HomeMy WebLinkAboutCeleery Stalk 500034 07 06 16.JH.PDFCommunity On-Site System
Mailing Addr.
Zip:
Name Change
Verification of Closure
Status Change
Water Community
Transient Non-Community
Non-Transient Non-Community
Non-Public Water Supply
\EHS 3960 (Revised 07/05)
Environmental Health Services Section (Review 07/08)
Report Received by:
WATER QUALITY: (.2535)
*1. Water clear enough to clearly see bottom of pool and pool drain ………..
*2. Disinfectant residual provided by:
free chlorine = (at least 1.0 ppm or 2.0 ppm where required);
bromine = (at least 2.0 ppm); or
biguanide = (30 to 50 ppm………………………………….
*3. Pool water pH = (7.2 to 7.8)…………...…………………………
*4. Water temperature of heated pool °F; does not exceed 90°F
(swimming pool) or 104°F (spa) ……………………………………………
5. Daily written records of water quality and test kit kept on site ...……………
POOL MAINTENANCE:
*6. Main drain covers secured and in good repair, no suction hazard. Single
drains protected by April 1, 2006 (.2537, .2539)……………………………
7. Pool walls and floor kept clean, free of debris and in good repair (.2537)…
8. Surface skimmers (with weirs, baskets and covers) or gutters clean, in good
repair, and functioning properly, no floating debris (.2518, .2537) …………..
9. Depth markings and no diving markers or signs visible and properly located
(.2523, .2537)……………………………………………………………………
10. Safety ropes with floats and contrasting color bands provided at shallow area
breakpoints (.2515, .2523)……………………………………………………...
11. Diving equipment, ladders, steps and handrails properly placed, in good repair
(.2517, .2521)………………………………………………………………….
12. Inlets and other fittings in place and in good repair (.2537)……………………
13. Contrasting band on steps and benches (.2521, .2516, .2532)………………….
14. Spa timer working properly (.2537)…………………………………………….
PREMISES:
*15. Body hook and ring buoy with throw rope or lifeguard with rescue tube
provided and properly located (.2530, .2537) ……………………………….
16. Fence or barrier with self-closing, self-latching gates properly constructed and
maintained (.2528, .2537) ……………………………………………………..
17. Decks unobstructed, properly drained, free of trip hazards (.2522, .2537………
18. Lifeguards present or warning signs posted (.2530) ……………………………
19. Signs prohibit glass containers or pets in pool area(.2530) …………………….
20. Caution signs posted at hot water spas (.2532) …………………………………
21. Pool and deck lighting provided at pools that operate at night (.2524, .2537) …
*22. Emergency telephone provided (.2530) ……………………………………….
EQUIPMENT ROOM:
23. Chlorine or bromine automatic feeders that meet NSF Standard 50 (.2535) …..
24. Approved pump, filter, and flow meter operating properly (2518, .2519) ……..
25. Equipment and chemicals kept in a dry, well-ventilated enclosure (.2533, .2534,
.2537) …………………………………………………………………………….
26. Valves and pipes identified by color codes or labels (.2518) ……………………
27. Filter backwash discharged through an air gap (.2513) ……………………….…
DRESSING AND SANITARY FACILITIES:
28. Bathhouse or rest rooms accessible; shower sign posted (.2526) ……………….
29. Required fixtures provided, clean, and in good repair (.2526) ………………….
30. Approved water source, no cross connections (.2512) ………………………….
31. Sewage disposed of in a properly operating sewage system (.2513) ………….…
32. Floors smooth, slip-resistant, kept clean(.2526) …………………………………
33. Hose bibbs and floor drains provided (.2526) …………………………………..
Purpose: General Statute 130A-282 requires the Commission for Health Services to adopt rules governing Public Swimming Pools. 15A NCAC 18A .2511 specifies the contents of an inspection form to record the results of
inspections. This form is developed to be used in making inspections of public swimming pools, spas, wading pools and water recreation attractions. Preparation: Local environmental health specialists shall complete the form
every time they conduct an inspection. Prepare an original and two copies for: 1. Original to be left with the responsible person. 2. Copy for the local health department. 3. Copy for the Environmental Health Services Section,
Division of Environmental Health. Disposition: This form may be destroyed in accordance with Standard-8.B.6., Inspection Records, of the Records Disposition Schedule published by the N.C. Division of Archives and
History. Additional forms may be ordered from: Division of Environmental Health, 1632 Mail Service Center, Raleigh, NC 27699-1630.
Inspection of Swimming Pool
Points
Deducted
(Check)
4
Pool Operator:
Health Department
Current Facility ID
Old Facility ID
Wastewater System:
Water sample taken today?
State: NC
Date of Insp/Chg:
Demerit Score:
Status Code:
City:City:State:
Location Address:
Zip:
Inspection
Conducted by:
N.C. Department of Environment and Natural ResourcesDivision of Environmental Health
Name of Establishment:
* Indicates critical item (6-point demerit)
66
64
64
4
44
4
4
2
2
6
4444446
4
222
222222
Comment Sheet Attached
1
2
3
4
1 4
1
2
V
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.
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** SEE COMMENT SHEET ATTACHED **
Comments:
.
6
Yes No
Yes No
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//
Inspection
Re-inspection
Visit
EHS I.D. #
18 Catawba
2018500034
8
0 7 0 6 2 0 1 6
A
SHOOK TARLTONCELERY STALK
333 10TH AV DR NE
HICKORY 28601
926 2ND ST NE
HICKORY NC 28601
3 0
7 6
8
1654 - Huffman, Jason
Total Time:
N.C. Department of Environment and Natural Resources
Division of Environmental Health
COMMENT ADDENDUM
Time In:
Time Out:
City:
Street:
ID:
Name:am
pm
am
pm
:
:
CELERY STALK
2018500034
333 10TH AV DR NE
HICKORY
1 0 3 1
1 0 3 2
1 minute
7
17
REPAIR POOL FLOOR: CHIPPING; REPAIR COPING ON POOL WALL
REPAIR CRACKS ON DECK
N.C. Department of Environment and Natural Resourses
Division of Environmental Health
COMMENT ADDENDUM City:
Street:
ID:
Name:CELERY STALK
2018500034
333 10TH AV DR NE
HICKORY
N.C. Department of Environment and Natural Resourses
Division of Environmental Health
COMMENT ADDENDUM City:
Street:
ID:
Name:
General Comments:
CELERY STALK
2018500034
333 10TH AV DR NE
HICKORY