HomeMy WebLinkAboutRock Barn Outdoor Pool PERMIT 500015 05 25 17N.C. Deparmont ofEwimumont and Natural Resources
D'nisw ofEvsi.woso WHeelth
PUBLIC SWIMMING POOL
OPERATION PERMIT
Tim In: 1 0 3 2 Elpm Tine Out: 1 1 4 5 RPM
Total Tine: 1 hr 13 minutes
Permission is granted to
*Update Existing Facility?
New Facilityll):.2 0 1 8 5 0 0.0. 1 5
Old Facility M:
*Date Issued 0 5 / a 5 / a 0 1 7
*Status Code: I
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
O
U
T D
O
O R P 0 0 L
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
G. t Agent
N.C. Dep t of rovmontm Na al Resowoa
Division ofEnvitaiHM
*Expiration Date: 1 0 / 3 1 / 2 0 1 7
Remarks
4000
r�
G
N.C. Depa man oflinvironmem and Natural Resomr¢s
DivisionofEnvimemenbl Health
PUBLIC SWIMMING POOL
OPERATION PERMIT
Permission is granted to ROCK BARN PROPERTIES
Owner or Operator
2018500015
Identifiotim Number
05/25/2017
Strtm Code:
ROCK BARN OUTDOOR POOL
Name ofPublic SeimmingPool
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
StrwtAd*m of Pod Locution
18
Comtry
Type of Pool: (check one) Swimming Pool
Wading pool
Spa
Specialized
Other (describe)
Signed: /2. e 4 ,4 �_ - Agent
N.C�ent o vironmem ,r7cluS al Resiur¢s
Diyua. ofE.M of Health
Expiration nate: 10/31/2017
Remarks:
INSTRUMONS
Purpose: General Statute 130A-281 states'No public swimming pool may be opened£¢ 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, andrrocation or suspension cress operating
permit. Those rales are contained in 15A NCAC l8A .2500.
This form is to housed as the permit specified above.
preparative: Local environmental health specialists shall issue apemit every time anew car reissued permit is indicated prepare an
original and me copy for.
1. Original given to pool owns or operator.
2. Copy for the IoW health department.
In the event the permit/transitional permit is suspended or revoked, complete the Suspenssm/Revoation form (DEM
4009B).
Dispositive: 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 Divisive of Enviro .t.1 Health
1632 Mail Service Center
Raleigh, NC 27699-1632
(Courter 52-01-00)
EHS 3962 (Revised 7/05)
Enviroammul Health Serviar Section (Review 7/08)