HomeMy WebLinkAboutNewton Elks Wading Pool PERMIT 510000 05 25 17N.C. Deparmmt ofEwimommt and Nalurd Resources
D'nis w ofEvsi..soml Hnith
PUBLIC SWIMMING POOL
OPERATION PERMIT
Time In: 0 2: 0 0 0 om Tie Out: 3: 2 0 0"
Total Tine: 1 w 20 minutes
Permission is granted to:
M I C H E L L E G I B S 0 N
'Update Existing Facility?
NewF,egityID:.a 0 1 8 5 1. 0 0 0 0
Old Facility m:
*Date Issued 0 5 / 2 5 / 2 0 1 7
'Status Code: I
Owner or Operator of
N E W T O N E L 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 9 4 9 R I D G E D R
city N E W T O N ST N C zip 2 8 6 5 8
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: ss- Municipal/Community
Territory #: 01
Waste Water .System: 3-3-Municipal/Community
EHS: 2031 - Levin, Paige
Signed
A
Agent
N.0 Dep IofEv nmmt and Remoras
Ditism Evvimvm Health
-Expiration Date: 1 0
/ 3 1 / 2 0
1 7
Remarks
4000
G
N.C. Depanment oflinviromnem and Natural Resources
DivisionofEnvus n renin Health
PUBLIC SWIMMING POOL
OPERATION PERMIT
Permission is granted to MICHELLE GIBSON
Owner or Operator
2018510000
ideatifioconNumber
05/25/2017
Status Code: I
NEWTON ELKS
Name ofPubltc SvimmingPool
to operate a public swimming pool as defined in G.S. 130A-280 and 15A NCAC 18A .2500 at
949 RIDGE DR, NEWTON, INC 28658
StrwrAd*a of Pod Location
18
Comtry
Type of Pool: (check one) ❑ Swimming Pool
Wading pool
Spa
Specialized
Other (describe)
Signed: N.Cmoams _malnA a�
Agent
DviDratomta.
th
Expiration nate: 10/31/2017
Remarks:
INSrIWCTIONS
purpose, General Statute 130A-281 states'No public swimming pool maybe openedfer use unless the owner or operator has obtained
an operation permit issuedby the Department'. General Statute 130A-282 requires the Commission for Health Services to
adopt rules including requirements for application review, expiration, renewal, andrevocation or suspension of an operating
permit Those mics are cmtained in 15A NCAC l8A .2500.
This form is to be used as the permit specified above.
preparation: Local envirmmmtal health specialists shall issue apemit every time anew or reismed permit is indicated prepare an
original and me copy fm
1. Original given to pool owns or operator.
2. Copy for the local health department.
In the event the pamit/trmsltrmal permit is suspended or re eked, complete the Suspensmm/Revocation form (DEM
4009B).
Disposition: This from may be destroyed in accordance with standard 8.11.6., 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
(Carrier 52-01-00)
EHS 3962 (Revised 7/05)
Enviro.mmul Health Services Semon (Review 7/08)