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Home My WebLink AboutForest Hills App 500036 05 11 23 (31 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 NAMING.LIVING.111111. ts''Catawl {ntyNC.gov C L1 -000009) Application for Public Swimming Pool`)Permit lVi h Po& r—F-"-"•ation Name of public swimming pool: Forest Hills Street address: 1420 11th Street Drive NW City: Hickory State: NC ZIP: 28602 Type of public swimming pool, Swimming pool []Wading pool []Spa []Other (describe) Date constructed or remodeled: Before May I, 1993 []After May 1, 1993 Dates of operation: Opening date: 5/8/23 Closing dote: 9/30/23 Opening Hours of operation: time: 8am Closing time: 9pm Owner InfnrrnAti" Name of owner: Forest Hills HOA Owner email: dthornburg@thornburgi Mailing address: 1420 11th Street Drive NW City: Hickory State: NC ZIP: 28602 Contact Person: Donna Thornburg, Property Mgr. Phone#: 828-328-2836 Operator(On-Site Manaaer) Information Pool operator: John Paul Knight Phone#: 828-310-5111 Street address: 4418 Granfloral Drive City: Hickory State: NC ZIP: 28602 Pool operator trained by: ["National Swimming Pool Foundation (Certificate#: 68-682019 Other(please specify) Application Submitted by: John Paul Knight []Owner Operator Signature of Applicant: Date: PurposeGeneral Statute 130A-282requires the Commission Health Servicesto adoptrules governing public swimming pools.The rules in 154 NCA(154.2500 require the owner or operator to apply annually for on 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 far the county it whirh the public swimming pool is located. A separate application must be completed for each public 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 ore published by North Carolina Division of Historical Resources. Reorder.Additional Forms may be ordered from:Division of Environmental Health, Department of Environmentend 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) 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 Forest Hills HOA ln# 2018500036 1. Pump Flow Hayward 1.0 Pump Manufacturer Model# Horsepower Maximum Pump Flow at highest speed FROM PUMP CURVE: 117 gpm. Pump use:Circulation/jet/feature(circle one) Has pump been serviced(disconnected from power for any reason)or changed out in last 12 months? YES 0 Flow meter manufacturer Blue & White Industries Flow meter reading 100 GPM 2. Drain Sump Measurements Is drain cover sumpless? YES/NO(if Yes,proceed to section#3) Sump manufacturer and model Hayward OR: Field built sump(circle if yes) Diameter of pipe entering sump 1.5 inches. Pipe enters through BOTTOM JD f sump(Must circle one) Distance between highest point of outlet pipe and top edge of sump 3 inches.Sump dimensions 8 Inches 3. Drain Cover Data—MUST RE INSTALLED PER MANUFACTURER'S INSTRUCTIONS-Attach Instructions to form. Number of main drains on each pump 1 Distance between main drains(on centers) feet inches Cover/grate manufacturer Hayward ,model WG1048F ,VGBA approval 2008/2017(circle one) Flow rating from instructions 120 gpm Cover(s)located on pool Igatk wall(circle one) Date installed 7/14/20 Lifespan 7 Yrs EXPIRATION DATE 7/14/27 4. Equalizer Covers Number of operable skimmer equalizers n/a Have the equalizers been permanently disabled? YES/NO Equalizer fitting Manufacturer n/a ,Model ,Lifespan Bulkhead adaptor Manufacturer n/a .Model ,Date Installed Diameter of equalizer pipe n/a Cover is located on(circle where mourned): Floor/wall Equalizer fitting maximum flow rating n/a gpm. Date equalizer cover/grates installed n/a EXPIRATION DATE: 5. Safety Vacuum Release System(SVRS)—Safety Vacuum Release System manutitcturcr/model#- StingyL SR- 500 You will be required to demonstrate effectiveness during permitting inspection. Date last tested c/3/23 6. m Line Choose One No vacuum line in pool OR FjProtective 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 John Paul Knight Signature Date NCDHHS Revised 4/1/2022 for immediate use. � CAl'AWBA COUNTY f•- L 100A SOUTHWEST BINDNEWTON,NORTII CAROLINA 28658 RECEIPT � 4, PHONE:828.465.8399 1► Thursday, May 11,2023 1842 sM www.catawbacountync.gov PAYOR: Knight Brothers Holding LLC Knight Brothers Holding L1,C(Knight,John Paul) PAYMENTS TRANSACTION NUMBER: TRC-63820025-11-05-2023 PAYMENT DATE: 05/11/2023 PAYMENT TYPE: Check 1055 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 05-23-422494 110-580200-663000 Pool Inspection Fee-Seasonal S150.00 TOTAL PAYMENTS: $1 50.00 FL I-0000092 CASE TYPE: Food&Lodging Institutions WORK CLASS: 50-Seasonal Swimming Pool SITE ADDRESS: 1420 1 ITH ST DR NW,HICKORY NC Manager DONNA THORNBURG,638 4TH ST SW,HICKORY NC 28602 Paid By FOREST HILLS HOA OF HICKORY INC C/O THORNBURG&ASSOC,PO BOX 3443,HICKORY NC 28f Pool Operator KNIGHT BROTHERS HOLDING LLC,4418 GRANFLORAL DR,HICKORY NC 28602 C:8283105111 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 05/11/2023 13:14 Page I of I