HomeMy WebLinkAboutRock Barn Wading Pool 510009 PERMIT 05 25 17N.C. Deparmmt ofEwimsewat and Natural Resources
D'nisw ofEmi.awso WHeelth
PUBLIC SWIMMING POOL
OPERATION PERMIT
Tim In: 1 0 3 3 Elpm Tine Out: 1 1 5 0 opm
Total Tine: 1 hr 17 minutes
*Update Existing Facility?
New Facilityll):.2 0 1 8 5 1. 0 0 0 9
Old Facility 1D:
*Date Issued 0 5 / a 5 / a 0 1 7
*Status Code: I
Permission is granted to:
R 0 C K B A R N
P
R
O P E
R T I E S
Owner or Operator of
R 0 C K B A R N
C
L
U B
O F G 0 L F
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 3 8 0 5 G 0
L
F
D R
N E
city C 0 N 0 V E R
ST N C zip 2 8 6 1 3
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 #: 01
Waste Water .System: 3-3-Municipal/Community
EHS: 2031 - Levin, Paige Signed
Agent
\.�Evvirovmmimd Katmai Resowas
Divism of ental Health
*Expiration Date: 1 0 / 3 1 / 2 0 1 7
Remarks
4000
r�
G
N.C. Department ofEnnronmem and'Natural Resources 2018510009
DivisionofEnvimnmental Health 1dentifiocon Ntunber
05/25/2017
PUBLIC SWIMMING POOL Datefssmd
OPERATION PERMIT Statns Code:
Permission is granted to ROCK BARN PROPERTIES of ROCK BARN CLUB OF GOLF
Owner or Operator Name ofPnblic SvimmingPool
to operate a public swimming pool as defined in G.S. 130A-280 and 15A NCAC 18A .2500 at
3805 GOLF DR NE, CONOVER, NC 28613
SrrwtAd*es of Pod Location
18
Comtry
Type of Pool: (check one) ❑ Swimming Pool
• Wading pool
Spa
Specialized
Other (describe)
Signed:/l %� ado, _ _ Agent
NAV. DepofEamronmentand Natural Remurcs
Dlvisimof .0 ental Health
Expiration nate: 10/31/2017
Remarks:
INSTRUCTIONS
Purpose: General Statute 130A-281 states'No public swimming pool maybe opm<dfor use unless the owner or operator has obtained
an operation permit issuedby the Depmmnmt'. General Statute 130A-282 requires the Commissiw for Health Services to
adopt rules induding requiremmu fa :pplica6w review, expiration, imewal, mdrevocatim a smpmsim of m operating
permit Those mics are cmtained in 15A NCAC l8A .2500.
This form is to be used as the permit specified above.
preparation: Local mvirmmmtal health specialists shall issue apermit every time anew or reissued permit is indicated prepare an
original and me copy fm
1. Original given to pool owns or operator.
2. Copy for the IoW health department.
In the event the pamit/transltrmal permit is suspended orreoked, complete the Suspenssm/Revocation form (DEM
4009B).
Disposition: Thisfmn may be destroyed is acmr&oce with standard 83.6., Inspection Records, of the Records Disposition Schedule
published by the N.C. Division of Archives and History.
Additional forms may be ordered from Division ofEnvironmantal Health
1632 Mail Service Center
Raleigh, NC 27699-1632
(Carrier 52-01-00)
EHS 3962 (Revised 7/05)
Environmental Health Servias Section (Review 7/08)