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3577 Hwy 158Account #: 990002264 Billed To: Joseph Neely Reference Name: Proposed Facility: SHELTER ATC Number: 5984 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 /Fax # (336)753-1680 OPERATION PERMIT Tax PIWEH #: F60000005001 Subdivision Info: RayLen Vineyard Lot # LocationlAddress: 3577 Hwy 158-27028 Property Size: 116.59 Acres **NOTE** The issuance of this Operation Permit shall indicate the system described on.the ATC has been installed in compliance with Article 11 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. System Type; IE CAI kdkr Y.T. Manufacture Tank Tank Date Tank Size 1275 Pump Tank Size Bedrooms: System Installed By:KSiird rlak Installer# Date": GPS Coordinate: r f Environmental Health DCHD 11/06 (Revised) Date: / 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 Account #: 990002264 Tax PINIEH #: F60000005001 Billed To: Joseph Neely Subdivision Info: RayLen Vineyard Lot # Reference Name: LocationiAddress: 3577 Hwy 158-27028. Proposed Facility: SHELTER property Size: 110.59 Acres ATC Number: 5984 Site Type:. XNew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior tq 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 chanLre. Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type V' # People 2-00 # Seats Square Footage(or Dimensions of Facility) (( Lot Size 110 &c_ Type of Water Supply: 0County/City well ❑Community Well System Specifications: Design Wastewater Flow (GPD) Tank Size].2sb GAL. Pump Tank /GAL. Trench Width_� Max. Trench Depth 3&n Rock Depth Linear Ft. [ l • nna�,cS��D'(, Site Modifications/Conditions/Other: Contact the Davie County Environmental. Health Section for final inspection of this system between 8:30 = 9:30a.m. on the day of installation. Telephone # (3361751-8760. je� Environmental Health Specialist�� 'v Date: lod -, DCHD. 11/06 (Revised) 28 J. Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 990002264 Tax PIN/EH #: F60000005001 Billed To: Joseph Neely Subdivision Info: RayLen Vineyard Lot # Address: Raylen Vineyards Location/Address: 3577 Hwy 158-27028 City: Mocksville Property Size: 110.59 Acres Reference Name: Proposed Facility: SHELTER **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: ) 3New ❑Repair ❑Expansion Permit Valid for: VO Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People Basement Basement plumbing Non -Residential Specifications: Facility Type �h&l # People? 0 # Seats Square Footage(or Dimensions of Facility) 3t;8$ Design Flow(GPD): Type of Water Supply: ❑County/City ETWell ❑Community Well Site Modifications/Perinit Conditions: 4 17 J � trsol/11 Site Plan System Type I LTAR Initial So Re air 25 Yb oR &Lck`avt vt�-s Environmental Health Specialis Date T 6/?_ i.p.l 1-06 APPLICATION FOR SITE EVALUATIONAMPROVEMaFEPERMEP & ATC Davie County Environmental Health ECEIVEM P.O. Boa 848/210 Hospital Street ® P (336)753-6790/IF x 27028 6) 753-1680 SEP 1 9 2012 {� AppJica orkFor ite luation/Improvement Permit ❑ Authorization To Constrey� TC) ❑ Both i UV A fgype of?lpplication: System ❑Repair to Existing System ❑Expansion/Modificatton o ung l/ ® '••IMPO IS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED 1� �YI TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. u APPLICANT INFORMATION Name to be Billed Qo-IC ,�•f i Contact Person S4e uk- 54'e" -I" Billing Address tit S Home Phone City/State/ZIP _ ' v t Ile AJ C 0 2 Business Phone ?i 0 Name on Permit/ATC if Different than Above Mailing Address City/Statef ip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: 0 Site Plan Xlat(to scale) v (Permit is !3Ud for 60 wi site �lan, no expiration with complete plat) +72 / 72 y / Y Owner's Name 0 �'c Phone Numbff r 7 7 b Owner's Address 'L7K t5L,.r1rr-,,tVCity/State/Zip wt,rShsrl t< few IV C.L7/ PropertyAddtess L -.S' -- ( City, ylltx: t A 27q_$ Lot Size/ l m Gt r- S Tau PIN# % Q7 000 O � Subdivision—Nae(if applicable Section/L.ot# V Directions To Site: �� If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? 4Ycs ❑No Does the site contain jurisdictional wetlands? ❑Ym-PNo Are there any casements or right-of-ways on the site? r1yes 040 Is the site subject to approval by another public agency? Dyes "No Will wastewater other than domestic sewage be generated? ❑Yes QNo IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes []No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/BusinessTotal Square Footage of Building 5 �i # People�� # Sinks #Commodes # Showers U # Urinals -Z— Estimated ater Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: ,Mmventiional ❑Acc pted ❑Innovative ❑Alternative ❑Other Water Supply Type: 0 County/City Water ❑ New Well Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �XNo If yes, what type? This is to certify that the that any permit(s) AT changes, or if the ' fo Representative of e laws and rules. locating and (la g Property ow*'rlor owner's Il' Sign given ❑Yes ❑No Revised 11/06 Eb o provid Japptat pplication is true and correct to the best ofmy knowledge. I understand ereaftert to suspension or revocation ifthe site is altered, the intended use in ion is falsified or changed I hereby grant right of entry to the Authorized �oun eatto conduct necessary inspections to determine compliance with applicable that I r e proper identification and labeling ofproperty lines and comers and bg cion, proposed well location and the location of any other amenities. legailitp ignature Site Revisit Charge Date(s): Client Notification Date: ERS: &-D? 149 ITIq Account # 116700 000 2Z& Invoice # APPLICANT INFORMA Account #: 990002264 Billed To: Joseph Neely Reference Name: Proposed Facility: SHELTER DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: F60000005001 Subdivision Info: RayLen Vineyard Lot # Location/Address: 3577 Hwy 158-27028 Property Size: 110.59 Acres Date Evaluated: f6l z Water Supply: On -Site Well k Community Evaluation By: Auger Boring K Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % I o HORIZON I DEPTH 0- -(D Texture group Consistence Structure kr Mineralogy- HORIZON R DEPTH(; -H2 5"A2 t 113 qq Texture group — C Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION h LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: P S LONG-TERM ACCEPTANCE RATE: LSA REMARKS: LEGEND EVALUATIONBY: AAA" hCUlid1(�VI OTHER(S) PRESENT: � {-wt Landscape Position 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 VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm NS - Non sticky SS - Slightly 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 Mineralogy 1:1, 2:1, Mixed lYots� 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(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■fid■■■�Z!■■■■■■��ir■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■►.%�lL!iii■��■■■■■■■■■■■■■■■■■■■■■■■■■■ ME OEM ■■■■ill ■■■■■■■■I■f■RIMA■Ell ■■■■■■■■■■ ■■■■11■■■■■■■■I■■If]J■'■■■11■■1►�17■■11�1�■'�■■11■■■■■■■11■■■■■■■■■■■■■■■■■■■■■■ ■■■■■Ili■■■■■■[■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■1■■■■■■■■■■■■■■■■■■■■■ ■■■■■11■■■■■■■ail■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■11■■■■■■■■r.�>tca■■■■■■■■ ■■li■■ ■■■■■■■■■11■■■■■■■■■■■■■Ali►.l■■■■■■■11■■■■■■I■■■■■■■■■■■■■■■■■■■■■ ■w■■■■■■■■■■■■11■■■■■■■!■■!l%2ir11■It■■■■■■■■■■■■I■■■■■■■■■■■■■■■■■■■■■ ■■■■■'■■■■■■■■■\l■■■■■■■fi\■■IrrYL■sI:J■■■■■■■■■■■■■■■■■■■■■■■■■■■■■moi■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ n~•26 Ixr ,r •N°rmnDar •.•A� 2010. . 00 211 O PG 693 . RB 733 O PL) aemgsP Stuns �.�N•CARO` .. 31e2 fa SEAL' Toe Lot 50.01 Toe Map F -e & JoyoiI Neel DB 211 O PG 693 BuAdirp e�T r Q) 4� U.- Meq -- Centerline 10' Well kl Waterline Easement (5' each side a CA) Sw Eorement Cdl Took NOTES: 1. Z-kv.. R/A 2. Wnimum BuM g S.U,-k Liras: Front 4& Rear. W. Side. IS 3. Warerahed Cl— tkn: None 4. No USGS or NCGS Nonumenk found w8hin 20& of Wt. 5. All dlataneea eh— — measraed ha —Ad 9r—w weans... �.rr w....."'... rte..... r....x. w.+. G -g. R SI- PLS < . E -pt W- SulNSvision LOT 1 1.199 Acres +/- PROPENI'r LINE CALL TARE COURSE BEARING DISTANCE L-1 S 143 97 1.54 22571' 1-2 N 713111'1 238.53' L-3 L-4 N 19.09'9"E 229.61' S70,36,1 7-E 221.62' CENTERLNE OF 1& WELL & WATEIU E EASEMENT CALL TARE COURSE BEARING DISTANCE WE -1 S 1D'161i297 188.77' IFmD R-roNOA CENfM E W ACCESS EASEMENT CALL TABLE COURSE PPA DISTANCE �_e.... , BFAR6VC DISTANCE T-1 S 29.43'7197 'n E-1 c��O 6&05' feN S 60'2D'O3"E S 32-53'23"E � w I - T—= M1a..adM1x.H Eie - mle r •rev - x - NNP (Nan..mwnaded Po'v4) m - d-A..r ae. ao aA m ce - r/7' q w c-,oi c- 100 0 - 100 200 300 E-4 E-5 N 59'OG'32"W N $1.0739"W GRAPHIC SCALE - FEET T-8 Ta un. Ody T-6 Torr Lot 50.01 T= Mop 50.01 Tae Map F 6 DB 211 O PG 693 STATE OF NORM CAROUM Ca JNTY OF WE t AnNw Mwd..A R..I.. OfBo.. a ao.M Cwnly s�a�' miaatrnaybr.�rceeN�nt. ro.`wb�OO.m.sy. W..lee Offke 10 APPRc #OIIIiEQ By THE COIMIY FLAMING D8WMWENP nq a 1 { -DK-10 PG*.27 9 Tae Lot 50.01 7'm Nap F-6 n/f Jowph F. Neely & Jeyoe N. Neely RB 733 O PG 579 —Brix Lane 10'+/- Asphalt Road en Cterline of Proposed 30' Access Easement (15• each side of CA) See Easement Call Table Survey for: Joseph F. Neely & Joyce R. Neely LAT 1 PGA of To. Lot 50.01 To. Mop F-6 Deed Book 211 O Page 693 1.199 Acrea +/- by 000rdonte geometry scaE tpwo.P OorgflY zaac WWE 1" 100' Farmington Davie North Carolina 11-26-2010 Stone Land Surveying Company__ A11^'E"R a.r.r fke. c.dmrm. Nurbn e -17w OB,RS l:.nw R.bwl Slaw. iL3 L-3162 12010 ' 3 Dw.. bw (336) 996-.)3]MAP N0. GNS groc..n7.. w.G 27aze 12010 yras W. b . SnE�U Vktnity Nap ("to Soda) TE LINE CALL TABLE CENfM E W ACCESS EASEMENT CALL TABLE COURSE BEARING DISTANCE COURSE BFAR6VC DISTANCE T-1 S 29.43'7197 115.64' E-1 J'O N BB'27"W 6&05' T-2 T-3 S 60'2D'O3"E S 32-53'23"E 508.66' 4421' E-2 E-3 N54-17 "W N 57'49'4997 79.93' 123.16' T-4 T-5 N51'29'06'1 N 45'51'2997 27.55' µ.BS E-4 E-5 N 59'OG'32"W N $1.0739"W 337AT 239.78' T-8 N 38.09'32'1 1734' E-6 N 62'2T51.1 44&20' T-7 T-8 N 60'15'4597 S 80'11'20'1 1161.90' 597.76' E-7 E-8 N 68'34'24'1 N 76'26'74'1 1000T 101.60' --*...IabgN..e rriir..n ho." ..Weds Mr aM e.enat. d1 —ft 01 J.. wW . P° atl air :or one .aN.wb b pubge or Phot. uw mtb6 !Vmg // .7`. E-9 ' E-10 N B3'34'14"W N 69.36'06'1 10241' 9921- E -11S 86'35'75'1 147.98' E-12 S 71'32'1&1 85.77' X - NMP (Nonnlonumented Pant) E-13 E-14 S 4744'071 S IVW49'1 121.67 22928' Survey for: Joseph F. Neely & Joyce R. Neely LAT 1 PGA of To. Lot 50.01 To. Mop F-6 Deed Book 211 O Page 693 1.199 Acrea +/- by 000rdonte geometry scaE tpwo.P OorgflY zaac WWE 1" 100' Farmington Davie North Carolina 11-26-2010 Stone Land Surveying Company__ A11^'E"R a.r.r fke. c.dmrm. Nurbn e -17w OB,RS l:.nw R.bwl Slaw. iL3 L-3162 12010 ' 3 Dw.. bw (336) 996-.)3]MAP N0. GNS groc..n7.. w.G 27aze 12010 yras W. b . SnE�U Vktnity Nap ("to Soda) ' 1 me a la( \ f0 -+-Boger Road S.R. 1438 60'Public R/W 20'+,+ /- Pavement I (w) h -by mt y tlal 1 or, (w as) 6M wn.r(.) } ` d tb.nraP..4' erabd beau a J.lowse I. ri ` M .ddNNen kN+m.6.n a awb C-4 ene Bet I Irby od. t w..daw.lae plo I e my Ws. .\� `. `♦ \ \ 01WER5: 0 ♦ H Joseph F. N-ly --*...IabgN..e rriir..n ho." ..Weds Mr aM e.enat. d1 —ft 01 J.. wW . P° atl air :or one .aN.wb b pubge or Phot. uw mtb6 !Vmg // .7`. 2705 t3orhnm Plxe 7Ana1or. Sakm. N.C. 27106 / 9� ' 1 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 <Bill.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 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900449 _ Tax PIN/EH #: 5851-41-4827.0001E Billed To: Joe Neely wn " Subdivision Info: Reference Name: Joe F. Neely Proposed Facility: Vineyard ATC Number: 2458 Location/Address: Boger Road (Site 1)-27028 Property Size: 99.806 Acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: a x.,22 &a CERTIFICATE OF COMPETLON ** IV NOTE** The issuance of this Certificate of Completion shall indicate t sys de ibed on Improvement/ eration Permit has been installed in compliance with Article 11 of G.S. Chap r 1 OA, S ion .1900 "Sewage Trea ent and Disposal Systems," but shall in NO WAY be taken as a guar tee hat the s stem will function satisfact rily for any given period of time. i Y Septic System Installed By: Environmental Health Specialist's Signature: � � Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT /W r. Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT(OPERATION PERMIT Account #: 989900449 Tax PIN/EH #: 5851-41-4827.0001E Billed To: Joe Neely Subdivision Info: Reference Name: Joe F. Neely -*�i91�)�i9 (f„p��q�� Location/Address: Boger Road (Site 1)-27028 Proposed Facility: Vineyard Property Size: 99.806 Acres **NOTEC * 'I'lii bfmprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms �_ #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type/& P� „/ _ #People #People/Shift / #Seats Industrial Waste: ❑ Lot Size 5� Type Water Supply Design Design Wastewater Flow (GPD) -�.]-L !� Site: New Repair ❑ System Specifications: Tank Size0& GAL. Pump Tank GAL. Trench Width Rock Depth /Linear Ft,_?eP Other: & Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 ” BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** I� Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) 404V APPI-RAIION FOR SITE EVAtTiATION/IMPROVEMENT PERMIT & ArL ��Davie County Health DepartmentEnvimmenfal Health Section P.O. Box 848/210 Hospital Street]Mockaville, NC 27028 (336)751-8760 e f�Y •'xn,1P0RTANT*** THIS APPLICATION CANA'Or BE PROCESSED UNLE S ALL REQUIRED I1,VORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN or instructions. Name to be Billed AlL�GcL �' %'L�,�ir per M►�CIC� �e��N�l?�., !!ailing Address o2 %®,i 4�C7-,10rMhon. City/state/ZIP gus'ness Phone �'� d 2. name on Permit/ATC if Different than Above Hailing Address y City/State/Zip j% 3. Application For: Site Evaluation 9 Improvement Permit/ATC 1� Both 4. system to service: House ❑ Mobile Home ZBusiness ❑ Industry ❑ Other `' ` s. If Residence: # People # Bedrooms # Bathrooms VDishvasher Garbage Disposal Washing Machine Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: ii Seats Estimated stater Usage (gallons per day) 7. Type of water supply: County/City ❑ well ❑ Comramiity e. Do you anticipate additions or expansions of the facility this system is intended to serve! ❑ Yes ANo If yes, what type! ***IMPORTANT"* CLIENTS AIUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBA111TED by the client with THIS APPLICATION. M Property Dimensions: 4K'/�3i� Y-9 3/ O X D[REcnONS (from Mocksville) to PROPERTY: � Tax Office PIN: #_ �� O�� DO- S"f�5 I ,ill ��j1,27(01042e9 c -Q Property Address: Road Name City/ZipC�1 If in a Subdivision provide information, as follows: Name: SA -rg ' Section: Block: Lot: Date Property Flagged: • 0? -OW -9157 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted In this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned be t o-�' to conduct all testingproceduresas necessary to determine the site suitability. DATE I� 3 / cI SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the follo ing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) Account No. �7 Invoice No. 2 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring ✓ Pit �>11-e I LOT DATE EVALUATED A IV 19� PROPERTY SIZE AcOzS ROAD NAME N 151 Public ✓ Cut FACTORS 2 3 4 5 6 7 Landscape position L, L Sloe % 0 HORIZON I DEPTH — 0_(.0 O-7 Texture group G L G!i Consistence t S Structure G� Mineralogy; HORIZON II DEPTH - —7 -2-D Texture groupG Consistence 5 — Structure L Mineralogy HORIZON III DEPTH LM 1 Cc O - Texture group Consistence Structure Mineralogy ' HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION l� S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: Y S LONG-TERM ACCEPTANCE RATE: a REMARKS: DCHD (01-90) LEGEND Landscape Position EVALUATION BY: n, OTHER(S) PRESENT: ��7 ✓ 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 CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky. SS - Slightly 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 Mineralogy 1:1, 2:1, Mixed Notes 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(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 ■E■ ■E■ ■■E NNE ■■ ■ ■ i■llr_Nom ■llNMIflvj� ■DIM■IIMM ■■Er■■•.■ ■ SEE NNE MEN ■■■ ■ ■■OM■E■■■ME■■E■ ■■ME■E■■OMME■M■ ■■■ ■■■■MEMO■■ ■■■�■■M■E■OMM■ ■E■MOM■EMMEMM■■ ■E■■E■■MME■MEM■ ■OM■■E■■EM■■ME■ ■■M■■E■■M■M■■E■ ■■EMMEM■E■E■■M■ ■■M■■M■MOMM■■M■ ■■MUMM■M■MEMM■ ■■■ ■E■E■MEME■ ■■M■■MEM■■■E■■■ ■■OM■■ME■EMEM■■ ■E■MOMMOMM■■■O■ ■E■■E■MEME■■E■■ ■OM■■M■■EM■■ME■ ■ME■■M■■EMM■■M■ ■M■ ■EMEMEM■E■ ■■n EMMM■E■■E■ ■■ME■■■■■■MEM■■ ■■■MMMM■M■■M■■■ ■■■■M■EMM■■E■■■ ■EMME■■E■E■■E■■ ■E■M■■■MME■EME■ ■EMMME■M■M■■ME■ ■■MUM■■EME■■E■ ■■■ ■■■■ME■■E■ ■E■E■ ■E■■■ ■E■■■ ■E■E■ ■E■E■ ■■N■■ ■■■E■ ■■E■ ■■■■ ■■■■ ■■■■■■■■■■■■■■■■■■ iiO9'iliil■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■ ■■■■■■ ■■■■■ ENE M■■■EN■OM■■ i■ME■ME■■■EM■■■EM■ ■■■M■MM■■■■MM■■MM■ ■■■MEMS■■■■EM■■MM■ ■E■■■■■■■■■ME■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■MOs■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MONS■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■M■■M■■■■■■■■■■N■■■■■■■■■EMM■■ ■■■■■■■■M■■■■■■N■NN■N■■NMN■■■■■N■■■■N■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■MA■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■NN�i■\J�■nil,>r■■■■■■■■■■■■■■■■■■■■■■■■E■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ d• 01. • 750 �� f� ' ' l 'D� ^ Cp CF q rAA, M 747 `,� P,d•tr -'/ 740 \ `�K80.42•00••E 299. {• \ pm \ De iic r �O 8 A79 2S p \ MqR os> T 66 0 \ it ^ X� 26 �\ Dg 0� pGR 17 IV 27 78 oo,• '4z•8 \ \ 760 O ` _ _ \ V� '?0• ^� 29 \ 30 ^° _ 770 \ P90 \ _ m 790 L 4 100, �• � � , � s _� ;>S \ \ \ X60 / 'W� 3¢ .30 R N ch 170. o• 4a• � 8-4 "Ion ;14 0 1 4 � • DORO P,qR� f� � Da ROS,, 48 ` 02 PG ? 6�3 . ,a� y Davie Count v Neal th Department Environmental Nealth Section PO Box 848 / 210 Hospital Street Mocksville, NC 27028 Phone. (336)751-8760 March 22, 1999 Joe Neely 2705 Bartram Place Winston-Salem, NC 27106 Re: 2 Site Evaluations - 100 Acre Tract/ Hwy 158 & Boger Rd Tax PIN #: 5851-41-4827 Dear Mr. Neely: As requested, a representative from this office visited the aforementioned site(s) on March 18 and March 19, 1999. Based on the information provided on the Application for Site Evaluation and after the evaluations were completed, both sites were found to be provisionally suitable for the installation of an on-site sewage disposal system. **SPECIAL NOTE: Based on the evaluations performed, Site I(Closer to Highway 15 8) will require approximately 540 linear feet of tail line for a four bedroom house and Site 2(Closer to Interstate 40) will require approximately 640 linear feet. These are subject to change and actual dimensions of the septic drain field will be determined at the time a permit is issued. Once you have decided which site you will build on, please contact our office. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, you may contact our office at (336)751-8760. Sincerely, Jeff G. Beauchamp, R.S. Environmental Health Section enc(s) Parcel #: F600000050Q1 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Prooerty Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: F60000005001 Account #:82532543 Owner Information I Tax Codes NEELY JOSEPH F & JOYCE R & PRUDEN H.N.& JOHNSON R.J.N ADVLTAX - COUNTY T /O JOSEPH F NEELY FIREADVLTAX - FIRE TAX INSTON SALEM NC 27106 1,714,15( Property Information r Township Land (Units/Type): 110.590 AC FARMINGTON ddress: 137 BOGER RD 1,669,24 Deed Information Local Zonin Date: 12/2010 Book: 00746 Page: 0749 00314 Plat Book: Page: 09 Le al Description PIN HWY 158 58551426077 Property Values Book Building: Month BXF: 59 Land: 1,714,15( Market: 1,714,74( ssessed• 45,50( Deferred: 1,669,24 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00182 0689 09 1995 WD Unqualified Vacant 0 2 00314 0699 09 1999 WD Unqualified Vacant 72,000 3 00733 0579 10 2007 WD Unqualified Improved 0 4 00746 0749 12 2010 WD Unqualified Improved 0 5 00211 0693 04 1999 WD Qualified Vacant 500,000 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 o��rF t� -0UR� Davie County Web Site All information on this site is prepared for the Inventory of real property found within Davie County. All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County, its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or implied, in fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnet/View.aspx?prid=962316 6/8/2016