HomeMy WebLinkAboutpool-scope-of-work-form-adaRonald Browder
Director
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POOL/SPA/WADING POOL FORM – SCOPE OF WORK
Facility Name: SR #: Date:
Facility Address: City: PR#:
Contact/Contractor:E-mail:Phone:
Work Descrip on:
Please complete the following informa on (All Fields Are Required. Enter N/A if not Applicable):
SIZE OF POOL, SPA, WADING POOL
GALLONAGE: (Surface Area) __________ x (Avg. Depth) __________ x 7.48 gal./cu.. = ________ gallons
TURNOVER RATE: POOL: (gallons) / 360 minutes =
SPA: (gallons) / 30 minutes =
WADING POOL: (gallons) / 60 minutes =
__________ gpm
__________ gpm
__________ gpm
EQUIPMENT PLEASE COMPLETE
FILTER:
•Rapid sand filters will be sized to the
flow rate (45GPM) at 45 TDH.
•All other filters will be sized to the flow
rate of 60 TDH.
•Provide pump curve for each pump.
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
Loca on/Method: _________________________________________
DE Separa on Tank: Make: _____________ Model: _____________
Select TDH Op ons:
End of the Curve
OR
RECIRCURLATIO
N PUMP:
Make: _______________ Model: _______________ h.p.: ________
# of Pumps: _______ GPM at the end of the curve: ______________
Measured TDH: __________ GPM at measured TDH: ____________
Measured TDH
(Complete TDH
Verifica on Form)
BOOSTER
PUMP:
Make: _______________ Model: _______________ h.p.: ________
# of Pumps: _______ GPM at the end of the curve: ______________
Measured TDH: __________ GPM at measured TDH: ____________
CHEMICAL FEEDER/DISINFECTANT: Make: ______________ Model: ______________ Type: _________
CHEMICAL CONTROLLER: Make: ______________ Model: _____________________________
FLOWMETER:Make: ______________ Model: _____________________________
GFCI:Exact Loca on: ___________________________________________
POOL/SPA/WADING POOL FORM – SCOPE OF WORK
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DRAIN COVERS:
Main (m): Booster (b):
Shared (Main and Booster):
A ach manufacturer specifica on sheets
for approval.
Covers manufactured a er 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)
Check which applies:
Safety Vacuum Release System: _________________________
Gravity Drainage System to a Surge Tank
Suc on Limi ng Vent System
Automa c Pump Shut Off System
Other Systems
EQUALIZER LINE COVERS:
Yes No
AUTO FILL:
Yes No
GUTTER/OVERFLOW SYSTEM:
Yes No
A ach manufacturer specifica on sheets
for approval.
Covers manufactured a er May 24, 2021
must be rated under ANSI/APS-7/ICC-16
2017.
Make: _____________________ Model: ___________________
Size: _____________________
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 ADJACENT TO DRAIN COVERS:
SKIMMER: _____________ MAIN DRAIN: _____________ COMBINED (i.e. only one suc on line): _____________
BOOSTER: _____________ SUMP DRAIN (PIPE TO COVER): Main ________ Booster ________ Equalizer ________
RETURNING PLUMBING SIZE: ____________________________________
Install all equipment according to manufacturer’s specification.
POOL/SPA/WADING POOL FORM – SCOPE OF WORK
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Schema c Diagram of proposed pool layout (show loca on of skimmers, drains, handrails, and etc.):
Descrip on of addi onal / other changes (i.e. plumbing, electrical, decking, fencing, and etc.):
COMPANY OR INDIVIDUAL DOING THE WORK: (Must have an ac ve / valid California License)
Name: _______________________________________________________________________________________
Address: _____________________________________________________________________________________
Phone Number: _________________________________ E-mail: _______________________________________
Contractor’s License Number: ____________________________________________________________________
A fee will be charged for plan review of this application. Contact (510) 567-6700 for more information.