WQ0031015_Application (FTSE)_20200507

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0300 - FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
22 r� 04loyb5'c,Gti'tU(
Application Number: d J� i��iJ� 1 "GOo he cm„p�eted by UwR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Meadowlands Development, LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: C.J. Ramey per I5A NCAC 02T .0106 t
Title: Manaein2 Partner
4. Applicant's mailing address: P.O. Box 10
City: Bethania State: NC Zip: 27010-
5. Applicant's contact information:
Phone number: (3333 ) 922-4000 Email Address: petera mev(Gueardilink.net
II. PROJECT INFORMATION:
1. Project name: Meadowlands Subdivision - Phases 7 & 8
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: W00031015 and issued date: 11/14/2006
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Davidson
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.007555` Longitude:-SO.163010'`
5. Parcel ID (if applicable): 6852-04-51-7119
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: James L. Walters License Number: 18584
Firm: Latham -Walters Engineering, Inc
Mailing address: 16507-A Northeross Drive
City: Huntersville
Phone number: [phone]
State: NC Zip: 28078
Email Address: jun akhvengineer.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
L Facility Name: Archie Elledge WWTF Permit Number: NC 0037834
Owner Name: Winston-Salem / Forsyth County Utility Commission
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. PermitNumber(s): WQ0024206 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Numbert's]Sif a12L7licable : WQCS00003
Owner Name(s): Winston-Salem / Forsyth County Utility Commission
FORM: ETA 04-16 Page l of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®N/A
2. Ifthe Applicant is a Developer of lots to be sold, has a Develo �er's Operational Agreement (FORM:: D[,V) been attached?
® Yes ❑No ❑N/A
3. If the Applicant is a home/Property Owners' Association, has an Oational emem(FORNL I IOA), been attached?
❑ Yes [:]No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (,Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Couunercial % Commercial
_ % Industrial See 15A NCAC 02T .010120))
"Is there a Pretreatment Program in effect'? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ® Yes ❑ No
➢ if yes, provide a copv of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f1)
Daily Design Flow iyb
No. of Units
Flow
Residential - Single Family
300 gal/unit
109
32,700 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gat/
GPD
gal/
GPD
Tutu(
32,700 GPD
a See 15A NCAC 02T_0114(b) (d). (e�C1h1nd-(eZLJ for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02"f_01 I4] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
S. Wastewater generated by project: 32700 GPD (per 15A NCAC; 02T._01.14)
➢ Do not include future flows or previously pennitted allocations
If pennitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain): _
FORM: FTA 04-16 Page 2 of

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) 7 Length (feet) Material
8 9744 PVC
➢ Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIIL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Fm ce Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude:
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) FLength (feet) Material
6, Power reliability in accordance with 15A NCAC 02T :0305(h1(l):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)('13);.
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per clay:
❑ Portable power source with manual activation, quid. -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump correction and telemetry - 15A NCAC 02T ,0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the potable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timefrannes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02'r .0;02(f1 &Icy ®Yes ❑ No
➢ 15A NCAC 02T.0305(t) contains minimum separations that shall be provided for sewers stems:
Setback Parameter*
11 Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewer including in benched trenches
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over, sewer)
2 feet
**Any private or public water supply source, including any wells, W S-I waters of Class I of -
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Tom slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ 15A NCAC 02T.0305W contains alternatives where separations in 02T.0305(t) cannot be achieved.
➢ **Str'earm classifications can be identified using the Division's NC Surface Water Classifications wchpage
➢ If noncompliance with 02T.0305(f) or (g). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ®N/A
➢ Seethe Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NC-M 02B .02007 ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained From the 401 & Buffer Permitting, Branch
5. Does project comply with 15A NCAC 02T_0105(c)!6) (additional permits/certifications)? ® Yes [:]No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sednnentation control plans, stornwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402 "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material. and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
NO Yes ❑❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Approval of the request is required prior to submittal of the Fast Track Application and supporting_
documents.
2. Professional Engineer's Certification:
that this application for
(Professional Engineer's name from Application Item I11.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain
portions of this submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this
material and have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6E, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, C.J. Ramey Managing Partner attest that this application for
(Signature Authority's name & title from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a
condition of this permit be violated. I also understand that if all required parts of this application package are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to
me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6E, arty person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:` / �"'"f Date:
FORM: FTA 04-16 Page 9 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Meadowlands Development, LLC
Project Name for which flow is being requested: 12433 Meadowlands -Phases 7 & 8
More than one FTSE maybe required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposer! wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: ARCHIE ELLEDGE
b. WWTP Facility Permit #: NC0037834
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
A11 flows are in MGD
30.000000
2.065412
19.320000
0.003300
21.399062
71.3%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
Pump
Pump
Station
Station
Firm
(Name or
Permit
Capacity,
Number)
No.
MGD
South Fork
14.400000
(A)
(B)
(C)
(D)i(B+C)
(E)=(A-D)
Design
Obligated,
Average
Approx.
Not Yet
Total Current
Daily Flow**
Current
Tributary
Flow Plus
(Firm / p fl,
Avg. Daily
Daily Flow,
Obligated
Available
MGD
Flow, MGD
MGD
Flow
Capacity***
14.400000
6.733753
0.171644
6.905397
7.494603
The South Fork Lift Station operates as a basin transfer station. Staff is capable of allowing peak flows to bypass the station and flow to the Lower
Muddy Creek WWTP by gravity. Therefore, no peaking factor is used when determining design average daily flow.
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Archie Elledge
Downstream Permit Number: WQCS00003
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Courtney Driver, P.E. certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
7l'/�ciGa ee 5-66A" 4-29-2020
Signing Official Signature Date
Assistant Utilities Director
Title of Signing Official
Page 2 of 6
FTSE 10-18

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Meadowlands Development, LLC
Project Name for which flow is being requested: Meadowlands Subdivision -Phases 7 & 8
More than one FTSE reay be required fo• a single prafect if the owner of the WWTP is not r•esporsiGle, jnr trl! pump
stations along the route gl'the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit #:
All flows are in IIGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f Total flow for this specific request
g. Total actual and obligated flows to the facility
It, Percent of permitted flow used
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
Pump
Pump
Station
Station
(Name or
Permit
Number)
No.
(A)
Design
Average
Daily
Firm Flow"
Capacity, * (Firm / pf),
MGD MGD
Main 41 WQ0024206 0.496 0.1984
(B)
Approx.
Current
Avg. Daily
Flow,
MGD
.0083
(C)
(D)=(B+C) (E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flova Plus
Daily Flow,
Obligated Available
MGD
Plow Capacity""
.0584 0.0667 0. 13 17
PS #2 WQ0024206 0.202 0.0808 .0029 .0231 0.0260 0.0548
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is <0.
Downstream Facility Name (Sewer): Archie Elledge
Downstream Permit Number: WQCS00003
Page 1 of 6
I TSL 10- 13

III. Certification Statement:
I James L. Walters, P.E. certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has-Oequate capacity to transport and treat the proposed new wastewater.
Title of Signing
Date
Page 2 of 6
FTSE 10-18
'2oZJ

ZoO3•a4
`oaoF wa 7fi9oc
Michael F. Easley, Governor
y William G. Ross Jr., Secretary
C North Carolina Department of Environment and Natural Resources
-i
O kokw Alan W. Klimek, P.E., Director
Division of Water Quality
February 28, 2005
Mr. Pete Ramey, Managing Partner
Meadowlands Development, LLC
P.O. Box 410
Bethania, North Carolina 27010
Subject: Meadowlands Subdivision
WQ0024206
Flow Reduction Approval
Davidson County
Dear Mr. Ramey:
On January 11, 2005, the Division of Water Quality received a flow reduction request via your
consulting engineer, Mr. Jim Walters, for the subject project consisting of 170 3-bedroom residences.
The letter requests an allowable flow rate of 240 GPD per dwelling based on the evaluated data for a
similar existing subdivision. The flow reduction will allow for a smaller pump in the development
which will eliminate some possible surcharging in the line as modeled by the receiving utility.
Information was provided by Winston -Salem -Forsyth County City/County Utilities that
summarized the water usage data for 64 lots in the Whitmore Subdivision between April 2003 and
February 2004 (ten months). The homes in this subdivision range from 2 — 5 bedrooms. The peak
month selected to evaluate was taken from the Winston-Salem Archie Elledge wastewater treatment
plant DMR reports over 2003 and 2004. April 2003 was the highest average flow month for the plant.
The average flow per home based on water usage records for the entire flow evaluation period is 220
GPD based on 3.8 bedrooms average and assuming 100% water/sewer ratio. For the peak month,
water usage averaged 236 gpd per 3.8 bedrooms (note that there was one lot with zero consumption
that was included in the calculation. Removing that and using 63 values, the average is 240 gpd.).
There is one swimming pool that was not included in the calculations.
The Whitmore subdivision and its collection basin is not currently built out and is fairly new. It
is assumed that inflow/infiltration is not a significant factor in the collection system and that any
irrigation accounted for in the water consumption values will balance out. However, 15A NCAC 2H
.0219(I)(3) requires that the top 10% actual daily values be averaged. Since the data provided was
not actual daily readings, additional conservativeness is necessary. Downstream capacity is of issue
in our state, the Division does not wish to promote capacity issues by granting flow reductions that
allow additional growth based on data that is not in complete accordance with 15A NCAC 2H
0219(I)(3). Measured daily values, whether on water usage or wastewater flows, are critical to our
decisions on flow reductions. Due to unknown actual daily readings, the Division will apply a 1.25
safety factor to the flow rate desired which equates to 300 gallons per day per single family
residence. When discussed with your engineer, he proposed that value for single family homes and
240 gpd for the townhomes and villas, which most are expected to be two bedrooms.
One Pretreatment, Emergency Response and Collection Systems Unit Internet http;Hh2o.enr.nc.state.us/ndpu
NorthCarolina 1617 Mail Service Center, Raleigh, NC 27699-1617 An Equal opportunity Action Employer
Nahaniy//f Telephone [phone] Fax [phone]%recycled/10% post -consumer paper

Mr. Ramey
February 28, 2005
Page
The Division hereby approves the use of 300 GPD per single family home and 240 GPD for
the multi -family units in all applicable non -discharge permit applications for only the Meadowlands
Subdivision. Regardless of the adiusted design daily wastewater flow rate, at no time shall the
A permit modification and fee is required to
flows have been allocated.
to any existing permits where
If you have any questions or comments regarding this matter, please contact Marie Doklovic
at [phone] ext. 371.
Sincerely,
i ===Zh�
Alan W. Klimek, P.E.
cc: Steve Mauney, Winston-Salem Regional Office
Jim Walters, PE, Latham -Walters Engineering (15507-A Nortbcross Drive, Huntersville, NC 28078)
PERCS Flow Reduction File

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Phase 7
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LATHAM WALTERS ENGINEERING, INC.
CIVIL ENGINEERING LAND PLANNING SITE DEVELOPMENT
L flf- 16507 A NORTHCROSS DRIVE
HUNTERSVILLE, NC 28078
April 28, 2020
Attn: Justin Henderson
NCDEQ — Winston-Salem Regional Office
450 W. Hanes Mill Rd.
Winston-Salem, NC 27105
Project Name: Meadowlands Subdivision — Phases 7 & 8
Subject: Permit Modification for WQ0031015
Justin,
We are submitting a request for modification to permit #W00031015 dated 11/14/2006. This
permit was obtained prior to the 2008 downturn and only a portion was developed. The
currently redesigned layout has an additional 11 lots. I have made a bullet list of updates we
would like to have addressed..
Length of lines change from 91931.E to 87441.f.
Number of lots permitted from 98 lots @ 300 gpd to 109 single family homes @ 300
gpd. Flow increases from 29,400 gpd to 32,700 gpd. (The flow reduction for
Meadowlands states 300 gpd per single family residence and 240 for townhom:es.)
Just note that a CPCN has been included with this submittal since Meadowlands
Development, LLC is a public utility. No Developers Operational agreement or HOA
documentation is included.
Please do not hesitate to call or email me if there are any questions. I can be reached at
[e-mail] or 704-577-2695.
Latham -Walters Engineering, Inc.
Meredith Hammill
PHONE: [phone]
MEREDITH@LW ENGINEER.COM

LATHAM-WALTERS ENGINEERING, INC.
16507-A Northcross Drive it <: 0eparfrnent of
Huntersville, North Carolina 28078 Environmental Quality
Ph [phone] Fax [phone] Received
[e-mail] V`,f"Y 0 7 2 4J
LETTER OF TRANSMITTAL Winston-Salem
Regional Office
To: NCDEO -Division of Water Resources
Winston-Salem Regional Office
Address: 450 W. Hanes Mill Rd., Suite 300
Winston-Salem, NC 27105
Job No.: 2018.17
From: Meredith Hammill
Date: May 5, 2020
Re: Meadowlands Subdivision — Phases 7 & 8
We are sending you: X attached
via
The following items:
specifications
under separate cover
copy of letter _x_submittal package
Copies
Date
No.
Description
1
5/5/20
5
Fast Track Sewer Application modification request)
1
5/l/20
1
$480 application fee check payable to NCDEQ
1
4/15/20
1
Meadowlands Development, LLC Annual Report filed w/ SoS
1
4/29/20
2
FTSE from the City of WS
1
4/28/20
2
FTSE for Meadowlands PS's
1
2020
1 1
8.5xl 1 color 7.5 min. USGS To o with site and waterbodies
1
2020
1
8.5x11 street level ma
1
11/22/05
5
CPCN for Meadowlands Development, LLC
1
4/29/20
1
Flow allocation letter from Davidson Co.
1
4/29/20
1
Flow acceptance letter from the City of WS Utilities
1
2/28/05
1
Flow reduction approval letter
1
4/28/20
1
Letter outlining modification items
1 11/1410ty (v Ori5iinc l pere+i+(c&p4) l. aV03101-
THESE ARE TRANSMITTED as checked below:
✓ For approval o Approved as submitted
o For your use o Approved as noted
o As requested o Returned as corrections
o For review and comment o Forms for signatures & submittal
Remarks:
Meadowlands Development, LLC is requesting a modification to permit W00031015. The
project name is "Meadowlands Subdivision — Phases 7 & 8". In 2006, this section consisted of 98
lots @ 300 gpd for a total flow of 29,400 gpd but the lot count has increased by 11 for a total of
109 lots @ 300 gpd for a total flow of 32,700. The project is located in Davidson Co. but effluent
will be treated at the Archie Elledge W WTP, owned by Winston / Forsyth Utility Commission. A

L.ATHAM-WALTERS ENGINEERING, INC.
16507-A Northcross Drive
Huntersville, North Carolina 28078
Ph [phone] Fax [phone]
[e-mail]
flow reduction letter for Meadowlands is attached, as is the original flow acceptance letter for the
original amount + new FTSE for 11 additional lots @ 300 = 3300 gpd.
(This permit is to serve what is now known within the development as Inverness Section 2,
Chestnut Hills Section 1, and Inverness Park.)
If you have any questions please do not hesitate to call. [phone] - Meredith Hammill

STATE OF NORTH CAROLINA
UTILITIES COMMISSION
RALEIGH
DOCKET NO. W-1259, SUB 0
BEFORE THE NORTH CAROLINA UTILITIES COMMISSION
In the Matter of
Application by Meadowlands Development, LLC, Post }
Office Box 10, Bethania, North Carolina 27010, for a ) ORDER GRANTING
Certificate of Public Convenience and Necessity to ) FRANCHISE AND
Provide Sewer Utility Service in Meadowlands ) APPROVING RATES
Subdivision in Davidson County, North Carolina, and )
for Approval of Rates )
BY THE COMMISSION: On July 25, 2005, Meadowlands Development, LLC
(Meadowlands or Applicant), filed an application with the Commission seeking a sewer
utility franchise for Meadowlands Subdivision in Davidson County, North Carolina, and for
approval of rates. The Applicant states that no customers are being served, and no other
person or utility seeks to provide the proposed service. The Applicant expects eventually
to serve 170 customers in Meadowlands Subdivision,
On the basis of the verified application and the records of the Commission, the
Commission makes the following
FINDINGS OF FACT
1. Meadowlands is properly before the Commission, seeking a Certificate of
Public Convenience and Necessity pursuant to G.S. 62-110(a) to provide sewer utility
service in Meadowlands Subdivision in Davidson County, North Carolina. This is the first
franchise sought by Meadowlands.
2. The service area covered is shown on the September 23, 2005, map drawn
by COE Forestry & Surveying and filed October 7, 2005. The area includes 170 lots in
various sections of Meadowlands Subdivision, including 42 lots in the Inverness section,
27 lots in the Medinah section, 38 lots in the Wakefield section, and 63 lots in the
Southern Woods section.
3. The Public Staff has recommended that Meadowlands be required to post a
$10,000.00 bond for Meadowlands Subdivision. Meadowlands has filed the required bond.
4. Meadowlands has the technical, managerial, and financial capacity to
provide sewer utility service in this new franchise area.

5. Meadowlands has filed all exhibits required with the application.
6. Davidson Water Company, Inc. (Davidson Water), a nonprofit membership or
consumer -owned corporation exempt from Commission regulation, will provide water
service in the Meadowlands Subdivision. Davidson Water will handle Meadowlands'
sewer billing services. Meadowlands intends to eventually turn the sewer system over to
the Homeowners Association.
7. The Meadowlands will purchase bulk wastewater treatment service from the
City of Winston-Salem.
S. On August 11, 2004, the NC Department of Environment and Natural
Resources, Division of Water Quality (DWQ), issued a Wastewater Collection System
Extension Permit No. WQ0024206 approving an eight (8) inch gravity sewer of
approximately 10,450 feet, and two (2) pump stations to serve 170 single-family
residences.
9. The $42.00 flat monthly sewer rate proposed by Meadowlands is reasonable
and should be approved.
10. Meadowlands proposed a flat monthly residential sewer rate of $42.00, a
reconnection charge of $50.00, and a tap -on fee of $500.00,
11. The $50.00 reconnection charge proposed by Meadowlands exceeds the
$15.00 reconnection charge set forth in Commission Rule R10-16(e). Meadowlands has
not proved cost justification for a reconnection charge in excess of $15.00 and has agreed
to accept the $15.00 connection charge.
12. The cost of the sewer system is being entirely recovered through the sale of
lots. Meadowlands withdrew the request for a tap -on fee.
Based upon the foregoing, the Commission is of the opinion that the $10,000 bond
and surety filed by Meadowlands should be accepted and approved, that the sewer utility
franchise requested by Meadowlands for Meadowlands Subdivision should be approved,
and that the recommended rates should be approved.
IT IS, THEREFORE, ORDERED as follows:
1. That the letter of credit filed in this proceeding, as surety for the bond in the
amount of $10,000 required by the Commission, is hereby accepted and approved.
2. That Meadowlands Development, LLC, is granted a certificate of public
convenience and necessity to provide sewer utility service in Meadowlands Subdivision, in
Davidson County, North Carolina. The franchise service area covers 170 lots shown on
the map filed with the Commission on October 7, 2005.

3. That Appendix A constitutes the Certificate of Public Convenience and
Necessity.
4. That the Schedule of Rates attached hereto as Appendix B is approved, and
deemed filed with the Commission pursuant to G.S. 62-138.
5. That Meadowlands shall maintain its books and records so that all
information required in the prescribed annual report to the Commission will be readily
identified from its books and records.
ISSUED BY ORDER OF THE COMMISSION.
This the 22nd day of November, 2005.
NORTH CAROLINA UTILITIES COMMISSION
rb„2105.02 Patricia Swenson, Deputy Clerk
3

STATE OF NORTH CAROLINA
UTILITIES COMMISSION
RALEIGH
,
DOCKET NO. W-1259, SUB 0
BEFORE THE NORTH CAROLINA UTILITIES COMMISSION
MEADOWLANDS DEVELOPMENT, L LC
is granted this
CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
to provide sewer utility service
in
MEADOWLANDS SUBDIVISION
(including the following sections)
SECTION
LOTS
Inverness
42
Medinah
27
Wakefield
38
Southern Woods
63
Davidson County, North Carolina
subject to any orders, rules, regulations,
and conditions now or hereafter lawfully made
by the North Carolina Utilities Commission.
ISSUED BY ORDER OF THE COMMISSION.
This the 22nd day of November, 2005.
NORTH CAROLINA UTILITIES COMMISSION
Patricia Swenson, Deputy Clerk

APPENDIX B
SCHEDULE OF RATES
for
MEADOWLANDS DEVELOPMENT. LLC
for providing sewer service in
MEADOWLANDS SUBDIVISION
Davidson County, North Carolina
Sewer Utility Service:
Flat monthly residential rate $42.00
Reconnection Charges:
If sewer service is cut off by utility for good cause $15.00
If sewer service cut off by utility at customer's request $15.00
Bills Due:
Return Check Fee:
Bills Past Due:
Billing Frequency:
Finance Charge for Late Payment:
On billing date
$25.00
15 days after billing date
Shall be monthly for service in arrears
1% per month will be applied to the unpaid
balance of all bills still past due 25 days after the
billing date
Issued in Accordance with Authority Granted by the North Carolina Utilities Commission in
Docket No. W-1259, Sub 0, on this the 22nd day of November, 2005.

a
LIMITED LIABILITY COMPANY ANNUAL REPORT101207
NAME OF LIMITED LIABILITY COMPANY: Meadowlands Development, LLC
SECRETARY OF STATE ID NUMBER: 0670719
REPORT FOR THE CALENDAR YEAR: 2020
SECTION A:
1. NAME OF REGISTERED AGENT: RAMEY, C J
2. SIGNATURE OF THE NEW REGISTERED AGENT:
STATE OF FORMATION: NC
Filed Annual Report
5/2020 09:45
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
5121 North Causeway Drive 5121 North Causeway Drive
Winston Salem, NC 27106-9695 Forsyth County Winston Salem, NC 27106-9695
SECTION B:
1. DESCRIPTION OF NATURE OF BUSINESS: Real Estate Development
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
5. PRINCIPAL OFFICE MAILING ADDRESS
5121 North Causeway Drive 5121 North Causeway Drive
Winston Salem, NC 27106-9695 Winston Salem, NC 27106-9695
6. Select one of the following If applicable. (Optional see Instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Hubbard Realty of Winston Salem Inc NAME: The Sherwood Company NAME: C J Ramey
TITLE: Manager TITLE: Manager TITLE: Manager
ADDRESS:
ADDRESS:
ADDRESS:
2110 Cloverdale Ave 5446 University Pkwy 5121 North Causeway Drive
Winston Salem, NC 27103 Winston Salem, NC 27105 Winston Salem, NC 27106
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
C J Ramey 4/15/2020
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
CJ Ramey Manager
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 2762MS26