HomeMy WebLinkAboutAPPLICATION FOR A SWIMMING POOLSEP 13 291g
Appliaatlon Type: (check box, see
Initial
I ] Penn* 109
I ] Transfer, change of owner or name
I ] Renewal
For Department Use Only
Fee Re.:a,;,ed $ pate
Check# From
OPeratingPemrit# 50-60-00365
S�gNN�
STATE OF FLORIDA St C"Cie DEPARTMENT OF HEALTHcoU�
til
APPLICATION FOR A SfNIMMING POOL OPERATING PERMIT
This original forth is to be completed and submitted with one copy. a set or construction plans & specs, a copy of the building
department's final inspection along with the appropriate fee.
1. Name ofProject /Facaiky Savanna Club HOA - Rec Center County . StLucie
Add2ssofpool 7869 Bromelia Circle
City Port St. Lucie Zip 34�—
2. NameofOaner Savanna Club HOA orqq
E-Mail sdowns@savannaclub ph. 7 340=0522
Mailing Address 3492 Crabapple Drive
City Port St.Luci6StateFL Zp 34952
3. Buildingg Lucie County DepartmentName: Bc3Q Dept 72 462-1553
2300 Virginia Avenue rhoneNrunber
P.O.66xor Street Address Ft. Pierce, FL 34982
CRY, State. Zip Code
E-maY Address
4, Pool Water Source City Water
5. Lighting (check OMY (X) No Night Swimming
( ) Outdoor. Three foot candies overhead and 1/2 watt par square foot of pool surface area underwater
( ) Indoor; Ten foot candies overhead and 8110 watt per square foot of pool surface area underwater
6. Pod Volume in Gallons: Main Pool Wading Pool Spa Pool 14 0 0�
7. Pool Bathing Load: 8
Number of Dwelling Units
S. Pool Dimensions: Width; 10 Length: 10 Area: 1 75 Perimeter31_4 Depth: Max.36 n MinPa:
_Sha Circle
9. Water Treatment Equipment Make and Model:
(A)RecirculatlonPump: Sta-Rite MaXPrO 50
Flow GPM At 4 5 TDH HP 112
(B)FIter; .Sta—Rite PLM 200 sq. ft. 200
DE Filter Area Sq.Ft Flow Capacity
(C) Disinfection Equipment Stenner Feeder Capacity 50 (C,pp) or (PPD)
(Secondary Disinfection if Applicable)
(D)pHAdjustmeitFeeder Stenner Feeder 50
(E)Test K_ Taylor Capacity fGPDI
d:
10. Equipment Substihrtions
DH 4159, Efh 1012014 (Obsoletes DH916 7108 and DH918 5112 editions) 64E-9.001, F.A.C. Page 1 of 2
CERTIFICATION OF OWNER r
The undersigned owner, or owners repr.wdtative, hereby agrees to operate the pool des ;,,__d in this application in accordance with
the requirements of Chapter 514 of the Florida Statutes (F.S.), and Chapter 84E-9 of the Florida Administrative Code, and maintain the
original construction approved under the Florida Building Code by the jurisdictional building department. This agreement includes
keeping a daily record of the information regarding pool operation on the monthly report form fumished by the department or on other
forms approved by the department and when requested, submission of the completed forth to the appropriate county health
department. ^�\\` /� p
Signedi t�t��i �v U Date
Name -caifX- aq m (h n
(print or type) (print or type)
REMARKS: Installing new 6"x6" Colonial Blue tile with new Depth Markers.
Install new QuartzScapes 3/8"-1/2" thick. Bring all Main Drain Covers to
t:uue
Design Engineer/Architect Name- Telephone:
Building Department Construction Approval Date Approval
ST, 4ucln County,
CERTIFICATION OF INSPECTION
I hereby certify that an inspection of this pool has been made and the foregoing Information is cored to the best of my knowledge and
belief. It is recommended the first annual operating permit be granted subject to the provisions of the Florida Administrative Code.
Signature DOH Engineer/Authorized Staff
Print Name
[ ] Change data entered into EHD by on
Instructions- Before submitting application to DOH:
For Initial Permit: Complete the entire application with owner certification. Include original and one copy of this
completed form, a copy of construction plans & specs submitted to the building department (electronic copy in PDF, TIF or
JPG format is acceptable), a copy of the building department final inspection approval, and the appropriate fee. Provide
design engineer's name and phone number in REMARKS. The operating permit number will be entered by DOH staff.
For Modification: Complete items 1 - 3, enter existing operating permit number, note proposed or completed changes in
the appropriate sections, and complete the owner certification on page 2. Include a copy of the construction plans &
specs submitted to the building department (electronic copy is acceptable) and a copy of the building departments final
inspection approval. Provide design engineer's name and phone number in REMARKS.
For Transfer: Complete items 1 and 2, enter eAsting operating permit number, then note changes in the page 2 owner
remarks section, and complete the owner certification on page 2. There is no fee or building plans required for a transfer
permit reissued due to change of ownership, name of facility, phone number, or mailing address.
For Renewal: Complete items 1 and 2, enter existing operating permit number, and complete the owner certification on
page 2. There is an annual operating permit fee charged for renewal.
DH 4159, Eff. 10114 (Obsoletes DH916 7/08 and DH918 5/12 editions) 64E-9.001, F.A.C. Page 2 of 2
�- SCANNED
BY
St. Lucie County ,
- For i
F osPihneftt use only
ee Recervad.3.
ch From----------------
rom _
APpusat)on Type: (check tmx sea f : a {riafn+cilans on batic
[ ItrtitfalAamdt Pt?�J1Rodif(estlon Resurface n 50-60-00369
I "I!ssfi4-than��aas+iowrtar or eurna 9 >amtit
I. t noml,,ECEivt!Q' i
RECEIVED
DEC 2 7 9 I STATE OF FLORID SEF:13
ST, Wcle u c , Nermucile I DEPARTMENT OF H L de
= -- GAT1ON FOR A SM MiNG POOLIT,i
This o4nai h m, is to wmptetedand:uhmlkee with one copy rant or
dsperimant's finef li6peCt�f1 along W the me p� $ specs, s copy of the bulling
ppmpdats fee.
'Name of EcIft.
Savanna Club_'HOA _ minty :,'St: -Lucie
Addrm'ctpad 7869 Brome ie circler i
City Port St. .`Lucie' �P 39952 .2 Nuna afOwntt .„ Savanna Club HOA. -
6Ma0sdowns@savannaclubor ..7 340=:0522
MatMgAddm" `3492 Crabapple Drive
qry Port—�ci�Shti FL
3. 8ulldingpepsrhnewNatrre, Lu ie County 27p 34952
2300 Virginia Avenue gaup f72 462-1553
PA. Box orSiteet AddieSa
Ft. piew=nrce r FL34982uNaabar
C-Y, smte. up Coda
Eanei AdGese - .. • _
4. PcdW&W.soume City Water i
5. Ughtiny (cher#.ona): (jU No Not kwiny - .. .
! ) Outdoor, Thtne [oat nnrBenf overhead and 1r2
( ) Ird00 : Ten foatcand4a ovedmad and arlo wan Per squam feet of pool autfacs area undmxater
B. Pod Vokane In GaWoaa: Main Pod 52 Soo P� Wuara toot of podauAaori area uMarrater
Wading Pod Spa Pool "
7. PoW Bathing Load 29 fir-
—Numbuof Dweling lJnda
S. PooLOUnernafoes: W7dIh: 38 , 42 Arm Perlmeter.160 peps Mac 5 MLL 4 S Rectangle
a;WaterTaatmert :
Egn+IWneniMalmandMwld: '
(A)R@dtmdaBonpuW MaxPro-Sta-Rite 146 '
2 Pentair Triton II Tr190 Flow GPM At 110 TDH 2
(B) Mar.Cand Fi 7 tpr 7, 0$
AreA Sq. FL Few Cap,city 1 0_ .6
(C) MInfactbn equ%x. r& Stenner Feeder
Capacity 5 0 (GPO) or (PPO)
(Secondary Oisf kum If Appilcabie)
(0) PH Adjustment Fooda, Stenner Feeder
!E)Ten IGL• Taylor C'P h'--50 tam
10. EqulpmentSubsbludom ,
• t4
OH 4159, Efr: 102014 (Obeoleius OH916 7= and OH918 5l12 odltbm) 64E-2.001, FAa Page 1 or2
he ra( mod OWf1Ef. — herby t graft �Oi> a tI7E'. i vt`J y
! T otlpirntt aP d-und �r theFbrkli ilma iF B) StSftend t hapLr� d in
- faepinp n dcAyrooaeCof the Code bytfw j k and mahtain ttr
fountcPPMMbyOndepalroe I t + the rI abaft bin 8ajtbtWbyaft or on is ? i
iaOMfambRiaappropitets
rs ti fi►f
.r /1 Crtype).
Lnstsllln a .�
4
4'hew 6 x6 Colonial Blue tile,'with new De �'
Install new uart2Scapes 11El �: 2' thick. P- Markers r'
Code t1 Main Drain Covers to f
Bring
Buflding r t r
{//���/�(�p���( /� ��y.��
Y" 1 . _ �•'�.. �. StM MLon ApOa. M Iste
`
ro td 4
C6 7VXATfONOFNSPMCTM
f'hwl6 c Wythatan peWOrf o(th1S '-'
baits! !t Is rscomtaNdad. 9W annu l lies Wan of be and
f � 1. �,e to �.bw of my#�y _ I
I�+rnft trr l rovkii na of the Maids
Adnibiji ettve'Code, ,
.-
t�
.TCian9e data enu r lrtn FHD'by i
on `1a .
r Instructions- ftfona subm3tfing aPPlfct6va to [Ft)H:
For tnkfat permk: Corripfata tttta`-
oomPteted fonrt a copy of oasetruc6on PPt)caNarf with owner oerfifia8on. fndude ariphtal and one copy of thiiij JPG fomtat fa acr�pbyb1e) a eopy of fire b c> nBs PartrneM fine( �fhe buY�rtg dePaitment (etechonlc COPY In POP TIP or '
�sdgn ®n9ineer c rome and phone number in REMARKS Thee ra don aPProYaL and the MWIDPrtate fee. proWe
` Forilodiffcatioa;rPerrritntart8erwill, beegtered.by"Dom 'statf. .
p bitildi gate Ute owner rb on nn �6 2 Vmber, nab' ProPosedor co*fated dwa asthe lrt
htcpeChartaPProvat: Prbklded n t(afectmrdcaopyfseeceptabtaj a 6arInerns'fittal
9iuser'snameandphone number
§rtµps.
For iYansfar. completeitetns 1 an 2, entt#r etastirg)"opefating permif nun er I
{. remarks eedion and astttplete the owner Cer6ftcatlon on e 2 • hm noW- dwriaes in the:pa9a 2 owner
1 Perrrd(reltsuaddU,e to mange of own�ahip, ttartte of facihiy, phone number, or. rttaiftn9 r�dra a required for a trtinafar
For
Pa9a� Therfo tie � r and Pemut fee oporatiro pemnt nuh-9w �l.ConVgl -the ownerceltifipBon an
forrertawal.
iDH4159.Eft.10/d'(06coteP DH?le�7M8and6F218SI12.W,,,)64E•9.001.FAC. Pe992o(2 - . i
App
Opwatbm pan*50-60-00365
STATE
DIEPARTU
APP OF
Thik L'CATION FOR A SWmMMC; POOL OPERMING fOM 15 to be Cg� PEUrr
dV�tW =MPY, a ft of
PMJIdIF4dW Savanna -SkIm wth sp" a Copy of ule &Aft
Addra'ag of pixi 7
869 Bromella- circle C=*—S --L U C �ie
Cfty. Port St Lucie
NAnwcfownw savanna cj." Hoi
IuA
mmftAddrmft::374�92=�appl. OwrIs@savannacjubor"ZZj 4
--:'��Drive
DWwftNanw
bftypPort St.Luci
-0522
Ln ietCounty
77zp 3&j2V0wMa2aaue —2
P-CatXwLj462-iss3te FL 349 �4
4- Pool Wftw8mVOk__ city Water
kxbot-, T7.hr*o faMORKUM OveOmW w1d 12 wie per sq� fbct of
6. PoolVoksm �. in GgMah foot cukabc Ovwhemd wid &JO MM pw OW=a bat of POO surlim OM4
7- PON ft2ft 8 PML-� Wadtna pool ---- padairfibaum - a UXWPMMW
00 o
&Qbwcf DmaMV UndsOthera Poo(per. —77�-
uftanwww. wift. 10 twr - �70 &,04C 175
WatarTreatfW4 ft,wIPwineiar.3I-4E)epftAfu36"
mwt Makb andMode.
Puwt Sta-Rite maxpro
—�
(B)p2w. -Sta-Rite pity
pqw 50
200 sq. ;Et
1: 1 -
AL�TDH�Hp Ii
(q DhWeego; Ge �03L-�- Sq.Ft ROWCApecay -
nt stenner Fe6der --------
(Ss*xtdwy DWmim� if AppSo
0 ff=WC,
(D) PH A*Wbym-t
Fe&jer Stlenner Feeder
(EjC,
Tea r&- Taylor so
10.
H 4159, Eip
I012014(ObmaVw D1,116
7108 AWA DH9I8 aM2 edfliom) . 64E-9.001. FA.C. Pape 1 C(2
eKta a:AftON 9FOMEft _ - --
`. umaleistpttaB ovaw; orownar'c repraaenta}rve fwebY e9rsas to -
!aquitemaCs of Chapter 314 of ttte Ffarda Statutes F.3. and P d�scrQ 6d ii this eQpNcidon In eacordaie a evltfi-
g�al �ucft 2PPtaved urdarthe-Fiorkin ( ), Chsptsr8lE-9 d the Florida Adm6listrative Code and mehthetn itte
keepktg a delyrecoid olthe B' r4 Coda byt!>aNdWctiotW bMWW dspertroent This eni i
c" regaMIM POW Opratfon of the xtderdss
t vedby
.byttte dt�rttnattt and when txptestsd, sutim6slon of tam to the awv is county
N. SEE 18
Name (Preto type) - _ Ta4_L�PYtP�n 0 (Yl4 Y1A�� autttag
tZEraarttc3- Installing, new 6"x6'.' Colonial Blue t31e with aew Depth -Markers.
Install 11Wi Quartzscapea 3/8"-1/2" thick. Bring all Main Drain
Code: `_Covers to
Dsstrn EnainaarlA naM me
Building'Depart onficonsinictlon ApproYal Date _
i
Approval Number
i
CER1F1t]A'FION OF WWECMON - - - -
t here&y is
that an InaPagicn of Oils pool has been made and tho r belisr, n fa rewmmended the rvat annual O�lsg Infona8an ls correct to the cleat of my xnc+viedpe and
Werattr�.Parmtt be granted subject to the provisions of the Florida AdafmBtretive Cods.. -
5;g emlr»errnutmrt:,edstffff
o.t, i
to
Pere Name ;
•'`_on
Inafrubtionc- Before submitting application to DOH:
For initial Permit: Complete the entire application with owner cerpticatiori. lrtdude OriWttal and one copy of this
completed roan, a copy of cant uctioh peril & sPeca submitted to the building department (efactronic copy in PDF, TIF or
JPG fomnat is acceptable), a copy 6design engineer's name and phone number- FUMAARKS. ding nThe operatingInspection I final p approval
vAb appropriatelbyDONstaff. provide
For Modification: Complete items 1 - 3, enter existing o
the opprW"sto ssclions, and cOmpfete the Owner c rrdfi rb� Permit number, note Proposed or completed changes In
specs submitted to the building doPartrnent etectronIc cc On page 2. Include a copy of the construction plans 3
Inspection ¢pPravxt. Provide design engineer's narrw and Phoneennumubarin REMARKOf the S. txa7ding department's final
For ft section.
Complete pals: y and 2, enter ffcating operating permit number, then note changes in the page 2 oHmer
remterlcs section, and complete the Owner certiftcaUM on page 2. There is no fee or building plans required for a transfer
Permit n tisaueddus to change.of ownership, name of Najty, plate nunber, or moiling address.
For Renewal: Complete toms 1 and 2, anterwdsting operating permit number, and comploto the Owner certification on ,
Page 2 There Is en annual operating permit fee charged forronewal.
Ott 4139, EH 1fY14 (Cbwtetes OH918 7r08 and DM18 Sr12 eddnrus) 84E-9,001, F,A.C• Page 2 or2