APPLICATION FOR APPROVAL TO CONSTRUCT OR RENOVATE A PUBLIC SWIMMING POOL

A $250 fee is required with each completed application.

Name of Facility:
Address of Facility:
City:	State:	NC	Zip:

Type of Plan Review:

New Construction	Remodel	Other

Type of Pool:

Swimming Pool Spa/Hot Tub Wading Pool
Special Purpose or Therapy Pool
Water Recreation Attraction (please specify):

Community Served (please check all that apply):

Fitness/Athletic Swim Club Spa Institution Hotel/Motel
Subdivision/Apartment Complex Institution
Other:

Select All That Apply:

Indoor	Outdoor	Year-Round	Seasonal (April 1-October 31)

Water Supply:	Public/Municipal	Private Water Supply

Sewage Disposal:	Public/Municipal	On-site Wastewater System

Pool overflow and backwash to:

Owner:
Mailing Address:
City:	State:	Zip:
Phone Number:	Email:
Contractor:
Contractor’s Address:
City:	State:	Zip:
Phone Number:	Email:
*Pools shall be constructed by a contractor licensed by NC Licensing Board for General Contractors as required by G.S. 87-1
Engineer:
Engineer’s Address:
City:	State:	Zip:
Phone Number:	Email:
* Pool plans and specifications shall be prepared by a registered design professional as required by G.S. 89C Engineering or G.S. 83A Architecture

The owner shall submit:

A minimum of two complete sets of plans for review. Plans shall be drawn to scale. All prints and drawings shall be a minimum of 18 x 24 inches and a maximum size of 36 x 42 inches. Plans shall include:

Plan and sectional view dimensions of both the pool and the area enclosed by the barrier fences to include the bathhouse and the equipment room and pool accessories;

Specifications of all treatment equipment used and their layout in the equipment room;

A piping schematic showing piping, pipe size, inlets, main drains, skimmers, gutter outlets, vacuum fittings and all other appurtenances connected to the pool-piping system;

Layout of the chemical storage room; and

Specifications for the water supply and wastewater disposal systems that include aspects such as well location and backwash water disposal where applicable.

Plan review fee payment of $250.00

Application for approval to construct or renovate a public swimming pool.

Specification documents submitted for:	If Applicable:

Circulation Pump	Pool Heater

Filter	Slide

Automatic Chemical Feeder	Diving equipment

Skimmers	Surge Container

Equalizer Suction Outlet Cover	Variable Height Surface Skimmer

Return Flow Meter	Water Recreation Features

Main Drain Covers/Grates	Feature Pump

Adjustable Inlets

POOL:

Will pool be lifeguarded? Yes No
Number of units of life saving equipment:	Ring Buoy & Body Hook:	of each
Location of emergency pool phone:
Pool Surface Area:	sq.ft.
Pool Perimeter:	ft.
Volume:	gallons
Turnover Rate:	GPM
Maximum User Loading for Pool:

Materials of Construction:
Pool Shell:	Concrete Vinyl Gunite Fiberglass
Other:
Pool Finish Color:
Pool Surface Finish Slip Resistant?	Yes No
Shallow Area Depth:	ft.
Pool Area <5ft deep:	sq. ft.	Slope in <5ft deep:
Pool Area >5ft deep:	sq. ft.	Slope in >5ft deep:
Number of Skimmers:	Number of Inlets:
Skimmer Pipe Size	in.	Inlet Pipe Size:	in.
Max GPM Equalizer Cover Can Handle:
Main Drain Size:	sq. in.	Max GPM Main Drain Cover Can Handle:
Main Drain Pipe Size:	in.
Hydrotherapy Drain Size (if available):	sq.in.
Max GPM Hydrotherapy Drain Cover Can Handle:
Hydrotherapy Drain Pipe Size:	in.
Feature Drain Size (if available):	sq. in.
Max GPM Feature Drain Cover Can Handle:
Feature Drain Pipe Size:	in.
Filter Flow Rate:	GPM per sq. ft. of bed area
Type of Disinfectant:	Chlorine Bromine Saltwater System Biguanide
Number of ladders provided:	Sets of steps and handrails provided:
Nighttime Swimming:	Yes No
Underwater Lighting (if provided):	watts/sq. ft of water surface
lumens/sq. ft of water surface
Will Deck Lighting be provided?	Yes No
If deck lighting is provided for night swimming, then it must meet rule .2524
Decking:
Type:
Finish:
Slope:
Barrier Fence:
Fence/entrance gate detail drawn on plan?	Yes (skip to next section)
No (provide fence schematic)
Type:	Fence Height:	ft.
Type of Release Mechanism on Access Gate(s):
Height of Release Mechanism on Access Gate(s):	in.

RESTROOMS AND SHOWERS:

Number or fixtures provided:
Males	Females
Showers:	Showers:
Lavatories:	Lavatories:
Water Closets:	Water Closets:
Urinals:
Bench or room provided for dressing?	Yes No
Are showers provided on the pool deck enclosure?	Yes No
Are showers drained to sanitary sewer?	Yes No
Shower(s) are required so that bathers may shower before entering the pool. For use as a cleansing shower, soap must be provided and shower(s) must drain to sanitary sewer or onsite wastewater system. Extra rinse showers and foot showers may deviate from these requirements.

CHEMICAL AND EQUIPMENT ROOM:

Chemical Room Dimensions:	width	length	height
Shelf provided
Lighting
Type of Ventilation	Natural Cross Draft Continuous Forced
Vented away from pool
Equipment Room Dimensions:	width	length	height
Lighting
Floor drain to sanitary sewer
Floor sloped not less than ¼ inch to drain
Type of Ventilation:	Natural Cross Draft Continuous Forced
Vented away from pool

CALCULATIONS:

POOL PERIMETER:

SURFACE AREA:

VOLUME (in gallons):

FLOW RATE (gpm):

TURNOVER RATE:

BATHER LOAD:

RESPONSIBILITY:

The Department shall approve, disapprove or provide written comments on plans and specifications for public swimming pools within 30 days of their receipt. If such action is not taken within 30 days, the plans and specifications are deemed approved. If construction is not initiated within one year from the date of approval, the approval is void.

The Swimming Pool Contractor shall contact the local health department when pool pipes are in place and visible so that the local health department may conduct an open-pipe inspection of the pool piping. Upon completion of construction, the contractor shall notify the local health department and the owner. The contractor shall provide the owner with a complete set of drawings, which show built, the location of all pipes and the connections of all equipment and written operating instructions for all equipment.

Prior to issuances of the operation permit, The Owner shall submit to the local health department a statement signed by a registered design professional stating that construction is complete and in accordance with approved plans and specification and approved modifications.

Omissions or non-compliance with the .2500 NC Public Swimming Pool Rules will result in plans being disapproved. No construction shall be initiated until plans are approved. If construction is not initiated within one year after plan approval, the approval is void. Any deviation from approved plans without prior approval from the Department will void approval.

Review and approval of these plans and specifications by the Cleveland County Environmental Health does not indicate compliance with any other federal, state, or local code, law or regulation. You will be responsible for obtaining approval from appropriate zoning and building inspection departments. Their numbers are included below to assist you.

ZONING / BUILDING INSPECTION	FIRE MARSHALLS

Shelby 704-484-6805	704-484-6816

Kings Mountain 704-734-4599	704-734-0555

Cleveland County 980-484-4975/4997	980-481-4841

If your business will be located in any jurisdiction other than those listed above, please check with your city manager and/or town hall for permitting assistance.

Date Application Submitted:
Applicant’s Signature:

APPLICATION AND PAYMENT CAN BE SUBMITTED IN PERSON OR BY MAILTO:

Cleveland County Permits Office

1333 Fallston Road

Shelby, NC 28150

*** Please call 980-484-4779 to arrange for submission and payment of fees**

Rev. 12/23