HomeMy WebLinkAboutLR Pool App 530050 11 03 23 -
ENVIRONMENTAL HEALTH
Catawba County Government Center
Ca awba county 25 Government Drive I P.O. Box 389 I Newton, NC 28658(848) 465-8270 I Fax: (828) 465-8276
public health Phone:
r� uuec.nrne.atrre.
Email: EHAdmin@CatawbDCountyNC.gov
Application for Public Swimming Pool Permit
1?o.IInformation
i tyl-tobbri. i
Na of pehlic swimming pool: ly t,rwi r ' }•Z ,.e._ Ukvt:Q c-r is 1 +0 Do i t 53400so
Street address: 7 S/ c5 t,,,,i c,.h P lac` N a
CitChy:' 4�4- nor
TYPs ILK State: 1V c- ZIP: Z
yMl p 2✓SwitRninp pool ❑WeeO peel ESpe []Other(describe)
Dail ed or realocieleciere may I, 1993 r
Dares � may I, 1993
*erotica Opening date:
tlos* dote Opening
Rows . eperetion: time:
Closing time:
i
Ow er Information
Now of owner. Le. if-
Owner email: Sc. .C- Ce4 u.
Mullin address+ 8 ` is
Grp 1 • _ - �.
5 Stat
e: —
'� ,,ZIP: 4c. I
Coe �I Person: r C11• a o. Pbooe#: f 2 8 -
Oper,for(On-Site Manager)Information
Pool op rater.__ fit4i,4 . Phan#: a2- - f:
310 - 3ga4
Street ress: 5-1.,.
�lcir_L, IV F r
or `�
"r a l,-4:6
State:NC ZIP: Z-E(fl o 1
;tip
Pooloperntoriraiaedby: 1pfational Swimming Pool Foundation (Certificate#:
[3:Ither(please specify) Nc ,-- _ 2 A t 4,
Am
i�+ lined , d�,t L�
aoweer ❑Operator
Sipeatere al Applicant: •
-
Date:
pm►ee0imehl?06-112 repine dmCommirs(gHes%Seviontrebptrulnpormio
y Risk let et wH hr etch public smilmeleq peel Ns lore Is to d r ewes re elgpeels isA apply fit permits.Properellm fie ln 1 SA eCAC I SA 2$00 remote tire a ehe r opera se tor to e h rew
INeu *weer ere 1esi�reprommi,i peel
elite
oc Is te Ise
eepeeA .sd w e.ried d hr.ech puts sells swm.The p Celiac completed fie~b ehdee/r t ice Mei as der enemy Mich fie public Heil pool Is Imol d.A
UMW* i cee DePebetla Mich are Club le be e.htelmd et I.Ind INC.deperteetL Dttpesilf.e Meese ram is heeds
beperteeueetteed Nomml Reeve yes.1630 Mel Sari,,UMW,Ri,,11C 27699.1171,Kistler 5ereals,Melee el tactorkel �-00)herder AlAdeeuA Form My be ordered boric NAM e(6uineueel IAA,
DOR196 /07I
rsnkeeumeNl Heed Smokes Sedet{heirs 4/061
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 Lem 01 ( y L l.?kIniucdcbi ID#
1. Pump Flow
Pump Manufacturer v)( A e, Model# 446/30 ,3, 2 AI(S Horsepower !D
Maximum Pump Flow at highest speed FROM PUMP CURVE; 525 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/NO
Flow meter manufacturer Flow meter reading GPM
2. Drain Sumn 11kasurements Is drain cover surnpless? YES/NO
Sump manufacturer and model OR: Field built swop(circle if es
)
Diameter of pipe entering sump (p 1
inches. Pipe enters thmugh BO�ITOM/ f sump(Must circle one)
g
Distance between highest point of outlet pipe and top edge of sump /(.•'S inches.Sump dimensions /2. X /Z h
3. Drain Cover Data-MUST BE INSTALLED PER MANUFACTURER'S INSTRUCTIONS-Attach Instructions to form.
Number of main,drains on each pump 2.. Distance between main drains(on centers) feet /5- inches
Cover/grate ma facturer i44 wcr e� ,model
Y lAk/032 7,tA•F ,VGBA approval 2008/2017(circle one) 1
Flow rating fro instructions: $45 gpm Cover(s)located on pool: loo /wall(circle one)
Date installed e. • 4;20 Lifespan 7 wet EXPIRATION DATE ao.vi
t.
4. • a_,e Coy s
Number of o, 1• skimmer equalizers D Have the equalizers been permanently disabled? YES/NO
Equalizer fitting I anufacturer ,Model ,Lifespan �#
i
Bulkhead adapts Manufacturer .Model ,Date Installed
Diameter of eq . izer pipe_ Cover is located on(circle where mounted): Floor/wallI.
Equalizer fitting aximum flow rating gpm. I
t.Date equalizer c•ver/grates installed
EXPIRATIOv DATE:
S. Safe Vacuum •elease System SVRS -Safety Vacuum Release System manufacturer/model#-
You will •' required to demonstrate effectiveness during permitting inspection.Date last tested
It•
6. Vacuum Line ,oose One
No vac ,' line in pool OR Protective cover on vacuum lines installed before May 1,2010,OR
Self-clos g,self-latching cover designed to be opened with a tool on vacuum lines installed after May 1,2010
Full name of p •in providing this information ✓ef CA id e rtr Phone number: As pk-40 is&7
Signature 4407
Date io/ * /Z tr3
dr
NCDHHS
Revised 4/1/2022 for immediate use.
.�$A Iill .I" a� CATAWBA COUNTY
I OOA SOUTHWEST BLVD
7
NEWTON,NORTH CAROLINA 28658 RECEIPT
C.3� 0 PHONE:828.465.8399
Friday,November 3,2023
1$4 Z sM www.catawbacountync.gov
PAYOR: LENOIR RHYNE UNIVERSITY
LENOIR RHYNE UNIVERSITY
PAYMENTS
TRANSACTION NUMBER: TRC-76937859-03-11-2023
PAYMENT DATE: 11/03/2023
PAYMENT TYPE: Check 371066
RECEIVED IN HICKORY
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
11-23-430032 110-580200-663000 Pool Inspection Fee-Year Round $200.00
TOTAL PAYMENTS: $200.00
FLI-0000184
CASE TYPE: Food&Lodging Institutions WORK CLASS: 53-Year-Round Swimming Pool
SITE ADDRESS: 751 STASAVICH PL NE DR,HICKORY NC
Applicant LENOIR RHYNE UNIVERSITY,PO BOX 7164,HICKORY NC 28603-
Owner LENOIR RHYNE UNIVERSITY,PO BOX 7164,HICKORY NC 28603-
**NO PEOPLESOFT ACCOUNT ASSIGNED**
Pool Operator PAUL SCHIFFEL,751 STASAVICH PL NE,HICKORY NC 28601
B:8283287427C:8283103924
receipt 11/03/2023 13:29 Page 1 of 1