WQ0041797_Application (FTSE)_20211208

LATHAM-WALTERS ENGINEERING, INC.
16507-A Northcross Drive
Huntersville, North Carolina 28078
Ph [phone] Fax [phone]
[e-mail]
LETTER OF TRANSMITTAL
Wi_st.
To: NCDEQ -Division of Water Resources Attn: Alexander Lowe
Winston-Salem Regional Office
Address: 450 W. Hanes Mill Rd., Suite 300
Winston-Salem, NC 27105
From: Meredith Hammitt
Date: Dec. 7, 2021
Re: W00041797 — Meadowlands — Chestnut Hills Section 2
We are sending you: X_ attached
via
The following items:
specifications •r,
copy of letter
Job No.: 2019.28
under separate cover
xsubmittal package
Copies
Date
No.
Description
2
5
Fast Track Sewer Application (modification request)
1
1
$480 application fee check payable to NCDEQ
1
4/15/21
1
Meadowlands Development, LLC Annual Report filed w/ SoS
1
11/22/21
2
FTSE from the City of WS
1
12/1/21
2
FTSE for Meadowlands PS's
1
2021
1
8.5x11 color 7.5 min. USGS Topo with site and waterbodies
1
2021
1
8.5x11 street level map
1
11/22/05
5
CPCN for Meadowlands Development, LLC
1
6/19/20
1
Flow allocation letter from Davidson Co.
1
6/25/20
1
Flow acceptance letter from the City of WS Utilities
1
2/28/05
1
Flow reduction approval letter
1
7/10/20
9
WQ0041797 — original permit
o As requested
✓ For review and comment
Remarks:
Meadowlands Development, LLC previously permitted Meadowlands — Chestnut Hills Section
2 in permit #WQ0041797. The original permit was for 16 lots @ 300 gpd for a flow of 4800
gpd. The applicant would like to modify this permit to include 1 additional lot. Therefore, the
modification will be 17 lots @ 300 gpd for a flow of 5100 gpd. The project is located in
Davidson Co. but effluent will be treated at the Archie Elledge WWTP, owned by Winston /
Forsyth Utility Commission. A flow reduction letter for Meadowlands is attached, as is a
THESE ARE TRANSMITTED as checked below:
o For approval o
o For your use o
0
0
Approved as submitted
Approved as noted
Returned as corrections
Forms for signatures & submittal

LATHAM-WALTERS ENGINEERING, INC.
16507-A Northcross Drive
Huntersville, North Carolina 28078
Ph [phone] Fax [phone]
[e-mail]
modified flow acceptance letter and FTSE from the City of WS. A modified flow allocation from
Davidson Co. is also attached. None of the originally permitted sewer has been certified yet.
If you have any questions please do not hesitate to call. [phone] —
Meredith Hammill

Narrative for Modification of WQ0041797
Meadowlands Development, LLC previously permitted Meadowlands — Chestnut Hills Section 2 in
permit #WQ0041797. The original permit was for 16 lots @ 300 gpd for a flow of 4800 gpd. The
applicant would like to modify this permit to include 1 additional lot within the same neighborhood, along
the same road where other lots were originally located. Proposed line layout and lengths remain
unchanged. Therefore, the modification will be 1.7 lots @ 300 gpd for a flow of 5100 gpd. The project is
located in Davidson Co. but effluent will be treated at the Archie Elledge WWTP, owned by Winston /
Forsyth Utility Commission. A flow reduction letter for Meadowlands is attached, as is a modified flow
acceptance letter and FTSE from the City of Winston-Salem. A modified flow allocation from Davidson
Co. is also attached. None of the originally permitted sewer has been certified yet.
Narrative for use of ductile iron pipe
The final downstream leg of sewer has been proposed as 90' of ductile iron pipe due to insufficient cover
needed to gain access to the downstream tie-in manhole. The leg crosses under a ditch which made the
cover less than 36".

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
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: 0 Individual.
❑ Federal
Corporation
❑ State/County
❑ General Partnership
❑ Municipal
3. Signature authority's name: C.J. Ramey per 15A NCAC 02T .0106(b)
Title: Managing Partner
4. Applicant's mailing address: P.O. Box 10
City: Bethania State: NC Zip: 27010-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
❑ Privately -Owned Public Utility
0 Other
II. PROJECT INFORMATION:
I. Project name: Meadowlands — Chestnut Hills Section 2
2. Application/Project status: 0 Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0041797 and issued date: 7/10/2020,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: W000
3. County where project is located: Davidson
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.010691° Longitude: -80.167593°
5. Parcel ID (if applicable): 6852-04-63-5379 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: James L. Walters P.E.
Firm: Latham -Walters Engineering, Inc.
Mailing address: 16507-A Northcross Drive
City: Huntersville
State: NC Zip: 28078-
License Number: 18584
Phone number: [phone] Email Address: tim(2)1wengineer.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Archie Elledge WWTF Permit Number: NC0037834
Owner Name: Winston-Salem / Forsyth County Utility Commission
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0031015
2. Downstream (Receiving) Sewer Information: 8 inch El Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00003
Owner Name(s): Winston-Salem / Forsyth County Utility Commission
FORM: FTA 06-21
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. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned)
❑ Residential (Leased)
❑ School / preschool / day care
❑ Food and drink facilities
0 Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
0 Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? 0 Yes❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? // Yes ❑ No
> If ves, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(0)
Daily Design Flow a,b
No. of Units
Flow
Residential — Single Family
300 gal/unit
1.7
5100 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal
GPD
Total
5100 GPD
a See 15A NCAC 02T .0114(b) (d) (e)(1) and (e)(2) 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 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 5100 GPD (per 15A NCAC 02T .0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
0 Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
O Other (Explain):
FORM: FTA 06-21
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
1125
PVC
8
90
DIP
➢ Section II & 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 requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: 0Longitude: - .
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): gallons per minute (GPM) at
5. Summarize the force main to be permitted (for this Pump Station):
feet total dynamic head (TDH)
Size (inches)
Length (feet)
Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(I)(B):
➢ 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 and may not be portable
Or if the pump station has anaverage daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant 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 timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
I. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (g)? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
2Water 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, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated Wetlands.
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 associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankmentor 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) xv
36 inches
> If noncompliance with 02T.0305(f) or (g). see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
> If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑ No ® N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
> Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. 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 must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that arc subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ 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 permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
L. 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?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, James L. Walters, P.E. , attest that this application for Meadowlands - Chestnut Hills Section 2
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item 11.1)
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,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pttmu 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 materialand
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or tertification 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. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
%Ntatrut%
North Carolina Professional Engineer's seal, signature, and date: H CA
SEAL
18584 1
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, C.J. Ramey , attest that this application for Meadowlands - Chestnut Hills Section 2
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item II. I )
attest that this application 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 arc not included, this application package is subject to being returned as incomplete. 1 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 143-215.6B, 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.
Signature:
Date: Ilri1�
FORM: FTA 06-21 Page 5 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: Meadowlands - Chestnut Hills Section 2
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit #:
c.
d.
e.
f.
g•
h.
WWTP facility's permitted flow
Estimated obligated flow not yet tributary to the WWTP
WWTP facility's actual avg. flow
Total flow for this specific request
Total actual and obligated flows to the facility
Percent of permitted flow used
All flows are in MGD
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
Station
(Name or
Number)
Pump
Station
Permit
No.
Main#1 WQ0024206
PS #2 WQ0024206
Firm
Capacity, *
MGD
(A)
Design
Average
Daily
Flow**
(Firm / pf),
MGD
(B) (C) (D)=(B+C) (E)=(A-D)
Approx. Obligated,
Current Not Yet Total Current
Avg. Daily Tributary Flow Plus
Flow, Daily Flow, Obligated
MGD MGD Flow
0.496 0.1984 .0086 .0608 0.0694
Available
Capacity***
0.1290
0.202 0.0808 .0030 .0228 0.0258 0.0550
* 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 < O.
Downstream Facility Name (Sewer): Archie Elledge
Downstream Permit Number: WQCS00003
Page 1 of 6
FTSE 10-18

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 adequate capacity to transport and treat the proposed new wastewater.
g Officia Signature
Title a
/t( Y IZcSIDcji
Signing Official
Te-
/2//2oz/
Date
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: 12454,Meadowlands-Chestnut Hi11s,Seo2
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed 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 2.052116
e. WW I'P facility's actual avg. flow 21.280000
f. Total flow for this specific request
g. Total actual and obligated flows to the facility 23.337216
h. Percent of permitted flow used 77.8%
All flows are in MGD
30.000000
0.005100
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:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
* 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 Tess 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.
1
Il/aa/al
Signing Official Signature Date
ipeor
Title of Signing Official
Page 2 of 6
FTSE 10-18

LIMITED LIABILITY COMPANY ANNUAL REPORT
te/20t7
NAME OF LIMITED LIABILITY COMPANY: Meadowlands Development, LLC
SECRETARY OF STATE ID NUMBER: 0670719
REPORT FOR THE CALENDAR YEAR: 2021
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: RAMEY, C J
STATE OF FORMATION: NC
Filing Office Use Only
E - Filed Annual
Report
0670719
Changes
2. SIGNATURE OF THE NEW REGISTERED AGENT:
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: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Real Estate Development
2. PRINCIPAL OFFICE PHONE NUMBER: [phone]
4. PRINCIPAL OFFICE STREET ADDRESS
5121 North Causeway Drive
3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
5. PRINCIPAL OFFICE MAILING ADDRESS
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)
n
I I The company is a veteran -owned small business
riThe 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:
2110 Cloverdale Ave
Winston Salem, NC 27103
ADDRESS: ADDRESS:
5446 University Pkwy 5121 North Causeway Drive
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 4/15/2021
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
C J Ramey Manager
Print or Type Name of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525
Print or Type Title of Company Official

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
Certificate of Public Convenience and Necessity to
Provide Sewer Utility Service in Meadowlands
Subdivision in Davidson County, North Carolina, and
for Approval of Rates
ORDER GRANTING
FRANCHISE AND
APPROVING 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.
8. 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.
2

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.
rb112105.02
ISSUED BY ORDER OF THE COMMISSION.
This the 22nd day of November 2005.
NORTH CAROLINA UTILITIES COMMISSION
62�
Patricia Swenson, Deputy Clerk

STATE OF NORTH CAROLINA
UTILITIES COMMISSION
RALEIGH
APPENDIX A
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

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
Reconnection Charges:
$42.00
APPENDIX B
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: On billing date
Return Check Fee: $25.00
Bills Past Due: 15 days after billing date
Billing Frequency: Shall be monthly for service in arrears
Finance Charge for Late Payment: 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.

DAVIDSON COUNTY PLANNING DEPARTMENT
GOVERNMENTAL CENTER
913 GREENSBORO STREET
POST OFFICE BOX 1067
LEXINGTON, NORTH CAROLINA 27293-1067
SCOTT LEONARD
PLANNING DIRECTOR
November 17, 2021
James L. Walters, PE
Latham -Walters Engineering, Inc,
16507-A Northcross Drive
Huntersville, NC 28078
Re: Flow Allocation, Meadowlands— Chestnut Hills, Section 2
Mr. Walters:
LEXINGTON 336-242-2220
In response to your request for sewer allocation for Section 2 of Chestnut Hills in The
Meadowlands, please accept this letter as confirmation that Davidson County will allocate
5,100 gallons per day from the original 216,000 gpd allocated for The Meadowlands. Chestnut
Hills Section 2 will contain 17 lots with a flow of 300 gpd each, totaling 5,100. Davidson County
will continue to monitor the overall allocation for The Meadowlands to insure the total does
not exceed 216,000 gallons per day.
If you have any questions or comments regarding this request, please contact me at this office
by calling 336-242-2229, or by email at [e-mail]
Sincerely,
Scott Leonard
Planning Director
"PLANNING FOR ,4 BETTER TOMORROW"

Winston-Salem / Forsyth County
ti l ities
Water • Wastewater • Solid Waste
Administration, P.O. Box 2511, Winston-Salem, NC 27102
0: 336.727-8000, F: 336-727-8432, wsfcutiilties.org
November 19, 2021
Mr. Scott Leonard
913 Greensboro Street
Lexington, NC 27293
In Re: Meadowlands — Chestnut Hills Flow Acceptance REVISED
Dear Mr. Leonard:
This letter is to confirm that the City/County Utility Commission will accept the sewerage from
Meadowlands -Chestnut Hills.
We are currently treating 852,825 gallons per day. Our contract with Davidson County has a maximum
discharge of 1,500,000 gallons per day; therefore, we should encounter no problems in treating an
additional 5,100 gallons per day. This sewerage will be treated at our Archie Elledge Wastewater
Treatment Plant (NC0037834). The wastewater collection system serving this area is properly sized and
maintained for this service.
If you have any questions concerning this subject, please give me a call at [phone].
Sincerely,
UTILITIES ADMINISTRATION
deige
Todd Lewis, P.E.
Senior Civil Engineer
Winston-Salem/Forsyth County Utilities
Call 311 or 336-727-8000
[e-mail]
City Caundl: Mayor Allen lolled; VMan H. Burke. Mayor Pro Tempore, Northeast Ward; Denise D. Adam, North Ward; Dan Besse, Southwest Ward; Robert C. Clark,
West Ward; John C. Larson, South Ward; Jeff Madntash, Norlhwast Ward; Annette Sdpplo, East Ward; lames Taylor, Jr., Southeast Ward; City Manager: Lae D. Garrity
County Commissioners; David R. Plyler, Chair; Dan Martin, VlceChair; Fleming EI-Andn; Ted Kaplan; Richard V. unvllte; Tanya McDaniel;GIorta D. Whhenhunr County
Manager:" Dudley Watts, Jr.
Winstan.salemlronyth County Wlhy Commission: Randall S. Tuttle, Chair, L. Wesley Curtis, Jr., wee Chair; Harold E. Day; Tom Griffin; Waring H. Hines; Duane Long:
Hugh WJernigan; Chrls Parker, lames Ruffin; Donald R. Stewart; Allan Younger

v(o•row e.
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
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 ih 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 riot 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/inflltratiomis 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(1)(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 ly 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�.1 Pretreatment, Emergency Response and Collection Systems Unit Internet http:l/h2o.enr.ncstate.us/ndpu
NorthCarolina 1817 Mail Service Center, Raleigh, NC 27699.1617 An Equal Opportunity Action Employer
Naturally Telephone [phone] Fax [phone]% recycled/10% postconsumer paper

Mr. Ramey
February 28, 2005
Page 2
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
wastewater flows exceed the effluent limits defined in the NPDES permit for the treatment facility or
exceed the capacity of the sewers downstream of any new sewer extension or service connection(s).
A permit modification and fee is required to apply this flow reduction to any existing permits where
flows have been allocated.
If you have any questions or comments regarding this matter, please contact Marie Doklovic
at [phone] ext. 371.
Sincerely,
an W. Klimek, P.E.
cc: Steve Mauney, Winston-Salem Regional Office
Jim Walters, PE, Latham -Walters Engineering (16507-A Northcross Drive, Huntersville, Nc 28078)
PERCS Flow Reduction File

sO<akia=,.r: Rd
Chestnut Hills
Sect. 2
Map data c2020 United States L