HomeMy WebLinkAboutGlen Oaks Golf Club Pool PERMIT 500003 05 19 17N.C. Deparmmt ofEwironmmt and Natural Resources
Mid.. ofEnsi.weseml Hnith
PUBLIC SWIMMING POOL
OPERATION PERMIT
Time In: 0 9 ] 6 o;m Tine Out: 1 0 3 0 OPm
Total Tine: I hr minutes
Permission is granted to
*Update Existing Facility?
NmFaaityro:.2 0 1 8 5 0 0.0.0 3
Old Facility M:
*Date Issued 0 5 / 1 9/.1 0 1 7
*Status Code: I
G L E N O A K S G 0 L F C L U B I N C
Owner or Operator of
G L E N O A K S
Name of Public Swimming Pool
to operate a public swimming pool as defined in G.S. 130A-280 and 15A NCAC 18A.2500 at
Address a 4 5 G 0 L F C 0 U R S E R D
city M A I D E N ST N C zip 2 8 6 5 0
County 1 8
Type ofPool: (check one)BSwimmingPool -Seasonal BSwimmingPool-Year Round
Wading Pool - Seasonal Wading Pool - Year Round
HSpa - Seasonal 2 Spa - Year Round
Specialized -Seasonal Specialized - Year Round
Water Supply: 5s- Municipal/Community
Territory #: of
Waste Water System: 4-4- Onsite Syetem
EH$: 2031 - Levin, Paige Signed
Agent
N.C. arYo Natural Resow¢s
Division ofEnvumwnmalHealth
*Expiration Date: 1 0 / 3 1 / 2 0 1 7
Remarks
4000
r�
G
N.C. Depammmt oflin irommm and Natural Resources
DivisionofEnvus n sent Health
PUBLIC SWIMMING POOL
OPERATION PERMIT
Permission is granted to GLEN OAKS GOLF CLUB INC
Owner or Opacmx
2018500003
beatification Number
05/19/2017
Stens Coda: I
GLEN OAKS
Nmne ofPublic SvimmingPool
to operate a public swimming pool as defined in G.S. 130A-280 and 15A NCAC 18A .2500 at
245 GOLF COURSE RD, MAIDEN, NC 28650
SrwrAdas of Pod Location
18
comtry
Type of Pool: (check one) Swimming Pool
Wading pool
Spa
Specialized
Other (describe)
Expiration nate: 10/31/2017
Remarks:
Signed: y24 '�e- - - Agent
N.C.artmenviroam�dNaturd Remmos
Dlvisim oflimimmnmral Health
INSTRUCTIONS
Purpose, General Statute 130A-281 states'No public swimming pool maybe opmedfor use unless the owner or operator has obtained
an operation permit issued by the Department'. General Statute 130A-282 mquirm the Commission for Health Services to
adopt rules including requirements fa application review, expiration, renewal, andrevocation or suspension of an operating
permit. Those rales are contained in 15A NCAC IaA .2500.
This form is to be used as the permit specified above.
preparation: Local mviroammtal health specialists shall issue apermit every time anew or reissued permit is indicated Prepare an
original and me copy for.
1. Original given to pool owns or operator.
2. Copy for the local health department.
In the event the permit/transitional permit is suspended or re eked, complete the Suspenssm/Revoation form (DEM
4009B).
Disposition: This from may be destroyed in accordance with Standard 83.6., Inspection Records, of the Records Disposition Schedule
published by the N.C. Division ofArchives and History.
Additional forms may be ordered from Division ofEnvir .t.1 Health
1632 Mail Service Center
Raleigh, NC 27699-1632
(Courier 52-01-00)
EHS 3962 (Revised 7/05)
Envirmmeoul Health Services Semon (Review 7/08)