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Home My WebLink AboutOakwood Apt Pool App 500099 05 22 23 Vr ENVIRONMENTAL HEALTH Catawba County Government Center catawba county 25 Government Drive I P.O. Box 389 I Newton, NC 28658 public health Phone: (828) 465.8210 I Fax: (828) 465.8216 MAKING LIVING.IrrTEl. Email: EHAdmin@CatawbaCountyN..gov FLI-L C- )3 .Q 3010 Application for Public Swimming Pool Permit ij) )Ct% 5 O09/ Pool Information ��, Name of public swimming pool: C)a oOrk Pt p Y * men y�fe n tS POO 1 Street address: l u 5 ?Dou n CkO.X J Sire l City: N ew-t-t. State: V4 Ci ZIP: o 6 s U Type of public swimming pool IV imming pool nWading pool nSpa n0ther (describe) Date constructed or remodeled: • Before M I, 19913 After May I, 1993 Dates of operation: Opening date: 5 rev (C a3 Closing date: CI Li ad9.3 Opening Hours of operation: time: ` D- D Wt 1 l Closing time: ct • oo-P" ` Owner InformationV Name of owner: ...c stiyY1G 14\ nQ ,q�C veft' CQ Te. Owner email: Pvf0(d • ‘crvIczatIvhail Oav,w 004 al irnentS Mailing address: 145 'OU IGtaly SiNet r City: I1r,v\IitoY1 •] State:NC ZIP: GI%it) % — Contact Person: taI1 W Ciy0\AlaGI, Phone#: 340 Llt.0L - 3110 Operator(On-Site Manager) Information Pool operator \t-1fa, ot., TYP,)(1.G1r phone#:(%616)(31 - o(r)NW Street address:C3a0 1 1 34'h \ V e • S City: tr k.OY%O State:NC ZIP: a cic 6 C-..9 Pool operator trained by: ational Swimming Pool Foundation (Certificate#: ) UOther(please specify) ( e 1'V'1 5-F.-you-rt. Application Submitted by _.1,Ni) (_._C3cii,Ndi.ftv Owner ( lOperator Signature of Applicant: Date: S 13 id. o a 3 Purpose General Statute 130A•282 requires the Commission Health Services to adopt rules governing public swimming pools.The rulesi n I SA NCAC 1 SA.2500 require the owner or operator to apply annually for an operation permit for cads public swimming pool.This Farm is to slow owners or operators of public swimming pools to apply for pencsits.Preparation:The information requested on this Form is to be completed by the pool owner or a designated representative of the owner.The completed appimtion is submitted to the local health department for the county is wblds the public swimming pool is located.A separate application must be completed for each pubic 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 whirls are polished by North Carolina Division of Historical Resources. Reorder:Additional Forms may be ordered born:Division of Environmental Health, Department of Environment and Natural Resources,1630 Mail Service Center,Raleigh,NC27699-1632,(Courier 52 01-00) DEN R3961a Revise d4/03i Environmental Health Services Sedion(Review 4/06) Y C 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 0 QA4W UO( ID# 1. Pump Flow, ,A` Pump Manufacturer`0u Model#Spatoia 15 Horsepower I •5 Maximum Pump Flow at highest speed FROM PUMP CURVErtim. PuiTV use Circulation 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 51.14 WIn1•{. I naUS1 (a Flow meter reading C) GPM 2. Drain Sump Measurements Is drain cover sumpless? YES/NO Sump manufacturer and model GO OR: Field built sump(circle if yes) Diameter of pipe entering sump a inches. Pipe enters through BOTTOM/SIDE of sump(Must circle one) •0{ /Distance between highest point of outlet pipe and top edge of sump J 'oZ. inches. Sump dimensions 9/1/1 3. Drain Cover Data—MUST BE INSTALLED PER MANUFACTURER'S INSTRUCTIONS-Attach Instructions to form. Number of main drains on each pump ti Distance between main drains(on centers) 3 feet / inches C¢'%.)tr Cover/grate manufacturer a,rQ,m ,model 5 tI,.J A ,VGBA approval 2008 017 ' cle one) i00n (VI Flow rating from15130 ' stetions: 7R' gpmll Cover(s)located on pool: Floor/walll (circle one) Date installed a3 I,ifespan S EXPIRATION DATE 5 6j( 5 a� 1 4. Equalizer Covers Number of operable skimmer equalizers Have the equalizers been permanently disabled? NO 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. Vacu Line Choose One No vacuum line in pool OR Protective cover on vacuum lines installed before May I,2010,OR Self-closing.self-latching cover designed to be opened with a tool on vacuum lines installed after May I, I,2010 Full name of person providing this information Kyle A. e + Phone number:_S9 D' 334 -81441 Signature J' Date 5'" /o`"P 3 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 expirationdate 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 y�4'A Cp CATAWBA COUNTY MIL 100A SOUTHWEST BLVD NEWTON,NORfI i CAROLINA 28658 RECEIPT V ,,� PHONE:828.465.8399 Monday, May 22, 2023 I g 4'L s.1 www.catawbacountync.gov PAYOR: Keystone Mgt Co Inc Keystone Mgt Co Inc(Crowder,Taylor) PAYMENTS TRANSACTION NUMBER: TRC-64625250-22-05-2023 PAYMENT DATE: 05/22/2023 PAYMENT TYPE: Credit Card 305601182 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 05-23-423036 110-580200-663000 Pool Inspection Fee-Seasonal $150.00 TOTAL PAYMENTS: $150.00 FLI-06-2013-038810 CASE TYPE: Food&Lodging Institutions WORK CLASS: 50-Seasonal Swimming Pool SITE ADDRESS: 745 BOUNDARY ST NUMBER 100,NEWTON NC 28658 Paid By KEYSTONE MANAGEMENT CO.INC,99 FISHERVILLE RD,CONCORD NH 03303 B:8284643170 Paid By KEYSTONE MGT CO INC,745 BOUNDARY ST,NEWTON NC 28658 **NO PEOPLESOFT ACCOUNT ASSIGNED** Paid By THOMAS MARTIN,99 FISHER VILLE RD,CONCORD NH 03303 C:8284643170 Pool Operator CHRIS HOUSER,745 BOUNDARY ST,NEWTON NC 28658 C:8284643170 receipt 05/22/2023 13:19 Page 1 of I