HomeMy WebLinkAboutFalling Creek App 500027 05 11 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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Application for Public Swimming Pool Permit
FL-1 -bmool
Name of public swimming pool: Falling Creek Association Pool /j) V i
Street address: 3561 5th St Dr NE [
City: Hickory State: NC ZIP: 28601
Type of public swimming pool [wimming pool Wading pool Spa [ lOtiier (describe)
Date constructed or remodeled:I✓1Before May I, 1993 I "Alter May I, 1993
Dates of operation: Opening date:5/25/2023 Closing date: 9/25/2023 Opening
Hours of operation: lime: 9:00 AM Closing time: Dusk
Name of owner: Falling Creek Pool Assoc. Owner email: kimtucker65@gmail.ce-
Mailing address: 3711 9th St Dr NE
City: Hickory State:NC ZIP: 28601
Contact Person: Kimberly LeCompte Phone#: 828-238-0384 �J`5 p it u
Pool operator: Aqua Clear Pool Services & Supplies Phone#: 828-781-0062 Dennis Grigg
Street address: 335 1st Ave SE
City: Hickory State:NC ZIP: 28601
Pool operator trained by: IV (National Swimming Pool Foundation(Certificate#: 64-462016 1
❑Other(please specify)
AppkEotian submitted by:Jason Higley, Board Member 173wner ❑Operator
Signature of Applicant: - / Date: .CJ><(//0 2-3
Purpose General Stoker 1306.282 requires the Commission Health Services to adopt tholes governing public swimming pools.The resin 15A NCAC I SA.2500 require the owoer or operator to.pply.n.wlfy
for an operation permit for eon public swimming pool.This form is to oeow owners or aporatars al pubic swimming pools io apply lac pewits.Preparation:Tie iefernralion r.q.ested on this form into be
completed by the pool owner or a dodgnaisd Topres.nl.iiv.oldie owaar.Tb.comple*d appicalian is sal mdped to the lord health d.pertmrmm l.r the comity in wind Ih.peblic swimming pool is lecaled.A
seporote appOMioa onst be censpkteel for end pails swimming pad Copies:Original to be maiatoimd at tho local halt*d.partenonc.Disposition:Ploaso refer*Records Retention end Di.posii.a
Sandals for Canty/District Heib D.parlmwk Aid me plinked by Noah Caroline Divisie.of Historical Resources. Reorder:Additional Forms may 6.wd.r.d front:Division al Ernianma.N H.ddc,
Deporonant.f E Neiman..well Neared Resources,1630 Mod Service Calaar,R shriek NC 27699-1632,(Cerioc 52-01.00)
DEMR 3961(Revisoi 4/03) E.vYosl.remd Health Services Section(Review C/061
Completed form must
Pool Drain Safety(VCR)Compliance Data
PERMIT CANNOT BE ISSUED IF FORM IS INCOMPLETE be submitted with
A separate form is required for each pumping system. application
Name ofPool fUl 1,y ('ee/ 110 ( As-Sc'C, .; t �! I
Address }5G I S f h s'"t Or /VG 14 t C f vY y n 4.�' 0 f
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.
1. Pumn Flow
Pump Manufacturer x I R L'Al P K S Model fl 7 C' ' f HorsepowerWit
Maximum Pump Flow. Maximum flow rate from piop_gpgg: )G' gpm. (Provide supporting eviderce if flow reduction)
2. Drain Sump Measurements This is the area under the floor drains,if field built sump may need to remove drain cover one time to measure.
(Check here if sumpless __,then proceed to next section)
Sump shapc:Round-width: inches diameter; OR Square- inches X inches
Sump minimum depth 1 y1- inches Diameter of outlet pipe in sump inches
Distance of top(inside)of outlet pipe from bottom of cover/grate 5 7 inches
Sump manufacturer and model f! if available
3. Drain Cover/Grate Data r
Number of drains on each pump Distance between drains(on centers) )
Cover/grate manufacturer �y l 'fC1 ,model I L /C w`f-:Y G .Lifespan:
J �
Maximum flow rating of cover/grate / 2' ? gpm(Door); � � gpm(wall)
Date drain cover/grates instal:ed: 5/ / ' Z 3 _ EXPIRATION DATE: -5/1/ .0
4. Equalizer Covers
Number of operable skimmer equalizers (/) OR Have the equalizers been disabled? YES/NO
Equalizer fitting Manufacturer ,model , Lifespun
Equalizer fitting maximum flaw rating
Date equalizer cover/grates installed: EXPIRATION DATE:
5. Safety Vacuum Release System(SVRS)—SVRS required if dual drains are closer than 3 feet on center or pump has a single drain with
blockable cover or sump.
Safety Vacuum Release System manufacturer- /v/ 4
Vacuum line-Choose One
V__No vacuum line in pool OR
Protective cover on vacuum tines 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
Signature ! i7 Dale 5 9_7) ( 'l-
7CthfiIS
Revised 102016
A C� CATAWBA COUNTY
100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
15 0 PHONE:828.465.8399
Thursday,May 11,2023
1$4 2 cM www.catawbacountync.gov
PAYOR: Falling Creek Pool Assoc
Falling Creek Pool Assoc(Lecompte,Kimberly)
PAYMENTS
TRANSACTION NUMBER: TRC-63836993-11-05-2023
PAYMENT DATE: 05/11/2023
PAYMENT TYPE: Credit Card
305132965
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
05-23-422525 110-580200-663000 Pool Inspection Fee-Seasonal $150.00
TOTAL PAYMENTS: S 150.00
FLI-000008 I
CASE TYPE: Food&Lodging Institutions WORK CLASS: 50-Seasonal Swimming Pool
SITE ADDRESS: 3561 5TH ST DR NE,HICKORY NC
Paid By FALLING CREEK POOL ASSOC,3711 9TH ST DR NE,HICKORY NC 28601
C:8288966112 KIMTUCKER65@GMAIL.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED**
Pool Operator AQUA CLEAR POOL SVCS,335 1ST AVE SE,HICKORY NC 28602
B:8287810062
receipt 05/11/2023 16:05 Page 1 of 1