swimming Pool Permit
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Pool Information
Brandywine )Name of public swimming pool:
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Street address: 102 Brandywine Drive NE
City: Charlotte State: NC ZIP: NC 28241
Type of public swimming pool n Swimming pool Wading pool Spa Other (describe)
Date constructed or remodeled:nBefore May I, 1993 XAfter May 1, 1993
Dates of operation: Opening date: 5/1 Closing date: 9/30 Opening
Hours of operation: time: 8A (losing time: 8P
Owner Inform;1!t,•f3 brian@tridentpoolgroup.com
Name of owner: Brandywine HOA Owner email: brian@tridentp0olgrol jr
Mailing address: PO Box 410725
City: Charlotte State: NC ZIP: NC 28241
Contact Person: Brian Yarmon Phone#: 704-400-1083
Operator(On-Site Mana.ger) Information
Pool operator: Trident Pool Group, Inc/ Brian Yarmon phone#: 704-400-1083
Street address: PO Box 410725
City: Charlotte State:NC ZIP: NC 28241
Pool operator trained by: nNational Swimming Pool Foundation (Certificate#: 214138
Other(please specify)
Application Submitted b . Brian Yarmon VP
y: nOwner 7-Operator
Signature of Applicant:Brian Yarmon Digitally signed by Brian Yarmon 3/182023
Date:2020.04.17 12:16:58-04'00' Date:
Purpose G eneral Statute I 30A-282 requ ires the Commission Health Services to adopt rules governing publ is swimming pools.The rides in 15A NCAC 1 SA.2 50O 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 inhumation requested on this form is to be
completed by the pool owner or a designated representative of the owner.The completed appicotion is submitted to the local health department far the county in whirl(the public swimming pool is located.A
separate application must he completed for each pubic swimming pool.Copies: Original to be maintained at the local health deportment.Disposition:Please refer to nomads Retention and Disposition
Schedule for County/District Health Departments which ore published by North Carolina Division of Historical Resources. Reorder:Additional Forms moy 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 Section(Review 4/06)
catawba county
public health
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 Brandywine ID#
1. Puma Flow Pentair SF-NI-IA 1.5
Pump Manufacturer Model# Horsepower
Maximum Pump Flow at highest speed FROM PUMP CURVE: 88 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 Blue and White Flow meter reading 80 +1- GPM
2. Drain Sumo Measurements Is drain cover sumpless. 0
Sump manufacturer and model Unknown OR: Field built sump(circle if yes)
Diameter of pipe entering sump 2 inches. Pipe enters through BOTTOM/SIDE of sump(Must circle one) UNKNOWN
Distance between highest point of outlet pipe and top edge of sump N/A inches. Sump dimensions
3. Drain Cover Data—MUST BE INSTALLED PER MANUFACTURER'S INSTRUCTIONS-Attach Instructions to form.
Number of main drains on each pump 2 Distance between main drains(on centers) feet >36 inches
Cover/grate manufacturer Aquastar model A10RCFRXXX ,VGBA approv. 2008 2017(circle one)
Flow rating from instructions: 200 gpm Cover(s)located on pool 45 wall(circle one)
Date installed 3/1/2021 Lifespan 5 Years EXPIRATION DATE 3/1/2026
4. Eaualizer Covers
Number of operable skimmer equalizers 0 Have the equalizers been permanently disabled? YES 0
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 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
x 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 thishi information Brian Yarmon, VP Phone number: 704-400-1083
ljiz � �J � 3/15/2023
Signature Date
NCDHHS
Revised 4/1/2022 for immediate use.
$A CATAWBA COUNTY
100A SOUTHWEST BLVD
' NEWTON,NORTH CAROLINA 28658 RECEIPT
V (_ PHONE: 828.465.8399
Wednesday,March 15,2023
1$4 2 sM www-catawbacountync.gov
PAYOR: Trident Pool Group Inc
Trident Pool Group Inc(Yarmon,Brian)
PAYMENTS
TRANSACTION NUMBER: TRC-59717727-15-03-2023
PAYMENT DATE: 03/15/2023
PAYMENT TYPE: Credit Card
302428610
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
03-23-419820 110-580200-663000 Pool Inspection Fee-Seasonal $150.00
TOTAL PAYMENTS: $150.00
FLI-0000069
CASE TYPE: Food&Lodging Institutions WORK CLASS: 50-Seasonal Swimming Pool
SITE ADDRESS: 102 BRANDYWINE DR NE ST,CONOVER NC
Owner BRANDYWINE C/O CEDAR MANAGEMENT,PO BOX 26844,CI IARLOTTE NC 28221
B:7047786359
Pool Operator TRIDENT POOL GROUP INC,358 CROMPTON ST,CHARLOTTE NC 28273
B:7044001083 BRIAN rr7RIDENTPOOLGROUP.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 03/15/2023 16:51 Page 1 of 1