PUBLIC SWIMMING POOL From ENVIRONMENTAL HEALTH 910 893 9371 03/22/2011 08 29 #290 P 001/004
HARNETT COUNTY PLAN REVIEW APPLICATION
SWIMMING POOLS
Review for Compliance with NC Rules Governing the Public Swtmnung Pools (15A NCAC
18A 2500)
All items are to be submitted through the Central Permitting Office at 108 East Front St
Lillington NC 27546 or by mail at PO Box 65 Lillington NC 27546 You may contact the
Central Permitting Office at 910 893 7525 Ext 2 However please contact our office with
questions regarding the contents of this application
If you have question contact one of the following Food and Lodging staff listed below at 910
893 7547
Gale Violette Greene RS Jaime Turlington RS
Food and Lodging Program Specialist Environmental Health Specialist
Cindy Pierce RS
Environmental Health Specialist
Plans which are submitted for institutional establishments require plan review to assure
compliance with the North Carolina Rules Governing Public Swimming Pools (15A NCAC 18A
2500) which is necessary to obtain an operations permit once construction is approved A plan
review fee of $300 00 must be paid when plans are submitted
Plans must be submitted with the following supporting documentation
/ Plans must show pool deck fencing and any other appurtenant building
Plans must include drawing showing the placement of equipment in the facility
including any equipment rooms chemical storage rooms toilets and bathing
facilites dressing rooms along with general plumbing electncal and mechanical
and lighting details
/ Piping schematic showing piping pipe size inlets main drains skimmers gutter
outlets vacuum fittings and all other appurtenances connected to the pool piping
system
/
✓ Specifications of all treatment equipment used and their layout in the equipment
room include equipment cut sheets
/
Plans must include a site plan locating extenor equipment such as dumpsters or
compactors and indicating the proposed connections to approved sewer and water
/ connections and backwash water disposal
✓ Plans shall be drawn to not less than one eight inch to the foot scale
gg
8/07
From ENVIRONMENTAL HEALTH 910 893 9371 03/22/2011 08 30 #290 P 002/004
PUBLIC SWIMMING POOL DATA SHEET
Pool e VQIllit leo Far MS
Location 205Vanics `erOct 1 LIII na 10(1 roC 2154
Pool Contractor Date of
Clayton Brit} Sons , In( , Construction Series 201 I
1 ii1 An r s e Idtk . _ ), w x' , II Ss w w
t
Pool volume S Slit s_Qllons f — Weathe • roof Buddln•
Surface Area I, O O,Sf Well Ventilated
Bather Load IQ 0 pu - S0 AS V Sanitary Sewer Floor Drain
Calif). Heim ht ft
Fibs •lass f — Concrete !_ D
r— Ventilated
Gunge Rounded comers in- [Jc' , Y„- h.,, jarZ
Other— S•ec 3 Make entnir L al
Number of Main Drains 2.. Model '
Size of grate 12," A 1 2 .linf,& 7 „� .�'
a `�'`• x '"lr. a ' a iglO
Anti Vortex nick_ VE1 6 I S1 tinted ✓ Sand DE Cartndge
Number of Returns/ Inlets ly Make ''.• r., • , a C
In wall C In floor R Model it 100C
Size of pipe 15 /2 0 /2 5 /3 O Circulation Rate (GPM) I Q5
Number of skimmers G Backwash Rate (GPM) l r
Overflow gutters n q, Pressure Gauge ,/
Number of Outlet Drains n 0.. Sight Glass
Hair and lint catcher Flow Meter ✓
rf ci . a rl is * Air Relief Valve
Location re/turbine / room. Pool Heater
Size of pipe 1.0 Tumover Rate
Other method to fill n la IF1"+.3 4r �, 44 T +�; 2fi r ee
Back Flow Prevention 12.92. Type Ehoston Make ail
Source of Water _ 1 I • v . Ub i :, Model Number I.
,Fin1W,s"V' f ': ,< s k'. s ailrr 'mil`ri �^,' , -� a,�:-
Finish �G.«�,t le vy u f aL....uEn= Fl or oleti broom fi n iSh con rat # toilets female e'
Minimum width I 1 ft # toilets male �� Floor WPM
EMI dram to
Slope 14 1 /z Pu ft # urinals ME sewer 4 au
✓ Deck drains X. Diving Boards # lavatories Non skid
✓ Hose Bib ✓ , Depth Markers # showers 2 floon •
Number of ladders 2 ;, ,113?.r5�; ;
Number of stairways I Sewer to 9 U1111100, (nvn L t 0 a
Outside rinse showers n w Pool overflow & backwash water rt � td � 9 ����
- 9:t ","'' S” '" v' m .a
:. �4, 3 ,a+i-z_✓� , ; r ' t4 ' ; .'' IS ■i ■-gtll'J�1P7V1:>'J�
Underground lights j
Deck lights X
Rrnq Buoy w/ rope /
Floating life line /
Shepherd s crook 1
Spa timer nI0,
Telephone ,/
F nn mpleted by
Rhoha Flguero kin n.strrr1i Aggestunt 3 22 H
N m Ttle Dat
From ENVIRONMENTAL HEALTH 910 893 9371 03/22/2011 08 30 #290 P 003/004
HARNETT COUNTY AOUATIC FACILITY REVIEW FORM FOR COMPLIANCE WITH THE
VIRGINIA GRAEME BAKER POOL AND SPA SAFETY ACT
Complete one from for each pump For example circulation system hydrojet or water feature pump
Name of Pool/Spa Vander(,rofl Farly.S County ita1rtwitt
Pool/Spa Address 205 Va►v jkcraf f Waal
Pool/Spa Owner V OM t tfO f J L LC Owners Phone q i n 32 g 5261
Owners Address V .0. Rox Z 191
Owner s E Mail in,() GO bV I[ i p i 1 f lid Owners Fax q 1i) 32T 5452
Pool/Spa Operator 17W *part } iM ' Operator s Phone
Operator s Certification' 1 X7 S
Operator s Address UWl>�J cw.
Type of Facility / Pool _ Spa Wading Pool _ Indoor Facility /Outdoor Facility
_ Other
Volume of Pool/Spa (gallons) 4 a I g g O g al l 045
Type of Suction Outlet and Maximum Flow Rate (check one)
Pump Make and Model Number Ponta I r Ch c i ILvai -cr CFI ( - N 1 -FE
C Mam Dram(s) r
Maximum flow rate the system can attam with clean filter and all valves open (gpm) 214
And Maximum flow rate with surface slommer /gutter line valve(s) closed (gpm) 41 a.-
OR Specify estimated maximum flow rate for this system based on hydraulic calculations and pump curve
(gpm) hl A
❑ Hydrojets Maximum Flow Rate (gpm) fL I ll` a
❑ Spray feature describe 41 rA, Maximum Flow Rate (gpm)
❑ Slide describe K` 0 V Maximum Flow Rate (gpm)
❑ Water Feature describe VI la- Maximum Flow Rate (gpm)
Location of Suction Outlets (check one) _ Wall _ Floor _ Separate Planes
Anti entrapment device or system that complies with Virginia Graeme Baker Pool and Spa Safety Act
Dual drains spaced a minimum of 3 feet from edge to edge
a k . Dual drains located on separate planes
oI0. Single main dram with Safety vacuum Release System that complies with ASME/ANSI A112 19 17 or
ASTM F2387 provide documentation from manufacturer
nl a SVRS Make and Model
10 Gravity drainage system Dual Dram Single Dram
p4 p Unblockable dram minimum 18 x 23 size Dual Dram Single Dram
; A I }� Permanent dram disablement Dual Drain Single Dram
From ENVIRONMENTAL HEALTH 910 893 9371 03/22/2011 08 31 #290 P 004/004
New Suction Outlet(s) Provide documentation that cover complies with ASME /ANSI A112 19 8 2007 For
custom or large grating attach venfication of field testing by a Registered Design Professional in accordance
with ASME/ANSI A112 19 8 2007
Make and Model Acosta r wA V lZiOi
Flow Rate (gpm) 400 /Wall /Floor Floor Separate Planes
Size of Cover 1 2'' A l2.'
Sump/Pot _ New Installation or _ Existing Sump /Pot
Manufactured (check one)
Make and Model
Unknown make and model
Specify Dimensions
OR /Field fabncated specify dunensions 4 12" X 12 t X oj tt
Meets the manufacturer s installation instruction for the cover specified above _ Yes No
Clearance between the cover and the suction outlet pipe (inches) g q
Intenor diameter of suction outlet pipe (inches) 411
Maximum anticipated flow rate through the grate (gpm) t g 5
New Equalizer Line Covers
Provide documentation that the cover complies with ASME/ANSI A112 19 8 2007
Make and Model pquas1-ar V" Roonrl ftnrXt, PUCK. )�
Flow Rate (gpm) 2.17 /Wall , "'Floor Size of Cover 10 i j r o UhfJ
OR
Temporary Disablement of Equalizer Lines (ail Items required)
All equalizer lines are disabled by plugging the equalizer suction line inside the skimmer pot
AND All equalizer lines are provided with a cover that is in good condition and cannot be removed
without the use of tools
Form must be signed by the facility owner and a Pool Operator and Owner
I hearby certify that the above referenced swinumng pool or spa complies with the Virginia Graeme Baker Pool
and Spa Safety Act and the information IS correct
Owner s Signatur 11 C 6241
Pnnt Name 2 �p t I— d t.-G C,� &.
Titlee t (gen) Z- ) Date 3 Zz' 1/
Operator s Signature Pnnt Name
Title Date