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HomeMy WebLinkAboutColony Square App 500032 05 11 23 QS) 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 M/IINt.LIVING./fJtI r. fn,. • -JI' Application for Public Swimming Pool Permit Nameofpublicswimmingpool: Colony Square i j) ,)Oac DSO U � Street address: 950 21st Avenue NE City: Hickory State: NC ZIP: 28601 Type of public swimming pool X1Swimming pool nWading pool Spa Other (describe) Date constructed or remodeled:nBefore May I, 1993 I after May I, 1993 Dates of operation: Opening date: 5/15/2023 Closing date: 9/30/2023 Opening Hours of operation: time: 8am Closing time: 9pm Tnfnrx'?kn Name of owner: Colony Square HOA Owner email: dthornburg©thornburgi Mailing address: 950 21st Avenue NE City: Hickory Slate: NC ZIP: 28601 Contact Person: Donna Thornburg,Authorized Property Mgr. Phone#: 828-328-2936 flnnrttnr (On_<;itrr trffare.:1(100 Trfnrmatton Pool operator: John Paul Knight Phone#: 828-310-5111 Street address: 4418 Granfloral Drive City: Hickory State: NC ZIP: 28601 Pool operator trained by: )( National Swimming Pool Foundation (Certificate#: 68-682019 nOther(please specify) Application Submitted by: John Paul Knight nowner )( Operator Signature of Applicant: Date: Purpose General Statute 130A-282 requires the Commission Health Services to adopt rules governing public swimming pools.The rules in 1 SA NCAC I SA.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 an 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 deportment for the county in which 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 deportment.Disposition:Please refer to Records Retention and Disposition Schedule far County/District Health Departments which are published by North Carolina Division of Historical Resources. Reorder:Additional Forms may be ordered hom:Division of Environmental Health, Department of Environment and Natural Resources,1630 Mail Service Center,Raleigh,NC 27699.1632,(Courier52-01.00) 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 Colony Square ID# I. Pump Flow Hayward Pump Manufacturer y Model# SP2615X20 Horsepower 1.5 Maximum Pump Flow at highest speed FROM PUMP CURVE: 122 gpm. Pump use-=Met/feature(circle one) Has pump been serviced(disconnected from power for any reason)or changed out in last 12 months? YES 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/4 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 BE INSTALLED PER MANUFACTURER'S INSTRUCTIONS-Attach Instructions to form. Number of main drains on each pump 1 Distance between main drains(on centers) n/a feet inches Cover/grate manufacturer Hayward ,model WG1048E ,VGBA approval 2008/2017(circle one) Flow rating from instructions 125 gpm Cover(s)located on poo Floor wall(circle one) Date installed 06-19-20 Lifespan 7 yrs EXPIRATION DATE 06-19-27 4. Equalizer Covers Number of operable skimmer equalizers n/a Have the equalizers been permanently disabled? YES/NO Equalizer fitting Manufacturer Na ,Model ,Lifespan Bulkhead adaptor Manufacturer n/a .Model ,Date Installed Diameter of equalizer pipe n/a Cover is located on(circle where mounted):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 manufacturer/model#- Stingi SR-500 You will be required to demonstrate effectiveness during permitting inspection.Date last tested 6. m 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 John Paul Knight Signature Date NCDHHS Revised 4/1/2022 for immediate use. �4'A • CATAWBA COUNTY E" 100A SOUTHWEST BLVD + NEWTO ONORTH CAROLIN E:828.65 83 9A 28658 RECEIPT WI V 0 Thursday,May 11,2023 1842 sn, www.catawbacountync.gov PAYOR: Knight Brothers Holding LLC Knight Brothers Holding LLC(Knight,John Paul) PAYMENTS TRANSACTION NUMBER: TRC-63821444-11-05-2023 PAYMENT DATE: 05/11/2023 PAYMENT TYPE: Check 1055 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 05-23-422501 110-580200-663000 Pool Inspection Fee- Seasonal S150.00 TOTAL PAYMENTS: $150.00 FLI-0000088 CASE TYPE: Food&Lodging Institutions WORK CLASS: 50-Seasonal Swimming Pool SITE ADDRESS: 950 21 ST AV NE ST,HICKORY NC Manager THORNBURG ASSOCIATES,638 4TH AVE SW,HICKORY NC 28601 B:8283282937 Owner COLONY SQUARE,PO BOX 3443,HICKORY NC 28603 Pool Operator KNIGHT BROTHERS 1-IOLDING LLC,4418 GRANFLORAL DR,HICKORY NC 28602 C:8283105111 **NO PEOPLESOF 1'ACCOUNTASSIGNED** receipt 05/I 1/2023 13:25 Page 1 of 1