Pool/spa Data Sheet - Sonoma County Department Of Health Services Page 2
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1
2Filter Pump(s): Number ___________ Make & Model ________________________________________________ H.P. ___________
_________GPM at _________feet of head.
Hair & lint catcher: [ ] Yes
[ ] No
Pipe Size: ________inches
or
Distance between drain covers:______inches
or
[
] Single Main Drain
[
] Split Main Drain(s)
[
] Unblockable Drain Type (Trough, Square, etc):_________________
Entrapment Drain Covers: Make & Model ___________________________________________ Floor [
] Wall [
] GPM Rating ______
Jet Pump(s):
Number ___________ Make & Model ________________________________________________ H.P. ___________
_________GPM at _________feet of head.
Hair & lint catcher: [ ] Yes
[ ] No
Pipe Size: _________inches
or
or
[
] Single Main Drain
[
] Split Main Drain(s)
Distance between drain covers:______inches
[
] Unblockable Drain Type (Trough, Square, etc):_________________
Entrapment Drain Covers: Make& Model ___________________________________________ Floor [
] Wall [
] GPM Rating ______
Flow Meter:
Make & Model ______________________________________________________________________________________________
DE Separation Tank [ ] Yes [ ] No Make & Model ________________________________________________________________________
Sump to backwash and drain to public sewer:[ ] Yes [ ] No
Backwash receptacle size _________________________
Chlorination or disinfectant feeders: Type ___________________________________________________________________________________
Make _______________________________ Model ______________________ Capacity _____________
Deck material: _______________________________________________ Deck drains: [ ] Yes [ ] No (If yes, indicate these drains on the plans.)
Restrooms/Showers: [ ] Yes [ ] No (If yes, submit plans.)
Drinking fountain:
[ ] Yes [ ] No
Safety Equipment
Yes
No
Yes
No
Life ring and rope
[ ]
[ ]
Illustrated respiration sign
[ ]
[ ]
12-ft. pole with body hook
[ ]
[ ]
Spa use warning sign
[ ]
[ ]
No Lifeguard sign
[ ]
[ ]
Emergency shut-off sign
[ ]
[ ]
Occupancy load sign
[ ]
[ ]
No Diving sign < 6 ft. deep
[ ]
[ ]
9-1-1 sign
[ ]
[ ]
FOR DEPARTMENT USE ONLY
Required turnover rate in GPM
Total Volume = ____________________ GPM
____________________
____________________
Turnover in minutes _________________
Pump capacity (GPM)
Filter capacity (GPM)
For Plan Check questions contact: Terry Macute REHS III 707-565-6544 or
Print Form
Clear Form
PoolSpaDataSheetrev100411.docx
Revised October 4, 2011
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