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Fill and Sign the Gutter Invoice Form

Fill and Sign the Gutter Invoice Form

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STATE OF MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY RESOURCE MANAGEMENT DIVISION Public Swimming Pools Equipment Change Form Date: SP Number: Pool Location Name: Address: City, State, Zip: Contact Person: Phone: (XX-XXXX-XX, found on the pool license, license application, or an inspection report) Fax: Pool Location: Indoor Volume (gal): Flow Rate (gpm): Filtration Pump Make and Model Number: Pump Motor Horsepower: Suction Pipe Size(in): E-mail: Outdoor Combination Optional: Perimeter (sq ft): Flow Rate Capacity (gpm): Discharge Pipe Size (in): Filter Make and Model Number: Filter Type: High Rate Sand Cartridge Pressure DE Other: @ Head (ft): Area (sq ft): Existing Variable Speed Drive: Y N Existing Number of Filters: Chemical Feeder Make and Model Number: Disinfectant: Bromine Chlorine Trichlor Feeder Capacity (lb Cl or Br / day): Please include an installation diagram. DEQ Approval: Approved New Filter Area (sq ft): Existing New For salt chlorinators, please use the separate form: Salt Chlorinator Installation Form Existing Chemical Controller Make and Model Number: Acid Feeder Make and Model Number: Flow Meter Make and Model Number: Pipe Size (in): Comments: New Feeder Capacity (gal / day): Existing New New Range of Readings (gpm): Denied by Date This form is used to document proposed changes to swimming pool equipment. This information will assist in determining if the equipment will meet the requirements of the Public Swimming Pool Rules. Please provide the requested information for the pump, filter, chemical feeder, chemical controller, and flow meter whether or not this equipment will be changed. Please mark “existing” or “new” for each piece of equipment. No change to any pool equipment is allowed until approval from DEQ is obtained. A construction permit may be required to obtain approval. Please fax or e-mail this completed form to: FAX: 517-241-1328 E-mail: sissonp@michigan.gov (e-mail in pdf format is preferred) Website: www.michigan.gov/deqwater Click on Campgrounds & Pools on the upper left. RMD Swimming Pool Program Rev. 11/10/2011 CONSTITUTION HALL  525 WEST ALLEGAN STREET  P.O. BOX 30241  LANSING, MICHIGAN 48909-7741

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