HomeMy WebLinkAboutGlenwood Place Apts Permit 500084 06 01 17N.C. Deparmmt ofEwirovmmt and Natural Resources
D'nis w ofEvsirovmmml Hsalth
PUBLIC SWIMMING POOL
OPERATION PERMIT
Tim In: 0 8 5 7 Elpm Tine Out: 1 9 8 0 opm
Total Tine: I hr 3 minutes
*Update Existing Facility?
New Facilityll):.a 0 1 8 5 0 0.0.8 4
Old Faality M:
*Date Issued 0 6 / 0 1/.1 0 1 7
*Status Code: I
Permission is granted to:
W Y N N E F I E L D P R 0 E P R T I E S
Owner or Operator of
G L E N W 0 0 D P L A C E A P A R T M E N T 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 5.1 0 0 G L E N W 0 0 D P L C T
city H I C K O R Y ST N C zip 2 8 6 0 2
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
��2 ti him Agent
N.C. Dep t of Ymmmt dNatmal Remoras
DitismofEvvimvm tai Health
*Expiration Date: 1 0 / 3 1 / 2 0 1 7
Remarks
4000
r�
G
N.C. Department ofEnnorearem and Natural Resources
DivisionofEnvivanuoul Health
PUBLIC SWIMMING POOL
OPERATION PERMIT
Permission is granted to WYNNEFIELD PROEPRTIES
Owner or Operator
2018500084
Identifiative Number
06/01/2017
staeucode: I
GLENWOOD PLACE APARTMENTS
Name ofPnblic SeimmingPool
to operate a public swimming pool as defined in G.S. 130A-280 and 15A NCAC 18A .2500 at
5200 GLENWOOD PL CT, HICKORY, NC 28602
SreetAd*ess of Pod Location
18
Comtry
Type of Pool: (check one) ® Swimming Pool
Wading pool
Spa
Specialized
Other (describe)
Signed: 4 _ . q , . - - — Agent
N.C. Dep�at ent o6mnad
avrokmdNatmal Resources
Diyun. oflinv mmnenou Health
Expiration nate: 10/31/2017
Remarks:
INSTRUCTIONS
Purpose: General Statute 130A-281 states'No public swimming pool may be openedfer use unless the owner or operator has obtained
an operation permit issuedby the Deparmnart'. General Statute 130A-282 requires the Commission fix Health Services to
adopt rules including requirements for application review, expiration, renewal, andrrocation or suspension of an operating
permit. Those rules are contained in 15A NCAC l8A .2500.
This form is to beused as the permit specified above.
preparative: Local environmental health specialists shall issue apermit every time anew m 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 orrNdced, complete the Suspension/Revocative form (DEM
4009B).
Dispositive: This form may be destroyed in accordance with standard 83.6., Inspection Records, of the Records Disposition Schedule
published by the N.C. Division ofArchives and History.
Additional forms may be ordered from Divisive of Environmartal Health
1632 Mail Service Center
Raleigh, NC 27699-1632
(Carrier 52-01-00)
EHS 3962 (Revised 7/05)
Environmental Health Services Section (Review 7/08)