DHEC Form 3441 "Swimming Pool/SPA Facility Information Sheet" - South Carolina

What Is DHEC Form 3441?

This is a legal form that was released by the South Carolina Department of Health and Environmental Control - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2019;
  • The latest edition provided by the South Carolina Department of Health and Environmental Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DHEC Form 3441 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Health and Environmental Control.

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Download DHEC Form 3441 "Swimming Pool/SPA Facility Information Sheet" - South Carolina

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Swimming Pool/Spa Facility Information Sheet
Bureau of Water
PLEASE FILL OUT ALL THE INFORMATION REQUESTED BELOW AND RETURN TO SCDHEC POOL INSPECTOR
OR MAIL TO SCDHEC CENTRAL OFFICE AT THE FOLLOWING ADDRESS:
BUREAU OF WATER/ RECREATIONAL WATERS 2600 BULL STREET COLUMBIA SC 29201
Date: ____________ Name of Facility:_______________________________
Permits #(S): ______________
______________
______________
Number of Indoor Pools/Spas: ___________
Number of Outdoor Pools/Spas: _______
Physical Address of Facility: ____________________________________________________________________
City:_______________________ State:____________
Zip: _____________
Phone #:_________________
Contact Information
(please print clearly)
Facility Owner's Name: ________________________________________________________________________
Address:____________________________________________________________________________________
City:________________________ State:____________
Zip:______________
Phone #:_________________
Owner's E-mail Address: _______________________________________________________________________
Management Company(if applicable): ____________________________________________________________
Address: ____________________________________________________________________________________
City:________________________ State:____________ Zip:______________ Phone #:_________________
Management E-mail Address: ___________________________________________________________________
Pool Operator of Record: _____________________________________________ Cert #:___________________
Address:____________________________________________________________________________________
City:________________________ State:____________ Zip:______________ Phone #:_________________
Pool Operator E-mail Address: __________________________________________________________________
Best Mailing Address for Invoice: ________________________________________________________________
City:________________________ State:____________ Zip:______________
Inspection Information
(please print clearly)
Designated Person to sign Inspection Forms on Site: _________________________________________________
Location where inspection form is to be left if no one is on site to sign: _________________________________
__________________________________________________________________________________________
Pool Log is Kept (Accessible Location During Inspection): _____________________________________________
Pool Equipment Room Access Code (if applicable): __________________________________________________
Form Filled Out By (print name): _____________________________ Title:_____________________________
Signature: _______________________________________________
DHEC 3441 (9/2019)
Swimming Pool/Spa Facility Information Sheet
Bureau of Water
PLEASE FILL OUT ALL THE INFORMATION REQUESTED BELOW AND RETURN TO SCDHEC POOL INSPECTOR
OR MAIL TO SCDHEC CENTRAL OFFICE AT THE FOLLOWING ADDRESS:
BUREAU OF WATER/ RECREATIONAL WATERS 2600 BULL STREET COLUMBIA SC 29201
Date: ____________ Name of Facility:_______________________________
Permits #(S): ______________
______________
______________
Number of Indoor Pools/Spas: ___________
Number of Outdoor Pools/Spas: _______
Physical Address of Facility: ____________________________________________________________________
City:_______________________ State:____________
Zip: _____________
Phone #:_________________
Contact Information
(please print clearly)
Facility Owner's Name: ________________________________________________________________________
Address:____________________________________________________________________________________
City:________________________ State:____________
Zip:______________
Phone #:_________________
Owner's E-mail Address: _______________________________________________________________________
Management Company(if applicable): ____________________________________________________________
Address: ____________________________________________________________________________________
City:________________________ State:____________ Zip:______________ Phone #:_________________
Management E-mail Address: ___________________________________________________________________
Pool Operator of Record: _____________________________________________ Cert #:___________________
Address:____________________________________________________________________________________
City:________________________ State:____________ Zip:______________ Phone #:_________________
Pool Operator E-mail Address: __________________________________________________________________
Best Mailing Address for Invoice: ________________________________________________________________
City:________________________ State:____________ Zip:______________
Inspection Information
(please print clearly)
Designated Person to sign Inspection Forms on Site: _________________________________________________
Location where inspection form is to be left if no one is on site to sign: _________________________________
__________________________________________________________________________________________
Pool Log is Kept (Accessible Location During Inspection): _____________________________________________
Pool Equipment Room Access Code (if applicable): __________________________________________________
Form Filled Out By (print name): _____________________________ Title:_____________________________
Signature: _______________________________________________
DHEC 3441 (9/2019)
Instructions for completing DHEC Form 3441 Swimming Pool/Spa Facility Information Sheet
PURPOSE: For collection of address and inspection related information.
INSTRUCTIONS FOR COMPLETION:
1. Facility will fill in the date, name of facility and the permit number(s) of the pool or spa.
2. Facility will fill in the number of indoor pools/spas, and the number of outdoor pools/spas.
3. Facility is to make a mark in the blank if there is no change in information from the previous year.
4. Facility is to fill in the physical address of the pool/spa along with the phone number.
5. Facility is to fill in the owner’s name, address, phone number, and e-mail address.
6. Facility is to fill in the management company’s (if applicable) name, address, phone number, and e-
mail address.
7. Facility is to fill in the Certified Pool Operator‘s name, certification number, address, phone number,
and e-mail address.
8. Facility is to fill in the best mailing address for invoices to be sent to.
9.
Facility will fill in the name of the person designated to sign the inspection form on site.
10.
Facility will fill in the location where the inspection form is to be left on site (if no one is on site
to sign).
11.
Facility will fill in the location where the pool log is kept.
12.
Facility will fill in the access code for the pool or equipment room (if applicable).
13.
Designated individual who filled out form will print their name and their job title.
14.
Designated individual who filled out form will sign their name.
OFFICE MECHANICS AND FILING:
This form will be kept in the Central Office and District main swimming pool files. Form retention
schedule is in accordance with Recreational Waters Retention Schedule Number HEC-SRW-RW-1R
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