HomeMy WebLinkAboutHampton Inn Pool 530078 Permit 12 18 17.SC.PDFN.C. Department ofEmironment and \atural Resources
Division of Environmental Health
PUBLIC SWIMMING POOL
OPERATION PERMIT
Time In: 1 1; 5 3 0 pm Time Out: 1 3 t- R pm
Total Time 37 minutes
Permission is granted to:
H A M P T O N I N N
*Update Existing Facility?
New Facility ID: a 0 1 8 5 3 0 0 7 8
Old Facility ID:
*Dare Issued 1 a/ 1 8 f a 0 1 7
*Status Code:
Owner or Operator of
H A M P T O N I N N P O O 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 1 9 5 6 1 3 T H A V D R S E
City H I C K O R Y ST N C zip a 8 6 0 0
County 1 8
Type of Pool: (check orae) F-1 Swimming Pool -Seasonal ❑o Swimming Pool -Year Round
❑ Wading Pool - Seasonal ❑ Wading Pool - Year Round
F-1 Spa - Seasonal F-1 Spa - Year Round
❑Specialized - Seasonal F1 Specialized - Year Round
Water Su pply: 6-6 - On -Site Supply
Territory #: 01
EHS: 1654 - Huffman, Jason
*Expiration Dare: 1 a / 1 8
Remarks
Signed
I 0 W
Waste Water System.
3-3 - Muricipal(Commurity
Agent
caaacxrs 7
4000
V_C_ Depaftment afEmifonment and Natural ResaLrces
Division ofEnv ronmmial Health
PUBLIC SWIMMING POOL
OPERATION PERMIT
Permission is granted to HAMPTON INN
L olvner or Operator
2018530378
Identification -Nunter
12/18/2017
Date Lsued
status c ode: I
of HAMPTON INN POOL
Name ofFuhlie S'67im ming Pool
to cq:erate a public swimming pool as defined in G.S. 130A-280 and 15A NCAC 18A .2500 at
1956 13TH AV DR SE, HICKORY: NC 28602
Streat_4dd-a.s of'Paol Locution
18
County
Type of Pool: (deck one) 0 Swimming Pool
❑ Wading pool
❑ Spa
❑ Specialized
❑ Od= (describe)
Expiration Datc;
Re marlin:
12118/2018
S igned: 9 Agent
N.C. Departmen a d a 9auracs
l7i, Y sign a=e to�j
WNRUCUON5
purpose: General Statute 13DA-281 states "No public swimming pail may be opened for use unl ms the owner or operator has obtained
an operation permit issued by the Dma imine _ Genera] Statute 134A -A2 requires the Commi ssian for Health Services to
adapt rut es including requirern nits for application revitw, txpiration, rmevvel, and rvocation or suspension of an operating
permit. Those -ales are cortai ned in 15A ItiCAC I 8 ,2 500,
This farm �s to be used as the permit specified above-
Prcparstioz: L ocal environments) hcatth specialists shall issue a permit evcry time a nein• or feissucd permit is inAcatcd_ Irrepare an
original and one copy for:
1. Original given to pool oamer or operator.
2_ Copy for the local health department_
In the Brett the permittrar sitional permit is suTended or revolcee� complete the Suspensicn.'Revocation form {DENR
40)9B) -
Disposition: This form may be destroyed in accordance with Sunda d S.B.6., Inspection Records, cf theRacards Da position Schedule
pub] iAcd by Ac N_C_ Division ofArchivcs and ILston•_
Additionalforms may beorderodfram: Di visionofEnvironmenLdHeAth
1632 Mail Service Center
Ral eigh, IFC 2764-1632
(Courier 52-41-04)
EES 3962 (Revised 7/05)
Enviretmettal Heallh Services Section (Review TOR)