Aquatic Facility Worksheet Δ Fee:(Required) New Pool or Other Aquatic Facility: $380 New Spa: $250 Remodel: $125 Establishment Name:(Required)Establishment Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number:(Required)Fax Number:Contact Name:(Required) First Last Email:(Required) Owner Name:(Required) First Last Owner Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Owner Phone:(Required)Owner Email:(Required) Enter Email Confirm Email The following MUST accompany this application:(Incomplete plans will not be accepted.)One complete set of hard copy plans showing the layout, equipment room, bath house, and showing the side view of the aquatic facility.(Required)Max. file size: 50 MB. Specification (cut) sheets on the following equipment: Pump, filter, heater, disinfecting device, chemical feeders, flow meter, skimmers, water features, slides, and other important equipment. All equipment shall be NSF approved. Drop files here or Select files Max. file size: 50 MB. Certified Pool Operator Certificate for this aquatic facility.Max. file size: 50 MB. Is this Aquatic Facility: (check all applicable boxes)(Required) General Use – open to any person who wishes to use it. Limited Use – use limited to residents, members etc. Annual Temporary Indoor Outdoor Night Swimming?(Required) Yes No Water Source:(Required)Wastewater Disposal:(Required)Backflow Prevention Method:(Required)Surface Area (sq.ft.):(Required)Volume (gallons):(Required)Length (feet):(Required)Width:(Required)Depth - Shallow End:(Required)Depth - Deep End:(Required)Filtration Rate (gpm):(Required)Turnover Rate (min. / hr.):(Required)Aquatic Facility Structure: Poured Concrete Gunite Fiberglass Other Other:Deck Finish Type:(Required)Slope to Drain ( ¼ inch per min.):Deck Width (4’ min. for limited use, 8' min. for limited use):(Required)Depth markers locations at:(Required)Gutter/SkimmerGutters:(Required) Yes No Details required on plans.Skimmer Make:(Required)Skimmer Model No.:(Required)NSF Approved?(Required) Yes No Number of Units:(Required)Throat Diameter:Filter InformationMake:(Required)Model No.(Required)Model No.(Required)NSF Approved?(Required) Yes No Number of filters:(Required)Type of filter:(Required)Area of filter (sq. ft.):(Required)Total filter area (sq. ft.):(Required)Circulation Rate (gpm):(Required)Backwash Rate (gpm):(Required)Turnover Rate:(Required)Pump InformationHorsepower:(Required)Strainer Size:(Required)Circulating Rate (gpm):(Required)Circulating Rate (tdh):(Required)Disinfecting DeviceMake:(Required)Model No.:(Required)NSF Approved?(Required) Yes No Chlorine:Type of Cl2:Bromine:Other:Chemical FeedersMake:(Required)Model No.:(Required)NSF Approved?(Required) Yes No Other EquipmentFlow Meter Make:Model No.:NSF Approved?(Required) Yes No Main Drains Quantity:Anti Vortex?(Required) Yes No Openings (5/8 inch max):Inlets Quantity:Indicate locations on plans.Deck Lights Quantity:Watts:Underwater Lights Quantity:Watts:Diving Board Quantity:Length:Ladder Quantity:Tread Width:Lifeguard Chair Quantity:Height:Portable?(Required) Yes No Ring Buoy Quantity:Diameter:Rope Length:Shepherds Crook Quantity:Length:Test Kit Make:Model:Spa Controls/Timer Time Period:Distance from spa’s edge:Drinking Fountains Quantity:Indicate locations on plans.Equipment RoomFloor Finish:(Required)Slope to drain (¼ in. per ft. min.):(Required)Bath HouseWill there be a bath house?(Required) Yes No Tempered water temp (°F):(Required)EnclosureFence Height:Self-latching gate?(Required) Yes No Latch Height: Yes No Gas Chlorine Storage RoomWill gas chlorine be used?(Required) Yes No Separate storage room?(Required) Yes No Window in door?(Required) Yes No Is the room vented?(Required) Yes No Scale Supplied(Required) Yes No Mask Provided(Required) Yes No Pool Slides/Flumes/Water FeaturesIndicate if planning to be installed:(Required) Yes No Will it be lubricated with flowing water? Yes No SignsPlease indicate exact wording. (Most commercial signs do not meet local requirements.)(Required)