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Health D epartment 18
�Div*ifti d 1QWk*fturt%11k%1h
Date of Ins p/Chg: 0 7 / I
a 0 1 3 Current Facility ID2018500006
Inspection of SmIntraing Pool
Status Code, A
Old Facility ID
Water [Ecommunity
[Etransient
[j]Nan-Transient Non-Communtly
Non -Community R]Non-Pubfic VVtiter SuPtity
Water Sam pla taken to dae. In spe:,,r:,,,
E]Yes R] No Re -in hon
lvisft
Name Change
Verifion cabof Ctosure
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Wastewater System: FF"Gmrnuntty
non-Sne Ystem
Status Change
Locatkan Address: 1520 13TH AV DR SE
HICKORY statec NC zip: 28602
-- U-11"'FrALOUE01
Mailing Ad dr. 1520 13TH AVE DR SE
City: HICKORY stw NC zip* 28602
Points a ludicatescritical item (6-p a intilemerin
Deducted
WATER QIJALITY, (.1,535) (t heck) Comments:
*1. Water clear en b ugh to clearly see bottom of pool and pool drain ........... 0 6 SEE COMMENT SHEET ATTACHED
*1. Dis-,infectantrees k tr Us tied by.
free chlorin e 3 0 (at least 1.0 ppm or 2.0 pprnwhere required);
bromine = _(at I east 2.0 pin u); or
biguanide = (30 to'50 ppm. 06
*3. Pool water PH = 7 E 4 (71 to 7A 06
*4. Water temperature of heated pool
(mvirurning pool) or ID4 F (spa) ...................... ......... 06
5, daily sen tt en r cc ords of water si al ity mid te st kit kept on site 04
POOL UAINTENANCE-
*6. Alam draixt covers secured "d in good rep air, no suction hazard. Single
dramsprotected by April 1,2006 (1537,.L539)1........ I � I.... .. 06
7 Pool malls and fl oor kept of earn, free of debris an d in good repair ( 2 5 37�) 04
03, Surface skim raters (with weirs, baskets and covers) or gutters clean, in good
rf,pmr,,vidfuric'aotiitqpropei'ly,nofloating deb.n's(,2513.,2537).,. , 04
9, Depth markings and no diving mark-ers or signs visible and pr operl y I ocated
(.25232537) ............ ....... � � . . ,, , , 04
1 O. Safety ropes cyi th floats air d contrasting col or bands provi ded atsin all ow area
brealtpoints (-25152523) .. ......... ............................ .. . ....... .... 02
11 Diving equilctment, ladders, steps and handn g rails properly placed, in repair
(25172521) .................. ......... ..... ............. ........ ... 02
12, Inlets and other fitfings in place suid in, good repair (2537),. .
13 Contrasting band co steps and benches (,2521, 2516, 2532),
14, Spatimer working properly (.2537), ........... ......... ... 01
PREMISE S-
*15. Body he ok and ring buoy with throm, r up e or lifeguar d with r escu e tub e
provided and praperlylocated (.2530,255-37)................... ..... 06
16, Fence or banier %ith self closing, self -latching gates properly constructed and
maintained (,2528, 2537) ......... 4
17. Decks unobstructed, properly drained, free c1trip hazards, (25222533171
18. Lifeguards present or warning signs posted ( 25530) , .. ............. I—— ........ 4
19. Signs prohibit glass containers or pets in pool area(,253Q, .............. 4
20, Caution Signs posted at hotwater Spas (12532) 4
21. Pool and deck lighting provi (led at pools that operate at might 2524,, ,-37)
g 25 4
*22.. Emergency telephone provided (1510) 6
EQUIPMENT ROONt
21 ChIcrine orbromine automaticfeeiersthat. meet NSFSt=dar4 50 (2,535) 0 4
24, Appro'vedpurap, filter, and flow meter operafingproperly (2518,,2519) .... 0 4
25 Equipment Said chernicals, kept in a dry, well-venfilated encloalre (,2533,, 2534,
26 Valves and pipes identified by color codes or labels ( 2518) ............... ', 8 2
27 Filter backwash discharged through an. air gap (-2513) 2
DRESSING AND SANITARY FACMITIES:
28, Batlitiouse or rest rooms accessible,
shower sager posted (,2526) C oiam ent Sheed attached
29, Required fixtures provided, dean, and in good repair (,252d) 2 OYes N o
30, Approved water source, no cross connections (2512) 2 R t Received by:
31 Sewage disposed of in a properly operating sewage system (,2513) 2
32, Floors smooth, slip -resistant, kept clean(2526) ...... ......... ... 2
33. Hose bibbs and it r drains prov 2526) 2
S and 11 rc""a", prov "2""
Inspection EHS LD, 1654
Conducted by
Jampam Genavd S tatta tt 130A-282 mqvai C.
im fectiorv, Thi'� roan is developed tot'a Used in n".k irg P&I stubtg Pooh, 1 W, W 4624 POC6 and Water men ato n kth W, tumv amen w 1,oe A, e mnivamm ahl Im &A s, peci aba b s hall coniplete tlu form
every hn* dwy corduck all its paction prapin ui arionil and hv000i fiar. L 04irw iobe l0with 6V nipomiWa p4r;0112. Copy fox the kxal 1"11% &paytnvid, 3. Copy for " ExiviromwntO Healffi Sex es Swtoy�
Divisiamof Em-miumid&I Heahli, ffiW#A&Vd Mus fonn, iiuFte degho)ed in a e withSWA&A -81,6, hupvcfionRe� i3d%, of fl* Pwod., Asymem &-hedlie VkhAe& ty t1w WC, DivumnofAvdu%vx 4rJ
Hi5txy. AaAifioxwl fonxu mayt* ctaemil from, Di6sionofFn%iio=*nW Health, 1632 Mail Seine* Conky Ralei;K NC 2709.;9-16W,
VEN13M QkwisfA 07"
------------- ------------- N,C, Department of Environment and Natural Resources Name: BESTWESTERN
Division of Environmental Health ID: 2018500006
Street , 1520 13TH AV DR SE
IRA"
Time In: 1 0 1 6 M'
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Time Out 1 0 a1 7
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Totat Tirne. 1 minute
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N-C, Department of Environment and Natural Resourses
Division of Environmental Health
Name, BEST WESTERN
ID� 2018500006
St re et -1 1520 13TH AV DR SE
city: -HIQKQBY
N.C. Department of Environment and Natura� Resourses
Division of EnvironrnentaE Health
ID, 2018500006
Street 1520 13TH AV DR SE