Loading...
HomeMy WebLinkAboutLake Hickory CC Splash Pad PERMIT 510012 05 16 17.LS.PDFN.C. Dep arunmt of E w ironmmt and Natural Resources Oh -Won offmirownental Health PUBLIC SWIMMING POOL OPERATION PERMIT Time In: 0 2' 4 0 0F!j am Time Out: 3 1 5 ©" pm Total Time: 35 minutes Permission is granted to: *Update Existing Facility? New Facility M. a 0 1 8 5 1 0 0 1 2 01dFacility ID: *Date Issued 0 5/ 1 6/ d 0 1 7 Status Code: i L A K E H I C K O R Y C 0 U N T R Y C L U B O iv ner or Operator of L A K E H I C K O R Y C C S P L A S H P A D Name of Public Swimming Poo! I j to operate a public swinim ing pool as defined in G.S. 130A-280 and 15A NCAC 18A .2500 at Address 4 3 0 1 T H A V E N W City H I C K O R Y S T N C zip x 8 6 0 1 County 1 8 Type of Pool- (check ane) ❑Swimming Pool -Seasonal ❑Swimming Pool- Year Round ❑o Wading Pool - seasonal ❑Wading Pool -Year Round ❑Spa - Seasonal ❑Spa -Year Round F1 Specialized - Seasonal ❑Specialized - Year Round 5-5 - MunicipaVcammunity Water Supply: Waste Water System: Territory #: 01 ENS: 1856 - Sears, Luke Signed Expiration Dare: 1 0 Remarks V.C. Department Divisim of En%ii 1 1 6/ 0 0 1 7 1 Health 3-3 - Municipal/Community Agent Crrracars l RP"jXing 4000 hi.C. Department ofEn-L ironrr:ent and Natural Resources Division of E nvi roirnental Health I it" 0 0 IMMIN 1kVj 101 WIN Zell] I OPERATION PERMIT Permission is granted to LAKE HICKORY COUNTRY CLUB Owner or Operator 2018510012 Identification dumber 05/16/2017 Date Issued Status Code: of LAKE HICKORY CC SPLASH PAD Xame of Public .5wimmingPool to operate a pi lbIje swimmino- pool as defined in G.S. 13 OA -290 and 15A NCAC 18A .2500 at 430 17TH AVE NVV, HICKORY, NC 28601 StrmrAd&-ess ofPool Locsuion 18 cQtity Type of Pool: (check one) ❑ Swimming Pool 0 Wading pool Spa Specialized Other (describe) Expiration Date: Remarks 10/16/2017 Signed: Agent N.C. Department of Girorxnent and _ a Resources Dnision cfEmi ental Health tk ': tl + ►b f Purpose: General Statute 13OA-281 states "No public swimming pool may be opened for use unless the owner or operator has obtained an operation permi t issued by the Depa tmene . General Statute 130A-282 requires the Compri scion far Health Services to adopt ntles including requirements for application review, expiration, renewal, an d revocati on or suspension of an operating pexmit_ Those rules are contained in 15A NCAC 18A _2500_ This farm is to be used as the permit spmified above. Preparation: Local environmental heath specialists shall issue a permit every time a new or rei smed permit is indicated. Prepare an original and one copy for. 1. original given to pool owner or operator. 2_ Copy for the local health department_ In the event the perntit(transhional pemut is suspended or revoked, complete the Suspension'Revocation form (DE "NR 4009B). Disposition: This farm may be destroyed in accordance with Standard S.D.6., Inspection Records, of the Records Disposition Sa§edule published by the N.C. Division of Archives and History. Additional forms may be orderedfrom: Division of Environmental Health 1632 Mail Service Center Ral ei gh. NC 27699-1632 (Courier 52-01-00) EHS 3962 (Revised 7/DS) Environmental Health Services Section (Review 7168)