HomeMy WebLinkAboutSpa Athletic Club Women's Spa PERMIT 550005 10 04 17 N.C.Department of Environment and Natural Resources *Update Existing Facility?
Division of Environmental Health
PUBLIC SWIMMING POOL New Facility ID: a 0 1 8 5 5 0 0 0 5
OPERATION PERMIT
Old Facility ID:
Time In: 1 0 : 0 4 X am Time Out: 1 1 : 0 0 X!5m *Date Issued 1 0 0 4 a 0 1 7
❑pm ❑pm
Total Time: 56 minutes *Status Code:
Permission is granted to:
SPA ATHLETIC CLUB
Owner or Operator of
SPA ATHLETIC CLUB
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 a 0 a N D A V N W
city HICKORY STNC zipa8601
County 1 8
Type of Pool: (check one) ❑Swimming Pool - Seasonal ❑ Swimming Pool- Year Round
❑Wading Pool - Seasonal ❑Wading Pool - Year Round
❑Spa - Seasonal X Spa - Year Round
❑Specialized - Seasonal ❑ Specialized - Year Round
Water Supply:
5-5-Municipal/Community Waste Water System: 3-3-Municipal/Community
Territory #: 01
EHS: 1655-Kain,Greg Signed ell,
Agent
N.Cronment
and Natural Resources
Division of Environmental Health
*Expiration Date: 1 0 / 0 4 / a 0 1 8
Remarks
Characters +.r:
Remaining j
4000
N.C.Department of Environment and Natural Resources 2018550005
Division of Environmental Health Identification Number
PUBLIC SWIMMING POOL 10/04/2017
Date Issued
OPERATION PERMIT status Code: I
Permission is granted to SPA ATHLETIC CLUB of SPA ATHLETIC CLUB
Owner or Operator Name of Public Swimming Pool
to operate a public swimming pool as defined in G.S. 130A-280 and 15A NCAC 18A .2500 at
920 2ND AV NW, HICKORY, NC 28601
Street Address of Pool Location
18
County
Type of Pool: (check one) ❑ Swimming Pool
❑ Wading pool
❑X Spa
❑ Specialized
❑ Other (describe)
Signed: /V� t/ 1 Agent
N.C. eparttnent o Environment and Natural Resources
Division of Environmental Health
Expiration bate: 10/04/2018
Remarks:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
INSTRUCTIONS
Purpose: General Statute 130A-281 states"No public swimming pool may be opened for use unless the owner or operator has obtained
an operation permit issued by the Department".General Statute 130A-282 requires the Conunission for Health Services to
adopt rules including requirements for application review,expiration,renewal,and revocation or suspension of an operating
permit.'Those rules are contained in 15A NCAC 18A.2500.
This form is to be used as the permit specified above.
Preparation: Local environmental health specialists shall issue a permit every time a new,or reissued permit is indicated.Prepare an
original and one copy for:
1.Original given to pool owner or operator.
2.Copy for the local health department.
In the event the permit/transitional permit is suspended or revoked,complete the Suspension/Revocation form(DENR
400913).
Disposition: This form may be destroyed in accordance with Standard 8.13.6.,Inspection Records,of the Records Disposition Schedule
published by the N.C.Division of Archives and History.
Additional forms may be ordered from: Division of Environmental Health
1632 Mail Service Center
Raleigh,NC 27699-1632
(Courier 52-01-00)
EHS 3962(Revised 7/05)
Environmental Health Services Section(Review 7/08)