HomeMy WebLinkAbout29 North Apartments Pool PERMIT 05 19 17N.C. Dep arunmt of E w ironmmt and Natural Resources
I1h-Won offmirowumtal Health
PUBLIC SWIMMING POOL
OPERATION PERMIT
Time In: 1 0' 0 0 0 am Time Out: 1 0 3 0 Qpm
Total Time: 30 minutes
Permission is granted to:
*Update Existing Facility?
New Facility M. a 0 1 8 5 0 0 1 0 1
01dFacility ID:
*Date Issued 0 5/ 1 9/ d 0 1 7
Status Code: i
a 9 N 0 R T H A P A R T M E N T
O iv ner or Operator of
a 9 N 0 R T H A P A R T M E N T S
Name of Public Swimming Poo!
to operate a public swimming pool as defined in G.S. 130A-280 and 15A NCAC 18A .2500 at
Address 1 1 4 a 9 T H A V E N U E D R I 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
❑Wading Pool - seasonal ❑Wading Pool -Year Round
❑Spa - Seasonal ❑Spa -Year Round
F1 Specialized - Seasonal ❑Specialized - Year Round
Water SuPP Yl, 5-MunicipaKcmmunity
Territory #: 01
ENS: 1856 - Sears, Luke Signed
Expiration Dare: 1 0 l 3 1/ a 0
Remarks
FOR OPENING PURPOSES ONLY
3-3 - Nunicipal/Community
Waste Water System:
Agent
CAP/lC*,1 M*
3975
hi.C. Department ofEn-L ironrr:ent and Natural Resources
Division of E nvi roirnental Health
I it" Is) 0 IMWIN lkVj 10 I let" 29111 Il
OPERATION PERMIT
Permission is granted to 29 NORTH APARTMENT
Owner or Operator
2018500101
ldenti fiat on Nunt er
05/19/2017
Date Issued
Status Code: I
of 29 NORTH APARTMENTS
Xame afPublic Swimming Pool
to operate a pi lb Ile swimmino- pool as defined in G.S. 13 OA -290 and 15A NCAC IRA .2500 at
114 29TH AVENUE DRIVE NW, HICKORY, NC 28601
StrmrAd&-ess ofPoo2 Location
18
cowity
Type of Pool: (check one) !❑ Swimming Pool
Wading pool
Spa
Specialized
Other (describe)
Expiration Date:
10/31/2017
Signed:
N.C. Department
Di-Ysion of Emit
Remarks: FOR OPENING PURPOSES ONLY
t�7+►b
Resources
Agent
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 aWye.
Preparation: Local environmental health 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)