HomeMy WebLinkAboutSpa Athletic Club 530059 PERMIT 10 04 17N.C. Deparanmt ot[ mtronmmr and Mount Remma
nM1iMn ofEur'aanmmW n W W
PUBLIC SWIMMING POOL
OPERATION PERMIT
'Update Existing Facility?
Nea,Facniym: 1 0 1 8 5 3 0 0 5 9
01dFaaliynY.
Time In: 1 1 : 0 0 ®ppm Time ac 1 J: 1 a ®pm Vatelssured 1 0/ 0 4/ 2 0 1 7
Total Time: 1 hr 12 minulas 'StaNs Code: I
Permission is granted to
S P A A T H L E T
I C
C L
U B
owner or Operwoid
BSwimming Pont -Seasonal
BSwimming Pool -Year Round
'
S P A A T H L E T
I C
C L
U B
Name ofPubl/ Swimming Pool
BSpa - Seasonal
BSpa-Year Round
to operate a public swimming pool
as defined
in G.S.
130A-280 and 15A NCAC 18A.2500 at
Address 9 1 0 1 N D
A V
N
W
city H I C K O R Y
ST N C zip 1 8 6 0 1
County 1 8
Type of Pool: (check ogre)
BSwimming Pont -Seasonal
BSwimming Pool -Year Round
Wading Pool -Seasonal
Wading Pool -Year Round
BSpa - Seasonal
BSpa-Year Round
Specialized - Seasonal
Specialized - Year Round
Water Su pply. ss-mamdrav o marry
Waste Water System:-maaidpauco nky
Territory #: 01
EHS: 1055-Kaln,orag
Signed
OZ
Agent
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Diwvm otEmmmwW He
DunnevEnnummv
•Expli effort Date: 1 0
/ 0 4 / 1 0 1 8
Remarks
4000
N.C. Deptem.et aEvwmmmtae6Nawa Bema¢e
2018530059
Ditivm ofEnviea®mCINdW
Nmtifiatim Number
PUBLIC SWIMMING POOL
10/04/2017
DHCIavN
OPERATION PERMIT
stmmcoda I
Pemlission is granted to SPA ATHLETIC CLUB of SPA ATHLETIC CLUB
sT or -operator NameofPuNw SlvimmingPool
to operate a public swimming pool as defined in G.S. I3GA-280 and 15A NCAC 18A.2500 at
920 2ND AV NW, HICKORY, NC 28601
StreerAdbesuofleocl Loconon
18
Covey
Type of Pool: (check one) ® Swimming Pool
Wading pool
Spa
Specialized
Other (describe)
Signed: Agent
N.C. oeen
mmdNdaal Rammw
Division ofEvvimvmevul H
Expiration Date: 10/04/2018
Remarks:
-----------------------------------------------------------------------------
INWFUCnors
purpose: Genual Stmute 130A-281 states- No public swimming pool may be opined fa use unless the owm or opeator has opined
an operant as permit issued by the Depmmmt'. Gmasd statute 130A-282 requires the Cm®issim fee Health services to
adopt tales indudng mcuk®rots for applicadon review. expiration, seemed, and remudon or ampmsim of on opvating
permit thou rules n contained is 15A NCAC 18A 5500.
This form is to beuseL as the fastest specified above.
Prelrsim: Lord mvirmmmtd hed0 specialists shall issue a permit every time a new or vaimed pewit is indmtnd 14gyrmem
aigwalmdmecopyfor.
1. Original given to pod o"eror operator
2. Cate for the local hdM department
In the event thepasmiMrmsitimd pewit is mspmded orrevoked, complete the SaspmsimrRevomim ram (DEM
4009B).
Disposition: This fate may be destroyed to atamdte«with Standard 82 C.1nspectim Records. ofthe RsoM Disjoanvon Sdtedule
Imp ished by the N C. Division a Archives and Fi stay.
Adidmal Across ones beadredfi®: Mvislm dpnv%mmmpl Health
1632 Mil Service Cmtm
Mask NC 27699-1632
EH 3962( sod 7N5)
Environments! HOHh Services Semm(Rmiew 7N8)