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Home My WebLink AboutHuntington Woods 500040 app 04 06 23 f F tNVIKUNMtNIAL I'9LALItt Catawba County Government Center catawba county 25 Government Drive I P.O.Box 389 I Newton,NC 28658 public a). hr health Phone:(828)465-8270 I Fax:(828)465.8276 ti Email:EHAdministrativeAssistams@CatawbaCauntyNC.gov • Application for Public Swimming Pool Permit FLI ,U DOOtto Pool Information /) Dfv)(�11 Name of public swimming pool: �� 1 104% �v `� ID c/ NOD (f Street address: R 11 4 £14 J 7 4l:.City: Pitts eel State: 1V®�C ZIP: a IQ g04 Type of public swimming pool IgSwimming pool ❑Wading pool ❑Spa ❑Other(describe) Date constructed or remodeled geforee May I, 199 her May 1, 1993 �f Dates of operation: Opening date:/',c s '13 Closing date:Pip Alt?3 Opening Hours of operation: time: g Q 721 Closing time: g p Owner Information I , 'a' I /' Name of owner: II�J IA► lA BOdr I4 Owner email: javo6 •Jirei-s bpi-& web. e Mailing address: 4? f J14i `JT City: flh CIA 0 State:NC ZIP: a O 601 1 Contact Person: hone#: r Z O 4 `rs- Operator(On-SiteA-Manager)Information � Pool operator: Ju o tt yi 7 &1 ceQ Phone#: r c i r ro Street address: 4) -4 7 4144 City: Mitts 01 State:NC ZIP: e•Q V Pool operator trained by:❑National Swimming Pool Foundation(Certificate#: ) ict 3,ci j olkiOiher(please specify) fo 00 ( 1,44 Application Submined by: 3 A`4 0 19 J 14(1 ❑Owner Operator Signature of Applicant: Date: 4 v / ? v er-W is • Porpaseaeneral Statute 1306.292requkestheCammission Health Servtsesto adoptrules governing public swimming pools.Tberulesla 1 SA NCAC I SA.2500 require lire owner or operator to apply annually for an operation permit far emir public swimming pool.This form is to allow owners or operdarsof public swimming pods to apply for pianos.Preparation:The imfatmatioe requested as the lam is to be completed by the pool owner or a designed representative of the owner.The completed opplkat a is submitted to the kcal health department Wire county Or which the public swimming pool is located.A separate appOcalkn must be completed for ea&pubic swimming pool.Copies:Original to be maintained at the local health department.Disposition:Please refer to Recants Retention and Disposition Schedule for County/Disnla Health Departments which are you shed by North Carolina Division of Nistorkol Resources.Reorder.Additional Forms may be ordered ham:Division of Environmental Health Department of Environment and Heurnl Resources,1630Mail Service Center,Rakich,NC27699.1632,(Cartier 52.01.00) DENR 3961(Revised4/03) Environmental Health Services Section(Review 4/06) • a OA 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 (—f)41/ ji� at �`0(9/ S tf194 ID# 1. Pump Flow l+A C )A/4 _ /4(1-D SP ? 6 if i 0 /� A_ Pump Manufacturer VI/ Model# 1-V` Horsepower J 2 Maximum Pump Flow at highest speed FROM PUMP CURVE: 4 4 T gpm. Pump use: irculatio r /jet/feature(circle one) Has pump been serviced(disconnected from power for any reason)or changed out in last 12 months? YES/ 10, Flow meter manufacturer Flow meter reading GPM 2. Drain Sump Measurements Is drain cover sumpless?�/ E NO Sump manufacturer and model /1"(4 �L// OR: Field built sump(circle if yes) Diameter of pipe entering sump 11 t'4 inches. Pipe enters through BOTTOM/SIDE of sump(Must circle one) , Distance between highest point of outlet pipe and top edge of sump Alf' ./.-"" inches.Sump dimensions ite.(T 3. Drain Cover Data—MUST BE INSTALLED PER MANUFACTURER'S INSTRUCTIONS-Attach Instructions to form. Number of main drains on each pump /V�� Distance between main drains(on centers) /v /� feet �7 inches Cover/grate manufacturer �(4 ,model /1/! / ,VGBA approval 2008/2017(circle one) Flow rating from instructions: l m Cover(s)located on pool:Floor/wall(circle one) Date installed !V 1l— Lifespan (1/ (4 EXPIRATION DATE i, / A 4. Equalizer Covers Number of operable skimmer equalizers 0 Have the equalizersze been permanently disabled? �/NO Equalizer fitting Manufacturer ►AI/li(4- ,Model k(/y ,Lifespan /17/ Bulkhead adaptor Manufacturer 1/(i .Model 4/0-- ,Date Installed Al(4 Diameter of equalizer pipe 0 /^-- Cover is located on(circle where mounted):Floor/wall Equalizer fitting maximum flow rating A// / 1 _gpm.Date equalizer cover/grates installed /V ( 4 EXPIRATION DATE: N( 4 5. Safety Vacuum Release System(SVRS)—Safety Vacuum Release System manufacturer/model#- AM— 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(v'aacc/uumjlines installed after May 1,220010 Q ,�j Full name of person providing this information T 0 Q uerf�V 4C'Phone number: p b O r g o4U Signature Pr Date 3 / 7 0 / C 01 NCDHHS Revised 4/1/2022 for immediate use. Instructions for Completion of the Pool Drain Safety Compliance Data Form Please review the instructions below to ensure the Pool Drain Safety Compliance Data form is properly completed and all required information required.All components must be approved and field verified by the Health Department prior to the issuance of an operation permit in accordance with Rule .2539(c). A FORM FOR EACH PUMPING SYSTEM MUST BE PROVIDED. 1. PUMP FLOW—Enter the maximum flow from the manufacturer's pump performance curve. For variable speed pumps, enter the maximum flow at the highest speed. If a flow reduction is requested, attach required documentation. A functioning flow meter will be required to permit a pool with a flow reduction. 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. 3. DRAIN COVER/GRATE DATA—Enter the manufacturer,model, lifespan expiration date and maximum flow for the main drain cover(s). For VGBA 2017 covers,attach a copy of the flow rate chart. 4. EQUALIZER COVERS—Enter the number of operable equalizer line covers,the manufacturer, model, lifespan expiration date and maximum flow for the equalizer covers. Provide bulkhead adaptor information. If all equalizer lines are disabled or pool has no equalizer lines,please 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). SVRS must be tested according to manufacturer's instructions,provide date of last test. If using other secondary method of preventing bather entrapment per 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. NC DHHS Revised 1/27/2022 . 114'A C'� CATAWBA COUNTY �1 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT .) $ PHONE:828.465.8399 Thursday,April 6,2023 I8 Z 5M www.catawbacountync.gov PAYOR: Dreisbach,Jakob PAYMENTS TRANSACTION NUMBER: TRC-61288198-06-04-2023 PAYMENT DATE: 04/06/2023 PAYMENT TYPE: Credit Card 303420665 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 04-23-420956 110-580200-663000 Pool Inspection Fee-Seasonal $150.00 TOTAL PAYMENTS: $150.00 FLI-0000097 CASE TYPE: Food&Lodging Institutions WORK CLASS: 50-Seasonal Swimming Pool SITE ADDRESS: 1785 12TH ST NE,HICKORY NC Manager HUNTINGTON WOOD HOA,PO BOX 3443,HICKORY NC 28601 B:8283282936 SHARDY@INGSOURCE.COM INGSOURCE.COM Pool Operator JAKOB DREISBACH, 1715 12TH ST NE,HICKORY NC 28601 C:8284858016 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 04/06/2023 14:22 Page 1 of 1