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523 Danner Rd� DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street � Mocksville, NC 27028 (336)753-6780. / Fax # (336)753-1680 OPERATION PERMIT �c�our�t #: 990005654 �ifir-,•�� Tc.�: Christopher Bolcato Re:fer�E�ce f��e: f�rn�os�c9 F�t;i€ity: Winery 'iax C�It�iEN #: 5820-68-9073 Bolcato �u�di�fi: iari ir3�c�: Locaiian;Ad�i�-�ss: Danner Road-27028 Prc��r#y S�iz�: 20 Acres 1 a�i'C Nurnb�r: 5822 _ **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article I 1 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of , time. � _ .� �1 �—�r � System Type:_�� S.T. Manufacturer ��1 Tank Date�� Tank Size � d�� Pump Tank Size�— System Installed By �� (',p ua � F • � � E.H. Specialist. Date: � �— � � — �� GPS Coordinate: � DCHD�] 1/06 (Revised) � 8'' � : � �`j ,� y� � \ " ^ O _ \� �._ ` �s�h � � cy � 5 c !� �w��r 1.�� (0 5r�p1�c .. - � , � ,. . , � ----- -- ---• -, , �'c`� t wu�. _ -- _...._ _.____ � /� I �, 1 � � t�} �3 ) I od "k 3 ' �,n,. � �� / �%� ��-�a Q�� .� � � � O � • , f . , �cct�u�i #: Bill�� 7Q: Re:fer�E�ce Nan�e: Pro�c�ssc9 Fac;iiif�: DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 990005654 �'�x F�I�iEN #: 5820-68-9073 Bolcato Christopher Bolcato ; u�at�i�ri�ian ln��: ' LocaiionrAd��ss: Danner Road-27028 Winery Pro��#y �iz�: �cr s . ite ype: ew ❑�epair ❑Expansion f��l`�i��3'i'his��horization to Construct (ATC) MIJST BE ISSUED'by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms # Bathrooms # People Basement0 Basement plumbing❑ Non-Residential Specifications: Facility Type � # People o�. # Seats Square Footage(or Dir ensions of Facility) Lot Size �� Type of Water Supply: ❑County/City C�°Well ❑Community Well d System Specifications: Design Wastewater Flow (GPD� '� Tank Size�j �� GAL. Pump Tank�AL. , � I, ��D� , Trench Width 3 G Max. Trench Depth� Rock Depth j�+ Linear Ft. t�s stated in 15A NCl1C 18��.1�69(5j Site Modifications/Conditions/Other:_ _ �ccepted System� rnay al�u bn used Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the dav of installation. Telenhone #(3361751-8760. ��tv�, R� n �� r \ � W h.Q.J�'� � � � R r 't ,� a �r �-\ 5 �'` v�5 t � � �.c dr�s��o- 5'L�� y �� K �uG � W�� ,c�� rY'd0 Mf _ ,r,_ ^ Ar,_`�.e u� a� l.� � i r� j; n i t g 1-� /. � �` y . (� o�� Environmental Health Specialist `' �u� �/ / /0�/,l�(//'/ � ' DCHD 11/06 (Revised) �{� � ��i Date: � / ` � ^ / ( .. r , , � . ,, � Davie County Environmental Health ' P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax(336)753-1680 Account #: 990005654 Billed To: Christopher Bolcato Address: 190 Pepperstone Drive City: Mocksville Reference Name: Proposed Facility: Winery IMPROVEMENT PERMIT Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: 5820-68-9073 Bolcato Danner Road-27028 20 Acres **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. _�._ _.__.._. __..�_..�._._�__ .__�_.___._______,.____ _ . . . _ ._ .. . . - - - .. .. _... .... _._...._.____.._____.._.__,..__� _._._.._�. Permit Type: ew ❑Repair ❑Expansion Permit Valid for: Years ❑No Expiration Residential Specitications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ W �,n�e' �o� �' `� Tcss'1��`5�^-- Non-Residential Specifications: Facility Type � vlti # People—� Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: ❑County/City �l ❑Community Well Site Modifications/Permit Conditions: �y "tated in 15A NCl1C �8;�.1�r,�(5) �' ��L"��siET�l�a :>u ,; u�:.�C Environmental Health Specialist i.p.l 1-06 � ,�. � � �% � �� J e � , . � �G( p �=�• �° u,bu � • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PE IT & ATC (' ,,,_. E,� � Davie County Environmental Health li l��- �a b �� J P.O. Box 848/210 Hospital Street C� ��S �%i� �� .0�7 Mocksville, NC 27028 �� LD `� � (336)753-6780/ Fax (336)7�5�3� 6�0i3.�� y__----� � � Appli�il�dY�'Fo`r: � Site Evalu�tion/Improvement Permit Authorization To Cons ruct (ATC) ❑ Both Type of Application: �1ew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility *� *IMPORTANT*** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 4 PPT T(` A 1�TT T1�TF(1R l��T A TT(11�T Name �/Jr � S7� l7 P I� O(.^ C��O Contact Person ��t Add'i-ess y� Home Phone (�p �) �(� j Q Q City/State/ZIP i� ( Q Business Phone �'F// a1�1 �//�7! i Name on Perniit/ATC if Different than Above Mailing Address City/State/Zi PROPERTY INFORMATION *Date House/Facilitv Corners NOTE: A survey plat or site pian must accoinpany this application. Included: ❑ Site Plan (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name % I,� Phone Owner's Address ��7 dr City/State/Zip / Property Address �' O City� Lot S�e �Q (�ACfiPS Tax PIN# QO� ��_(�g Subdivision Name(if applicable) Section/Lot# Directions To Site: l�D! �� h ��ah nnm i�� n�rn(` (in(�Y� LA'Plat(to scale) If the answer to any of the following questions is "Yes",supporting doc entation must be attached: Are there any existing wastewater systems on the site? Yes �o Does the site contain jurisdictional wetlands? Yes No Are there any easements or right-of-ways on the site? Yes No Is the site subject to approval by another public agency? Yes %No Will wastewater other than domestic sewage be generated? _ Yes �No IF R�SIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: OYes ❑No Basement Plumbing: DYes ❑No IF NON-RESID�NCE FILL OUT THE BOX BELOW Type of Facility/Business i l Total Square Footage of Building �,'�j D� # People �_ # Sinks �_ # Commodes # Showers — # Urinals -- Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: �onventional ❑Accepted ❑Innovative ❑Alternative ❑Other \�ater Supply Type: ❑ County/City Water �Tew Well ❑Existing Well ❑ Community Well /�� Do you anticipate additions or expansions of the facility this sysfem is intended to serve? ❑ Yes �No If yes, what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any pennit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use chanQes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to deterniine compliance with applicable laws ld rules. 1 understand that I am responsible for the proper ide�itification and labeling of property lines and corners and loc ' g n aggi king the house/facility location, proposed well location and the location of any other amenities. Site Revisit Cl�arge Property owner's or o�vner's legal representative signature Date(s): �- /��/ f Client Notification Date: Date EHS: Sign given GYes �No Account # ;�>�� Revised I 1 /06 Invoice # —��-�/� S , fX�S�� II �' �\�C'�` �> Ex�S{;n5 �,� �r�l 3. �c�� rJe�J �b��i��h� �1, �C �C i FsT f��E� � ;"63�, ��, .' " - __ .___,_,- • �. � DAVIE COUNTY HEALTH DEPARTMENT - ' •' � . Environmental Health Section ' Soil / Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005654 Tax PIN/EH #: 5820-68-9073 Bolcato Billed To: Christopher Bolcato Subdivision Infa Reference Name: Location/Address: Danner Road-27028 Proposed Facility: Winery Property Size: 20 Acres Date Evaluated: �� t u -' e Wei � nit Wa er S pply: On Sit 1 Commu y Evaluation By: Auger Boring Pit FACTORS 1 2 3 Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEP'TH Texture group Consistence Structure SOIL WETNESS RESTRICI'IVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE - SITE CLASSIFICATION: !� `, LONG-TERM ACCEPTANCE RATE: � 2� Public Cut 5 T- 6 T �•.. , EVAI.UATION BY: � OTHER(5) PRESENT: � 7 REMARKS: LEGEND i.andsca.pe Positi n : R- Ridge S- Shoulder L- Linear slope FS - Foot slope N- Nose slope CC - Concave slope . CV - Convex slope T- Terrace FP - Flood plain H- Head slope Texture S- Sand LS - Loamy sand SL - Sandy loam L- Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C- Clay CON�ISTENCE �� VFR - Very friable FR - Friable FI - Firm VFT - Very firm EFI - Extremely firm �'e.L NS - Non sticky SS - Slighdy sticky S- Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P- Plastic VP - Very plastic Structure SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic ' lYlineralQev 1:1, 2:1, Mixed � No s Horizon depth - In inches . � Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsui[able) _ TTAR - T.nnv_terrn arrPntanrP ratP _ oal/ria��/fY7 rnrTr+..r�.,� ..� • ii ■■ ■■ ■■ ■■ ■■■ ■�■ ■�■ ■�■ ■�■ ■■ r_a ■ ■ v ■�■ ■�■ ■�■ ■�■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ �—�� =-----�..—��.�� ■�!:�i��V��■ ■■��■��M*.i��■��■ ■■��L!i��r��■ � \/�id��■ ■■��■��■G�7■��C•it;�-_`��■\��■ ■�■��C\�7��I�r�� ■�� 1��=�� :��ass��■ ■��/�i�C7��\��`7��f/��■ ■��lti:��■�/!\■�:�1��■ ►��►1��:D��t �\7[��I\��■ ■■��i��■ ■�i�l�[�71■�■■ ■��■��P� ■ ■1�►%Ii��I��A ■��■■c.-.��. ��i�:: ■��■��•.��►vr:■�r: ■��/��c7��C�■�\!��■ ■��■��C:.��\�[�lr�� ■��■��.��a:��/�■ ■!!��ir�■�■■��C��:��■■ ■■��■■v��■��■ ■��/�■ ■��■ v��w��■■ ■��a��►��■ ■ ■�■��■��■��■�■■�■ ■��■��o�■��■�■ ■��■��■�a��■��■��■ ■�■��■�■��■�■■ ■��■��■��■��■■ ��■��■�a��s�e��■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■ ■■ ■■ ii ii ii ■■ ■■ ■■ ■��■�■�O�■��■ ■��■��■��■ ��eu�1��i��■ ■��r�iri��■ ■��■��■�■��■ ■��■�■��1■ ■��■ ■��!7�■ ��.��:.�i�i��■ ■��■ ■��■��■ ■��■��■ ■��■��■ ■��■�■��■ ■��s��■ ■��■��■��■�■��■ �z� ■ ■ ■ ■ ■ ■��■ ■��■ ■��■ ■��■ ■■��■ ■��■ ■��■ ■��■ ■��■ ■��■ ■ , rs.��.�. I �aw I r►b � p6 t16 PG 5P1 . `.� I �ZZ i '� Hii� �� ?� � � � m O �� m � �_o—o � R�dJOWrL+b+ PW 482Q6dN1 GO W PGht � a�� ree s�m�vv�e G7717►GBCN wi�r�6ao "Gdntcla�m' Parcel rrarso.�a.a�.�+r� �se�rn I 0977 3q. Pt. I rw sszrnaan I� G9IIOPGM Q.�Q AGI�S G9Yl8PG1�b , � �8 � s esos'�st (�.sa� 1 �� I � t. w � = Ne'R�°i,=� �ae�° �u ue i�� av.ar �a iMR � ltr- f2 !O Nwfn d � : � � N 20'2230L D�awnk �•ti �� . �� LEGCND N �09TiNG 6tON ►P! OR IXISTING IRON RLGR CAIf Da9TING A%IL GNG D�9TiNG M1GlL IRON TMR Da9TING IRDN T BAR en� oa3nNc �rora . rr rarrr rar rou�ro ae ser V CDC.t Of MWAQIT WW R1GttT-0f-WAY QM LORRIG�TID A1[TAl FlR ►IH ►MCA WQJfItH'ATION NIAAO[R 7t 1IILtt10NG �CDDTAI ,x- a�xe�wtRe rv� • -0. owmuo unun � � �� ' NOTFS� . 1. Ta �rml Idaf huoa� Niw�bv. SC20GL9073 Y. Daed Rdawwv� pnt d DO I EO 7s 4G9 � �r�tsi�e�.. • � , �. m,paey e �x w�ea w�wn � 5�c,r nooa nm�d � /oe r pr �OdA hod Irouam Rafa A4/ . 447105020Q1 datad 9q*mbar 17. 2000) 5. �.bp i property awnd� RA Me 275.SY Rod 4G0.00' Tnct Pour 20.000 i1CPC3 T1'�ct Three 22.875 Aues G*.11�wiMWJ r►r saac�tbwe D� 525IG 409 v�a.r�aw r►� semr�aeti LO q0►GYld �rvcm #bVW 3 84'sl'I6T 17E{.tp• m^ao~p �y�f��r�e�y�ll 5 Ldr[�+.IMi+d� d . P@45blL�tb5l'i . . G957►G'�d 1 DAVIE COUNTY REGISTER OF DEEDS PIAT REGISTR.4TION FILED FOR REGISTRATION AT _____ 0'CLOCK _M. THIS, THE ____ DAY OF _,__, 2011, AND RECORDED IN PLAT BOOK __ PAGE __. M. BRENT SHOAF, REGISTER OF DEEDS FILING FEE PAID. BY: Tnct One I 6.000 Acres �,. TnctTwo . l� � �.8 � 5,lcres --�.../ . :Gf LIJYRtsFMld1 1�0� DD5��i01 I I CER7IFICATE OF ONNERSHIP AND DEDiCATIDN i nx.ey amury tnat i m, ms owno ot t�s Droparty a�.�.m�a nnew�. .nicn 4 ixatea � tna wemdeion y.t.amuon or oo�• co�oty ana Uat i n...ny aaoPt tny .�ea�.m�o� pio� .nn my tres coo.�t. w�eer.n minlmum Eu�Einq �etDa<k linet on0 EeEI<ote dl �lrrola (roaM), alleye, valks, paks an0 oMer Mle� ond aoaemm�. to puelk o. vrnnt. uu as �o�ea. oo�aa ,». 000��r oo�. � L� N 8� Q�'°. S SITE `�`' , ae S�°° yJ cP^� � 4°y. � NwD«AMrdaf o o� �rOn. � S SS3E'49^M � �� CA� as.x' ��,�yy VICINITf MAP NTS R�N�w INfic�r'� C�rtllleGt� ST�TE OC NORTH [AROLINA CWNTY Of DAVIE i. R.w.. ano.r of DaNs CounlY. �tity inoi tM mav a.lal ie .,nim mh eauroauo� i. arn.sa m i. on .iawm�y r.a,�r�.oi. rw r.o«emq. � � ' � � _ RMw INflcx p Dol� _ Nn o� �^'� NO CUNWHC DEDARTMEM'➢GROVAI RE�UIRED. P!L 58D�B709'1 � �� DOB781G6Y! ,,,, � PUNNING DIRECTOR � � = � � �, JEiFREY C. ALLEN esrtify lhal Ui4 plot Wa -- tlrawn unOr my up '�bn Irom an xhd wrwY matl� � �� ax my �upervinion (eeaa awcripUon rocortlatl h Book �"'V'� re�ciearl9heical�ee� ��Mawn /rom�inl«mal'wn�foundain � Book �� OWe�iOSEQ; lhat �ha rallo of Drocialpn � 5/'1J97'1668 eoleubted L 7:10.000+; �hal Nla Olat • DrpareE In [OY/I�GYA ec<ordonn rit� GS {7-JO ,. w„«�a.a uoi ryaana G.S 47-JD(Ixit)6. l�i� Wrwy b a� ayceplbn lo lh� a.r�wo� ei .�eam�roo. �� Wlinan my ttiqinal �Iqnolw�, reqletratlon numb�r � � anE wal t�4 7lh Eoy ol Mart�. 2011. t�f PROFESSIqJA� �AND SUflYFYOR �-3810 �gg �' pl47&'00f51i9 wrn r�n9 � PREUMINARY PLAT "� NOT FOR RECORDATION, CONVE1tAN6ES.- Q6 . SALES o�+n,cR; Dauld .be Darmbr 9� 1 Trn�orth Rd A�hebaro, NC 27023 Donald Joe Danner Clarksville Township - Davie County NORTH CAROl1NA 150' 75' 0 150' 300' scu.E wTc .oe / ow�wN 1':150' 04/11/11 020i JCA/MCF �1VS ieMo su�vntnc Nkn GeonwUca, P.C. (C-3191) PO Box 89, Advance, NC 27006 (336) 782-3796 wwwlJlenGeomoticn.com 1 � '' � ` �� '��. 1 � _ J ' � � �'� _� : � � : �� . ' .. ..• �r�� ` � ` `. ` � �_ ` l 1 , � , ` , , \ ' , , , �, � ��.v,,'. • n - ._: �,. _ _ ; ,., � ---�_ 1, �cx.. 0 ' -- - --:, �� ___. , / C1� c � � �:, _ �, c �_----` — �.,�-,. _.�. _ , �( , 1 ( y ;�'`. ' � --�._� � . N � �� --- - _ _ - -- ----�. _.`,... , . � j � d �-e � t �. �� ' � ` l� � � '. � \.a � o�'� L ��' ,� `� <��' � o � l�� T� � �� by� S � � �� f v � _ -'� �c, � � i fl _ � ° : 1 �: �� . �% r� f,� �0�7 ' � � 7 � J _ n �,�( x = �'''�� (f�.L' �` � 'pt �J� ;� �� (�' �^; i \ �� _ , l� \ � , � �:��}� _.� _ �._. _ _� :� , _ _ _ _ -------�. � :s ,; s � � � �,�\\r. t . . '�.J. . � � .. " � .4 'i y,� � �� . . 1 � � � k � �� a! �;`� .�K � _ � �: .. . " ". _. � 4 ' , ,� .. . . - ' .: ` ,. , i r ! ��. � '�'i E .. . . � _. �' _�}. �/. ,�.`, . . .r ' . � �h� ''.��a' . ... . . . . . � ... . . �' � ` : � ,�. , - r ,, , . � F �,<<� . �„�,.,.�� ' ,�e.�— - ,-. `,"- - �: : : �.�"'_ !>.., � _ ,_ . � .�,�� .;, �, � . �� r�. I K� `� .l - � . ...K�FAe� . .. ;.,. �"d��.''�"�" .. .. � � ; � i ti <<.« �t 1 � .' :�' � �1! �. ' � � � APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT � Davie Couaty Environmental Nealth ��, � t� �' � P.O. Box 848/210 Hospital Street �+ ��1" � � Mocksville, NC 27028 J��i � e t � (336)753-6780/ Faa (33� 753-1680 8r Q ZO,, �{ i Application For. ❑ Site Evaluation/Improvement Pemut �Authorization To Construct(AT� ❑ Both � r/ / Type of Application: �ew System ❑Repair to Existing System ❑ Expansion/Modification of Existing System or Facility sss�MPORTAN7"" THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED [NFORMATION 1S PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed . f/ ��fi` ��/ (�� Contact Pcrson � Billing Address Q �� Homc Phonc City/State/Z[P D O Business P6one 0 Name on Permit/ATC if Di,,t'fereru than Above Mailing Address City/State/Zip YKUY�K1 Y 1NrVKMAl1UN 'llate House/Nacll� l;orncrs Hla cd NOTE: A survey plat or site plan must accompany this application. Included: ite Ptan ❑Plat(to scate) (Permit is lid for 60 months wit s�te,Plan, no expiration with complete plat.) �� Owncr's Namc Y� � L'I " Phone Numbcr � Owncr's Address x' P � City/State/Zip ��(��J�UJr`� Property Address City Lot Sizc �� Tax PIN# vu� Q�(Q�3 Subdivision Namc(if applicable) Scction/Lo Directions To Sitc: ��1 D� l bYl �/� /1►7E� If the answer to any of the following questions is `j�es", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes o Does the site contain jurisdictional wetlands? ❑Yes o Are there any easements or right-of-ways on the site7 ❑Ye o Is the siie subjeci io approval by another public agency7 ❑Yes o Will wastewater other than domestic sewage be generated7 ❑Yes �No FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Gazden TublWhirlpool OYes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Ycs ❑No FILL OUT THE BOX Type ofFacilityBusincss � e ' ..�' —'Fotal Square Footage of Building �� `'� �"# Pcople 1 # Sinks .3 # Commo es /�# Showcrs # Urinals Fstimated Water Usage (gallons per day) (Attach documcntation of similar facility water consumption) FOODSERVICE ONLY: # Scats Type system requested: ❑Conventional DAccepted ❑Innovative �Alternative ❑Other Water Supply Type: � Counry/City Water YXNew Well ❑E�cisting Well ❑ Community We11 � Do you anticipate additions or eacpansions of the facility this system is intended to serve? O Yes ❑ No If yes, what type? This is to certify that !he information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revceation iFthe site is altered, the intended use changes, or if the infortnation submitted in this apptication is falsified or changed [ hereby grant tight of enuy to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comeis and locating and fla�ing or sfaking the houseJfacility locatioq pmposed well locafion and the location of any other amenities. Prope owner's or owner's legal representative signature Site Revisit Charge �/ Date(s): ll ClientNotificationDate: Date EHS: Sign given ❑Yes ONo �O �//) Revised 11/06 vX 1 A�o�,t# 5l�6�f Invoice # �� µd�as o 5 a �� p ��.f , Davie County Environment�l Health r �� P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 WELL PERMIT Accou�t �: 990005654 Bifici� To: Christopher Bolcato Refer�rtce Na€�i�: F�ro�as�;d F'��:ility: Winery-Well '��x Pl�f.%�H #: F4000000603-Well Suk�c�i�isior� in�o: : LocaiiortrAd�r�ss: 523 Danner Road-27028 , i�ro��riy Size: 23 Acres AT�c��the��loyees of the Davie County EH Section shall in'no way be taken as a guarantee that this well will produce water of any particular quantity or quality or for any amount of time. This permit is valid for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that e has been a material change in any fact/circumstances upon which this permit was issued. Permit Type: New � Repair ❑ Abandonment ❑ Pro osed Well Location Diagram Certificate of Completion Diagram $�P e 1\ x.=, , � , . � �� ` ,�h O� �' -�- � �`_ _ '7 � � �, u e.�� 1 /✓ 3 � y� , � � � ( �` , ( �`�, � �� _ � � — . 4 � � � � p �� • � J� �-�� _. ^� �, � _.a � �� !� f � � � �'� y� Comments: _ _ � Driller: �� (�.�, 1 Certification #: 4� a � i Grout Inspected: � �-10 �� Well Head Inspected: �� 3� v� a j� GPS Coor 'nates: EHS: Date: �Q� �� EHS: Date: �—�� w.n. �-os � ��' �' �� PPLICATION FOR PRIVATE WELL PERMIT s�� 2� 2�� Davie County Environmental Health P.O. Box 848/210 Hospital5treet �,�, � �(,� �,� Mocksville, NC 27028 (33�753-678Q / Fax (336) 753-1680 THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. APPLICANT INFORMATION Name to be Billed Chr�s' o Billing Address J City/State/ZIP Name on Permit if Different than At Mailing Address PROPERTY INFORMATION ivt� i�: A survey piai or s�ie pian musi accompany Owner's Name� f11719/..�,�(` �P� Owner's Address f� � �ir. j� � Qf Property Address �� G nnPr RtI Lot Size �Q rC�S Tax PIN# Subdivision Name(if applic,ible) Directions To Site: F70/ /i �� f'/' DEVELOPMENT INFORMATION �il U Contact Person Home Phone �, b Q 6 n Business Phone �_�l /^ti� 7 ) -7 City/State/Zip *Date House/Facility Corners Flagged Phone Number City/State/Zip City / Section/Lot# rGiiiu� iy�c: i�cw rvcu � vvcuncYau vvcur�ucuiuviuucu� vui�i ��Y��..y� � Facility Type: Residential Food Service Church Commercial Other Are There Any Septic Systems Currently On The Site? YES NO Do You Intend To Install A New Septic System On This Site? YES � NO TERMS AND CONDITIONS: This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying and marking the property lines and corners. The applicant is responsible for making the site accessible. By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for Davie Counly Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to determine the best lo tion for a well. � �� Signed Date 7/30/09 rte evisit arge Date(s): Client Notification Date: EHS: Account # Invoice # Sizing of Wine Tasting Areas Date: Tue, 14 Oct 2003 11:30:09 -0400 From: Trish Angoli <trish.angoli@ncmail.net> Organization: NC DENR DEH OSWW To: Kevin Neal <kevin.neal@ncmail.net> CC: Joe Pearce <joe.pearce@ncmail.net>, Steven Berkowitz <Steven.Berkowitz@ncmail.net>, Bill Jeter <Bi11.Jeter@ncmail.net> Kevin, Here are guidelines for sizing of wine tasting areas: 1. The minimum system size is 200 gpd 2. The design flow is based on 3 gpd/person and 25 gpd/employee 3. The winery must provide a reasonable estimate of the number of people visiting the winery per day If you have any questions, let me know. Tricia _: iy: �. s�' �� ''� r�" � 'i ' -.f !Ci '3P R; �: `�. ..:% 9• _ -r.F+" �� t�w_�e. �..T_� _ ��:,� �, tf.'., � � cs,F� R �� ', ' .'� , a ^ � . } :. X' . , . : " " . �. �. � ' v, '_ . '�'!. ��fi��i �♦ .�. �� '; � �� a �� . �� 3,R ♦l. I I i.'' 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" __ _ R sa . �C...;C"�,��y;.� � i�>y:-. f�:'. �s�s+f�a.a . �•�� r .:.�t .r:y � f �� Pt� �� .�:= .{1`:. a:.w�� - � :i: 1 �sl �"�If�/'� ' - - - " - f ,:: ' : £_ r =<.:• �: " � ., �.r, :"i�,� ,.� f t� s :.! �� a�. a > -- � :, ti-_� �, �.,..� s. - -:....- 3 �.» _ :_.�, �= s., - : �.- t=3- �:K�...�.. � — ��-c „7. -�4-.e ,� . .� �,_ .�� . ..� .x ... :-'._ �. ..' �F•c � �i . ,k-.i� a..t.. !r` '? ' .�3� - F-ti I�i.� �`i. � r, "=F- 3:_ "3`�� " :.�a e. FW_«.... t .. .#E-•i,k__.=.,f .;.,t. - . y oy�: R4::-+. '��.. .:t.... - _ . �4 - Y - `! .'.#�+.. * �-i ♦!' ii, �_a'ti �:ia4�'.,4� s:: �. �` . - .''�`',�i i �." � •_,., . ,_T .• f�" �i3 M +.... �_ .. .'•s.+r *..r s_ . .r,s: .. v.� .-..��.��: ,..a„ •.� .,..o, �+-G. �.-,�.. _..,��. ..��, � _ . i:4�i �.�� F 0�.. J �'1 � .+...�� : S E: � �y�C:-�� M-�., e � a _ i` "'^.:. �i i`'T�' t- ..."�F:- �Yi:� 'C'. ��3a . � C:F.:._: Y' ��'-Z' i ::M . .a ._ 4-.}r A' -�_; .T.;:S.:1- . . _ r �f/ RECEIVED �uG > 5 zo�Z North Carolina State Laboratory Public Health ��ox28047 n Environmental Sciences Raleigh,�'�r,�� http://slph.ncqublichealth.com M i c ro b i o I o Phone: 919-733-7834 g y Fax: 919-733-8695 Certificate of Analysis Report To: DAVIE CO ENVIRONMENTAL HEALTH P O BOX 848 Name of System: CHRISTOPHER BOLCATO 523 DANNER RD MOCKSVILLE, NC 27028 MOCKSVILLE, NC 27028 EIN:566000295EH COURIER #: 09-40-06 StarLiMS Sample ID: ES080112-0114001 Collected: 07/31/2012 11:00 Robert Nations III�IIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIII'IIIIIIIIIII Received: 08/01/2012 08:29 Angela Heybroek ES Microbiology ID: 38685 GPS Number: Sample Description: Comment: Sample Source: New Well Well Permit Number: Sampling Point: Well head 0087 Environmental Microbiology - Colilert Profile Method: SM 9223B Test Name: Colilert Analyte Test Result Analyst Date Total Coliform, Colilert E. coli, Colilert Report Date: 08/09/2012 Present Absent Explanations of Coliform Analysis: Susan Beasley Susan Beasley O8/o2/2012 08l02/2012 Reported By: Susan Beasley If coliform bacteria are Absent, the water is considered safe for drinking purpose. If coliform bacteria are Present, the water is considered unsafe for drinking purpose. Presence of E. coli (bacteria) generally indicates that the water has been contaminated with fecal material. It must be remembered that a water analysis refers only to the sample received and should not be regarded as a complete report on the water supply. North Carolina State Laboratory of Public Health 06 N. W?m� gton St. Environmentai Sciences Raleigh, NC 27611-8047 htto://slph.ncpublichealth.com Inorganic Chemistry Phone: 919-733-7834 Certificate of Analysis .-.F�i�919-733-8695 ��=�EIVED Report To: ROBERT NATIONS DAVIE CO ENVIRONMENTAL HEALTH P O BOX 848 Name of System: �C HEALTI� CHRISTOPHER BOLCATO 523 DANNER RD MOCKSVILLE, NC 27028 Courier # 09-40-06 MOCKSVILLE, NC 27028 EIN: 566000295EH StarLiMS ID: ES080112-0022001 Date Collected: 07/31/12 Date Received: 08/01 /12 Sample Type: Sampling Point: Well head Sample Source: New Well Temp. at Receipt: 5.0 Sample Description: Comment: Time Collected: 11:00 AM Collected By: Robert Nations Well Permit #: 0087 GPS #: New Well 1(Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic < 0.005 0.010 mg/L Barium < 0.1 2.00 mg/L Cadmium < 0.001 0.005 mg/L Calcium 9 mg/L Chloride < 5.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0.05 1.3 mg/L Fluoride < 0.20 4.00 mg/L Iron 0.49 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 3 mg/L Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L Nitrate 1.30 10.00 mg/L Nitrite < 0.10 1.00 mg/L pH 7.5 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 5.50 mg/L Sulfate < 5.00 250 mg/L Total Alkalinity 42 mg/L Total Hardness 36 mg/L Zinc 0.12 5.00 mg/L Report Date: 08/13/2012 Page 1 of 1 Reported By: >�ricold �ull North Carolina State Laborato Public Health P�O. B°X28o4' � 306 N. Wilmington St. Environmental Sciences Raleigh, NC 27611-8047 http://slph.ncpublichealth.com M i c ro b i o I o Phone: 919-733-7834 g y Fax: 919-733-8695 Certificate of Analysis Report To: Name of System: n��r��D DAVIE CO ENVIRONMENTAL HEALTH CHRIS BOLCATO i�� P O BOX 848 SEP �� 2��2 190 PEPPERSTONE MOCKSVILLE, NC 27028 MOCKSVILLE, Nc Z�o�C HEALTH EIN:566000295EH COURIER #: 09-40-06 �- __ StarLiMS Sample ID: ES091112-0077001 Collected: 09/10/2012 11:15 Andrew Daywalt IIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Received: 09/11/2012 08:40 Angela Heybroek ES Microbiology ID: 39575 GPS Number: Sample Description: Comment: Environmental Microbiology - Colilert Profile Test Name: Colilert Sample Source: Well Sampling Point: Well head Well Permit Number: Method: SM 92236 Analyte Test Result Analyst Date Total Coliform, Colilert Present Darneice Lyons o9/12/2012 E. coli, Colilert � Absent Darneice Lyons 09/12/2012 Report Date: 09/13/2012 Explanations of Coliform Analysis: Reported By: Susan Beasley L� �'�t�a�� If coliform bacteria are Absent, the water is considered safe for drinking purpose. If coliform bacteria are Present, the water is considered unsafe for drinking purpose. Presence of E. cofi (bacteria) generally indicates that the water has been contaminated with fecal material. It must be remembered that a water analysis refers only to the sample received and should not be regarded as a complete report on the water supply.