HomeMy WebLinkAboutscope-of-work-pool-spa-fillable-8-2-23POOL/SPA/WADING POOL FORM – SCOPE OF WORK
ALAMEDA COUNTY ENVIRONMENTAL PROTECTION DIVISION 1131 Harbor Bay Parkway, Alameda, CA 94502/ Phone: (510) 567-6700 Page 1 of 2
Facility Name: SR#: Date:
Facility Address: City: PR#:
Contact/Contractor: Email: Phone:
Work Description:
Please complete the following information:
SIZE OF POOL, SPA OR WADING POOL
(Surface Area) ________________ x (Ave. Depth) _______ x 7.48 gal./cu.ft. = __________________ gallons
TURNOVER RATE: POOL: (gallons) / 360 minutes = _____________ gpm
SPA: (gallons) / 30 minutes = _____________ gpm
WADING POOL: (gallons) / 60 min. = _____________ gpm
EQUIPMENT PLEASE COMPLETE
FILTER: Make: Model: # of Filters:
Sand ____ D.E. ____ Cartridge ____
Sump with Air Gap (required for Sand and DE Filters): YES ____ NO ____
Cartridge Filter Wash Down Area: YES___ NO ___ LOCATION/METHOD_____________
DE Separation Tank: Make ________________ Model ____________________
RECIRCULATION PUMP:
BOOSTER PUMP:
Make: Model: h.p.: # of Pumps:
Make: Model: h.p.: # of Pumps:
CHEMICAL FEEDER/DISINFECTANT: Make: Model: Type:
CHEMICAL CONTROLLER: Make: Model:
FLOWMETER: Make: Model:
GFCI: Exact Location:
DRAIN COVERS:
Main (m): ____ Booster (b): ____
Shared (s): ____
Attach manufacturer specification sheets for approval
Covers manufactured after May 24 2021 must be rated under ANSI/APS-7/ICC-16 2017
Number of Drains: □ one □ two □ Other (specify #): ___________
Split Drains: At least three feet apart from inner edge of covers: YES ____ NO ____
Hydraulically Balanced & Symmetrically Plumbed: YES _____ NO _____
Make: _____________________ (m/s) Model: _____________________________ (m/s)
_______________________ (b) ______________________________ (b)
Size: _______(m/s) _________ (b) Date Manufactured: ________ (m/s) _______ (b)
Check which applies: □Safety Vacuum Release System: _____________________________________
□Gravity Drainage System □Suction Limiting Vent System
□□
POOL/SPA/WADING POOL FORM – SCOPE OF WORK
ALAMEDA COUNTY ENVIRONMENTAL PROTECTION DIVISION 1131 Harbor Bay Parkway, Alameda, CA 94502/ Phone: (510) 567-6700 Page 2 of 2
EQUALIZER LINE COVERS:
YES:_____ NO: _____
AUTO FILL:
YES _____ NO_____
Attach manufacturer specification sheets for approval
Covers manufactured after May 24 2021 must be rated under ANSI/APS-7/ICC-16 2017
Make: __________________________ Model: _____________________________
Size: ______________ Date Manufactured: _______________________
Split Eq Lines: At least three feet apart from inner edge of covers: YES ___ NO ___
Hydraulically Balanced & Symmetrically Plumbed: YES _____ NO _____
NUMBER OF SKIMMERS:_________ NUMBER OF EQUALIZER COVERS: _________
SUCTION PLUMBING SIZE:
SKIMMER: _________________ MAIN DRAIN: __________________ COMBINED (i.e. only one suction line): _________________
BOOSTER: _________________ SUMP DEPTH (PIPE TO COVER): Main __________ Booster __________ Equalizer ___________
RETURN PLUMBING SIZE: ______________
Install all equipment according to manufacturer’s specifications.
COMPANY OR INDIVIDUAL DOING THE WORK: (must have an active/valid California License)
Name:
Address:
Phone Number: Email:
Contractor’s License Number:
A fee will be charged for the plan review of this application. Contact (510) 567-6700 for more information.
Schematic diagram of proposed pool layout (show location of skimmers, drains, handrails, etc.):
Description of additional/other changes (i.e., plumbing, electrical, decking, fencing etc.):