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670 Wyo Rd . • ' � DAVIE COUNTY ENVIRONMENTAL HEALTH � P.O.Box 848/210 Hospital Street ' Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 �n 1 5�� L-1�-e'e- � � ��e`r�"vl7t ERATION PERMIT � �- Lll��Pl t�r" Account #: 990005178 � Tax PIN/EH#: 5843-15-8112 Billed To: Morton Buildings Inc. Subdivision Info: Reference Name:�-fy�j I11A.f�a�i 2 I�IiCk0�5�aW►�) Location/Address: 670 Wyo Road-27028 Proposed Facility: Wine Tasting Facility Property Size: 53.272 Acres ATC Number: 4920 **NOTE**The issuance of this Operation Pernut 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�function satisfactorily for a�}y given period of t�e. . ` ��a �J �� d System Type. // S.T.Manufacturer�i Tank Date / Tank Size_� v Pump Tank Size___ '�6'/1L !, /� �7 � � 4,k.0 �� System Installed By: .Specialist: � Date: � -�� \ ' � �/ �j,C� � / � ,�b� TG �a �lf�V G�v , � / / �' ;� I- r5"�ti � �� a , ,..- 3 l o ; \, �; P��c� ��, L� 0�� , � , �� a� � � Y I ,�, �� , 4 la ( � �� 8 , . � �ty . � � � �,� �� ` 1 r� \ � � DCHD 11/06(Revised) , � . Pd o� , DAVIE COUI�TTY ENVIRONMENTAL HEALTH tnq�1 P.O. Box 848/210 Hospital Street 1� Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR�VASTE�VATER SYSTENi CONSTRUCTTON Account #: 990005178 Tax PIN/EH#: 5843-15-8112 . Billed To: Morton Buildings Inc. Subdivision Info: Reference Name: , Location/Address: 670 Wyo Road-27028 Proposed Facility: Wine Tasting Facility Property Size: 53.272 Acres ATC Number`. 4920 Site Type: 8�w ❑Repair ❑Expansion *�NOTE**This Authorization to Constnict(ATC)MiJST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building pernut(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 Basement❑ Basement plumbing❑ �a s I,'.� ��+'G�� Non-Residential Specifications: Facility Type ��'� �People �Seats �� Square Footage(or Dimensions of Facility) a, (�S� Lot Size / • a-'aC1`PS Type of Water Supply: C'1""County/City ❑Well ❑Community Well $ystem Specifications: Design Wastewater Flow(GPD) Tank Size �d0�AL.Pump Tank��l- "AL. / �� - �/37 �o-� Trench Width 3 lD Max.Trench Depth 3 L�Rock Depth�/�'� Linear Ft. ,�5 :,[�3ied i� 151� NCr1C 1u"�.��i�� .��-�o��id✓� SiteModifications/Conditions/Other: ,.�,,.,�, �.L..-..r- „�,.,, s.,, ,��:<_.. .,.,�,T-' _,_.r�. �. +�. Contact the Davie County Environmental Health Section for final inspection of this system between 8:30-9:30a.m.on the da of installation. Tele hone# 336 751-8760. _ _ ` � - __ � � � \ \ .Y � � � \ � � � � � � ti� —� d � � � ��„n.tr'y o . J` . � s \/ p�� /l �( � Q�/ � V � � 3 � -� P O� � _�j �� 1� ' _—__ G, ,e�__�_ o Envuonmental Health Specialist �� Date: /� "� / —C/U ..nrrr� ,�ini/n.._.:.....7\ � . . � . ` , . Davie County Environmental Health . - P.O.Box 848/210 Hospital Street � ` Mocksville,NC 27028 � (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990005178 Tax PIN/EH#: 5843-15-8112 Billed To: Morton Buildings Inc. Subdivision Info: Address: 615 US Hwy 64 East Location/Address: 670 Wyo Road-27028 City: Lexington Property Size: 53.272 Acres Reference Name: Proposed Facility: Wine Tasting Facility **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. Pernut Type: ew ORepair ❑Expansion Pernut Valid for: 0'�ears ONo Expiration Residential Specifications: #Bedrooms #Bathrooms #Peo le Basement� Basement plumbing❑ Non-Residential Specifications: Facility Type ��N��G's��^5 �Peo�� #Seats �� X 3 u��S.e�„'T- Square Footage(or Dimensions of Facility)—'�Cv o y Desig�Flow(GPD): �� Type of Water Supply: Q"County/City OWell ❑Community Well Site Modifications/Pernut Conditions: �`e5 sta4ed in 15I� PJ�r1C 1.�'i,^�.1�u�;S) i:i.(:��7i �y�i�iiT��Tii�y c'J.iSv u:; ua�,�.e S stem T e LTAR Initial ` „ Q. Re air �,�?o Q-rcl�..e`��`v►1 C'�' • �- Site Plan 3t0 � /�� , _- _ / � _ � _ ` , � . � �a� �� _ �53�� l � � � �q / I ("`� ^ - ,�p ��C'''1 ��.�/ �\ `�/ � ,` � / � � `�_`��/ �i a� �� +1 i �� ti � JJ J':u �� 1 \ u � � �O _ \ � � a N��.�.s� � Environmental Health Specialist Date f O � i.p.l 1-06 - � . 10 f i9/b� ;h� �o �ue%p�n� .S,�rv�c�s ,, .�, v�Ih�eN � � - tSPPL TE EVALUATION/IMPROVEMENT PERMIT & ATC �,r,p l�� Lr�.,,, � '�, '�` avie County Environmental Health �Q� ,: � �� . - P.O.Box 848/210 Hospital Street ,�., ,� 0 2 Q O$ Moc ksvi l le,N C 2 7 0 2 8 �� Ie-�'� ' QC� . (336)751-8760/Fax(336)751-8786 �I yY�Q ' �. ��SN ',..� � Application `I�o�:. , �,,;�;u��t;��on/I nent Permit ❑ Authorization To Construct(ATC) ❑ Both Type o�Applicati��i":' �;N ,v, em ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IM ORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed��4�rl,✓�v,,/diiy��f/C. Contact Person .-�e.��N ��-'/��<'i�� Billing Address(�/S[;, J/�.;,�Y Home Phone 33F_-Z•��f-O`/ d �ity/State/ZII' L� �ivt�iy _ J�G ,,� 72�i�- BusinessPhone >3�—S�i�Ci"37Z`� Name on PermiUATC if Diffe�-e�zt than Above t�J:/'' 1 G�0 I S Mailing Address (1 )U j,tJ K � City/State/Zip �� J'�r e� [C ��'�' PROPERTY INFORMATION *Date House/Facility Corners Flagged j� �i�s" NOTE: A survey piat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Pernut is�valid for 60 onths with site plan,no expiration with complete plat.) 331c"�7��'�2� Owner's Name t�;+ c ,s Phone I�Tumber�-8f( '�13�yy/�( Owner'sAddress ' (/�!; l`� City/Stat /Zip�%'LUt�G�'�i��w i'lC Z�G��' Property Address (l?�p�,�,Te �E" City /fj�¢��,,^l�� Lot Size Tax PIN# ,��y3 1�— �/I Z Subdivision Name(if applicable) Section/Lot# � Directions To Site: I�wT C� N ��,,.��`�..�;�,T%n.�!Tfv�i�� r� L��/� �� 3r��e t��'��c-�'-� If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systen�s on the site? ❑Yes�No Does the site contain jurisdictional wetlands? ❑Yes,�No Are there any easements or right-of-ways on the site? ❑Yes pNo Is tfie site subject to approval by another public agency? ❑Yes,BNo Will wastewater other than domestic sewage be generated? ❑Yes�7No IF R�SIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms Garden TuU/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBusiness LuiNp%�;sl N�F�t, ;1 Total Square Footage of Building�/(��) #People # Sinks�_ #Commodes�_ #Showers G #Urinals 4 Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested:,�(Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water fk�(New Well ❑Existing Well ❑ Conununity Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes (,�'1 No If yes,what type? This is to certify that the infornzation provided on this application is h-ue and correct to the best of my kno�vledge. I w�derstand that , any pernzit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes, or if the inforn�ation submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Deparhnent to conduct necessary inspections to deterrnine compliance with applicable laws and�niles. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or staking the ouse/facility location,proposed well location and the location of any other amenities. ` �� Site Revisit Charge Pr erty owner's or owner's legal representative signature Date(s): fd (D O� Client Notification Date: Dat EHS: Sign given ❑Yes ❑No Account# �� Revised 11/06 Invoice# �� ' � �U DAiCKZ D. N1VriVLJ 1L7—LO3/6 /�� ✓�t� _______________�__.___ GQ(J !/� \�� ---_._._.._ �,G S `\` � A.C. � Elec.Pnl. M.B. � 0� �- ;-- ---; ---, Go . Twin 3060 Twin 3060 �8 Twin 3060 Twin 3060 �� • '--'� �`�- ' -------------------------------------------- -------------- Mens ;— "�� Womens ��_-�� nl Display Area � �� _ % / -�\068 36'x 45'Winery Area �� G x 5'Fireplace 15 Cieling Hieght — II �� 2�X 3��POfCfI 6'x8' �1 --, g�Xg� � � Cleanup� ^ Mech.Rm. '�\_;�� ( lis`i'\7 � Display,Area �---1 � � 8'Checkout Counter 12'x 10'Offce „ � � „ �� i � i ---------=---------------------==----, I � 3060 3060 6068 I 3060 . �\\ 8'x 20'Porch 8'x 20'Porch ' 16'x 12'Gabie Porch . , , , „ , , „ „ - ,. . .,,- , . • , ..., „„ , � � •-----------------------------------------------------------=,. , �-------------------------------------------------------------•� , , , ----------------------------------------------------------------; ; , • --_:__-=----:-____:-_ -______:--___:_:__::-_______ --- --- ---------- -- -------- ---- --------- � ,, , � - --------------------------------------- ------------------------------ � �, , , , ; , , , , ,, , , , , , ., ,� � , , , ,, � � ' �----------------•-----------------------------� � �� crz:z � ,; , ,; , , , - �, , , ,; � � �-------------------------------------------------- �� ._._. . .__.__.. , ,.__. � . '�---- . . . ------------------------------ . _._ •-------------------------------------- ------------- . ---------------- _.... . . �-._ . . . _,- - .,.. ..___._ f f_. � ;�,�,,, . ; . ..._.__..__ p .�..:__. . �,. 1 , . - - --__ 5-��,� �JA i z�: t�I!L�01� 1 ac Nem�ce' .Ra 4�3;:0' Ar.le Fr,o ^�,,. �_.,,_„_ . r�� . �� „�...�.�..r-�' f� . . 7 �_- � . . � . ' . . . � . � �� Tax Lat 9.01, Tax Map -5 nif 8arry t�{icho{s & wif Kathleen D. Nichcis --�-~' ,;,; & 8ernice Marjorie Ncr h Nichots �''' � N. � FtB 423 � PG 283 - , ��r.� "_' � m 3�a' � �' �� __�-,—�-''*� 4 ` �"' Tax Lot i 13, Tax lNaa 6-5 ti: . .�_'Z *v Barry Nichols & wife Kathleen D. Nicheis ' ,�� & Btmice �Sarjorie Harrah Nichols w � R`y�r . ��,..�� R8 423 � PG 283 & P8 8 � PG 24 � �� ► � � cT �`-" �6 ��"� /—.., *z� �' � '`\ t �- , so /a' N r � 3�� , ,� .� _, -� o � —PK—��cii Fr,d g CL S.R. 143C i��—��`~� � TaX LO� 9.01, TaX �-5 n �=' � �-t 1� � Pcir,t I �-f�'' ,-~ - - ` ,J n/f Ba r r y Nich 4s 8c w�Kath{een {1. ichois o °' T v . , :--�'`-_ _:_-'"��E�=�-4'�_ � k 8ernice Marj� �e F-tar r a�Nichois t 5.oa� A to e �; � r, �'" /--"� '%� �� ` RS 423 � PG �8 � !RS Foirt A � � n � . _�"_- -�-=�"� � F4",�,. cc _ i��r' � � - � � � `�� . Gona L-1 - �l �. , Drne A to E n . � j �12'+j— Privote Grovel Qrive � NMP Point G �� J �. f�) `� .\ � �'� -� . Tox Lot 9.Oi, Tax Map B-5 \� � � �' G�o G a�.s' tiouse _ p n f f Barry Nichois ac wife Kathieen D. Nichois �`.;,-�\ t z +/- P��w e Grcrvei Orive '��,' F;�� _ ; r & Bemice �Sarjorie Harrah Nichols �.�► ��` ' �� . � RB 423 � PG 283 E;�� - ' =;'^--..�_ .', �� .�+�j �----�.2• '�=.=�'"�-.�`_�--+~_ _"�-,� ��,�� , o� � !� f�9-' '�-_._^---�__ _� ' F,�"` °'-� '� /2" ETR Fnd t➢ East EP S.R. 143� �` y ^~!��'�� IRS Point F �`� � Point N ` F t�� E� CG ' CENTERL1�fE £_,, t2 .,�, REVISED 25' ACCESS EASEMENT - - (See Easerrtent Ca(S T�ble) . — Foce of Curt+ • ' � DAVIE COUNTY HEALTH DEPARTMENT • � ' � Environmental Health Section • Soil/Site Eyaluation APPLICANT INFORMATION �ROPERTY INFORMATION Account #: 990005178 Tax PIN/EH#: 5843-15-8112 Billed To: Morton Buildings Inc. Subdivision Info: Reference Name: Location/Address: 670 Wyo Road-27028 Proposed Facility: Wine Tasting Facility Property Size: 53.272 Acres Date Evaluated: � G Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition L.. Slope% HORIZON I DEPTH ��" Texture grou Consistence S tructure Mineralo HORIZON II DEPTH Texture rou Consistence Structure Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE . SITE CLASSIFICATION: EVALUATION BY: �/r � LONG-TERM ACCEPTANCE RATE: ' � OTHER(S)PRESENT: .��" REMARKS: f LEGEND i.andscape 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 T�xiur� 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 � a, SC-Sandy clay SIC-Silty clay C-Clay O� � r� �� CON�ISTENCF. I l (� VFR-Very friable FR-Friable FT-Firm VFI-Very firm EFI-Extremely firm �d � I�� ` �s � r,�� ,�,g � NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky y��`I G NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic �v �� / � �r> >r d � SC -Single grain M -Massive CR-Crumb GR-Granulaz ABK-Angular blocky � � SBK-Subangular blocky PL-Platy PR-Prismatic �� Mineralogv 1:1,2:1,Mixed � LY41�.� � 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-gaUday/ft2 DCHD OS/OS(Revised) � , � �� C� C� � ONJC�, ip; � � � Davie County Health Depart� � T:� \) �� ,�#��; � ` APR 1 5 2�"�� ,�� , ;�,'�' ��, Environmental Health Secti n �� '=4� �� , �;__. � ��f �,�� ,�=r ;� -�� ,. �� : � ,� Mc��r ��t �-�: p.o. so� s�.s , �,�f�Kt �� , �__ ENVIRONMEN? --EAL� _ , �-�t��;� �. � `; '` .��',� a.� (Q��' �.1,�5 1�1'�►y �y 210 Hospitzl Street DANECO ��.�<z,''�,„� - ¢ �,`. � � C� r�. �' ��C,, 2�Z`�Z Courier# : 09-4�0-06 p f � ,� �" �ZX inc�•'►1,NL ' ,,"�'` . �-`�'.,��.:`��'�� J Mocksville, NC 27028 ��.�_,�.,�"w� t�lG��lz�v� �U��1 c1'��nc�S �°., n' �k� 1'lione:(336) -753-6780 P'ax:(336) -753-1680 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Name: , ..Q�"��/ /�,�,�,`j,d f S Phone Number,�.�(,�—�`/.� `�g� � (Home) Mailing Address: � C� _ (Work) G� � Z 7C�Z� � � -f� �-- p / Detailed Directions To Site:��i �O/ �/'C.�! �f L'��syt,�v�.�16�t1 L D /�I�GG� �'7^ (,�t�(/Cj !�� l. 3.►�• i s� % �,��:L�- Property Address: �j 7�) \l�'Vr) Ie� Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: � Type Of Facility: �i�'t.i;'� Date System Installed(Month/Date/Year): � U� Number Of Bedrooms:�Number Of People: S��r.� Is'The Facility Currently Vacant? Yes � If Yes,For How Long? Any Known Problems? Yes No If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: A'�C Jr h�{,^ Number Of Bedrooms: � I� Number of People � ��"�} Requested By: Date Requested:��Ca � S�� gnature) For Envir�nmental Health Office Use Only ��X �,Il��N. e��✓v��}�, Approved isapproved `�i3en�+��'�331t��j(p-3�Z�-� Gs��r �� 3� • z��'G.Sa et,�n�t c}�C, 7 L � �� Comments: � �! :'J � � � 4'�s � � � r S'�C ��T;s.�. Environmental Health Specialist d Date: ' "� *The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee (extended or limited)that the on-site wastewater system will function properly for any given period of time. Payment: Cash hec MoneyOrder # Z,�� Amount:$ /�'G!� Date: �/•�'�� Paid By: Received By: � Account#: ,�Ta6 Invoice#: � Zg� '� �a�.�d -b �e,v.s.e�c�s � +� �D{,� �a,r,�c� �t�z�-�u a�