WQ0041964_Application (FTSE)_20200908

September 4, 2020
Surface Water Protection Supervisor
North Carolina Department of Environmental Quality
Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road — Suite 300
Winston-Salem, NC 27105
[phone]
Regarding: Williard Place Subdivision — Phase 1
4355 and 4361 Barrow Road
High Point, NC
Dear Sir or Madam:
NC Department of
Environmental dauality
4..
SEP 0 8 2020
` Winston-Salem
Regional Office
Please find attached fast track application for the gravity sewer line for the above referenced
project. Included in this package are the following:
1. One original and one copy of the Fast Track Application
2. One check for $480 (#62646)
3. One original and one copy of the Downstream Sewer Flow Tracking/Acceptance
Form
4. One original and one copy of the USGS Topographic map and street level map.
5. Developer's Operational Agreement.
6. N.C. Secretary of State LLC documentation.
The proposed public sanitary sewer extension will serve 44 detached single family ownership lots
for Williard Place Subdivision — Phase 1. The project is located on 4355 and 4361 Barrow Road
in High Point, North Carolina. The public sewer extension will be permitted for the gravity sewer
into the existing 8" sanitary sewer line owned by the City of High Point on the western side of the
subject property. The proposed public sanitary sewer will be installed by Windsor Investments,
LLC and be owned and maintained by the City of High Point.
Please call if you have any questions.
Very Truly Yours,
Ale i9ha
Mike Otto
Enclosures
621 Eugene Court, Suite 100, Greensboro, NC 27401-2711 • PO Box 21882, Greensboro, NC 27420-1882
Phone [phone] • Fax [phone]
Website: wwry horum-wadc.cam
N.C. License #: C-0868

State of North Carolina
nWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02T, 15A NCAC 02T .0300, Division policies and good engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303
Projects not eligible for review via the fast track process (must be submitted for full technical review):
> Projects that require an environmental assessment in accordance with 15A NCAC 1C .0100;
Projects that do not meet any part of the minimum design criteria (MDC) document;
Projects that involve a variance from the requirements of 15A NCAC 2T;
> Pressure sewer systems utilizing septic tank -effluent pumps (STEPs) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items
are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and
reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
1Y If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
® Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
M Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
® If the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
❑ If the Applicant Type in Item I.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional En ineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page I of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
y Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215.67 a .
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump 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 in the case of a multiple station power outage. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
® Developers of lots to be sold
® Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
(828) 2964500
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washinaton Regional Office
943 Washington Square Mall
Beaufort, Bards, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilminaton Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pander
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Allegheny, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & 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: Windsor Investments, 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: David Michaels per 15A NCAC 02T .0106(b)NC Department of
Title: Registered Agent Environmental Quality
Received
4. Applicant's mailing address: 5603 New Garden Village Drive
City: Greensboro State: N.C. Zip: 27410-8595 SEP 0 8 2020
5. Applicant's contact information: Winston-Salem
Phone number: 336) 282-3535 Email Address: DMichaels(&_windsorinvestments.com Regional Office
H. PROJECT INFORMATION:
1. Project name: Williard Place Subdivision - Phase 1
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date: _
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.0470' Longitude:-79.9906'
5. Parcel ID (if applicable): 171234
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Homer S. Wade License Number: 10771
Firm: Borum. Wade and Associates. P.A.
Mailing address: 621 Eugene Court - Suite 100
City: Greensboro State: N.C.. Zip: 27401-2711
Phone number: 336) 275-0471 Email Address: hswadeaborum-wade.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Eastside Wastewater Treatment Plant Permit Number: NCO024210
Owner Name: City of Hieh Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
OwnerName(s): _
FORM: FTA 04-16 Page 1 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 NNo ❑N/A
2. If the Applicant is a Developer of lots to be sold, has a Developa's Operational Agreement (FORM: DEV) been attached?
N Yes [-]No ❑N/A
3. If the Applicant is a Home/Property Owners' Association has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply)
N 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/Commercial % Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes [—]No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes N No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.0114(fl)
Daily Design Flow a °
No. of Units
Flow
44 Lots @ 4 Bedrooms/Lot
360 gal/day
44
15,840 GPD
gal/day
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
15,840 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.011.41 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 15,840 GPD (per 15A NCAC 02T .0114)
A Do not include future flows or previously permitted allocations
If permitted 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 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
1638
PVC
8
318
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 requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force 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) Length (feet) Material
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(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
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
It shall be demonstrated to the Division that the portable 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 timeframes, 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 02T 0305(f) & W
➢ 15A NCAC 02T.0305(f) enntains minimum aenarations that shall be provided for sewer systems:
Setback Parameter*
Separation Rectuired
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, WS-I waters of Class I or
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
Top 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.0305(g) contains alternatives where separations in 02T.0305 cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(fl 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 NCAC 02B .020M ❑ 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
sedimentation control plans, stormwater 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 Hues 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

X. CERTIFICATIONS:
1. Does die submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pub Station_s
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10.14) and supporting documents for
review. Anproval of the request is required Prior to submittal of the Fast Track Application and supoortine documents
2. Professional Engineer's Certification:
I Homer S. Wade, P.E. attest that this application for
(Professional Engineer's name from Application Item 111.1.)
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 143-215.68, 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:
SEAL
1077'1
3. Applicant's Certification per 15A NCAC 02T .0106(b):
that this application for
(Signature Authority's name & title from Application Item 1.3.)
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 143-215.6B, 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. 77..�
Signature: Date:/ r� �V
FORM: FTA 04-16 Page 5 of 5

Public Services Department
Terry L. Houk
DIRECTOR
NORTH CAROLINNS INTERNAfIONALCIT"e'
September 3, 2020
NCDENR
Winston-Salem Regional Office
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
Project: Willard Place Subdivision Ph.1
Private Sewer
Applicant: Windsor Investments, NC
Dear Sirs:
This is to acknowledge that the City of High Point will accept for treatment in the Eastside
Wastewater Treatment Plant (Permit #NC0024210), wastewater flow from the above referenced
project in the amount of 15,840 GPD, which will be discharged to facilities operated and
maintained by the City of High Point.
If further information is needed, please let me know.
Very truly yours,
Tent' L. Ibuk
Director of Public Services
TLH/tab
City of High Point, P.O. Box 230, 211 South Hamilton Street, High Point, NC 27261 USA
Fax:[phone] Phone:[phone] TDD:336.883.8517

i)ivi•ainrl of IMA101. ilus,nurc(-.
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Plow lyacking for Sewer Extension Applications
(FTSh 10-18)
Application Number: 2Q20-.153 .
Entity Requesting Allocation: Windsor Investment LLC
Project Name for which flow is being requested; Millard Place Subdivision Phase t
More that one ME n+++y be regrdredfor a single project if the owner of the lMVTP is not responsible far all prune
stations along the route of the proposed ivastwvaterflmv.
I. Complete this section only If you are the owner of the wastewater treatment plant,
a. WWTP Facility name: Eastsido WWTP
b. WWTP Facility Permit it: NC-0024210
:<:til!lJlolYs.nre; in.h1'�D:?`.`:
c. WWTP facility permitted flow: 26.0000
d, Estimated obligated flow not yet tributary to the WWTP:
o. WWTP facility's actual average flow:
f, Total flow for this specific request:
g. Total actual and obligated flows to the facility:
h• Percent of permitted flow used:
0.7867
15.8250
0.0158
16.6276
63,95%
11. 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)
(13)
(C)
(D) = (D+C)
(B)-(A-D)
Pump
Pomp
Finn
Design
Approx.
Obligated,
Total Coacill
Availublo
slntioa
siation
Capacilyl
Average
Carrel
Not Yet
Flow Pills
Capacity)
(Noma or
Permit
Daily Flow'
Avg, Daily
Tributary
obligated
Number)
Number
(FirnJp(I,
Flow,
Daily Flow,
Plow
A1GD
MUD
MGI)
GIGO
MOD
AIGD
Walemiew -
W00024100
2.1320
0.9928
0.5501
0.4118
D.9618
•0,0690
mrxd51e
w00008572
30.0897
11.4842
••
WA
MA
UNIA
wilt
WA
UNIA
W1 A
8.3996
0.7691
UNIA
UWA
MIA
WIA
UN1A NNIA NNIA UNIA NNIA HNIA
* The Firm Capoeity (design flow) of any pump slntioa is defined n9 0r0 maximum pumped Don• that
cot, be ncldeved with the largest pump tniw„ out arse vice.
** Design Ave2•agD Flow Is the arm capacity of the pump stallon divided by file peaking factor (po not
less than 2.51 per Section 2.02(A)(4)(c) of the A1inirnum Design Crlterin.
*** A Plmmb,g Assessment Addendum shall be attached for each pump stnlian located between Cite
project connection point and the WWTP where the Availnble Capacity Is S 0.
Downsirenm Facility Mine (Sower);
Downsirenm Permit Number:
9.1688
UWA
eWA
6WA
2.3154
UWA
VNIA
UN/A
Page 9 of 6 FTSE 10.10

III. Certification Statement
I, Terry Houk cerlify 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 cruse any capacity related
sanitary sewer overflows or overburden any downstream pump station on route to the receiving treatment
plant under normal circumstances, given the implementation of the planned improvements identified in the
pinning assessment where applicable. This analysis has been performed in accordance with local
established policies and procedures using the best available data. This corliflcation applies to !hose items
listed above in Sections I and Il plus ail attached planning assessment addendmus 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.
9/1/2020
Signing Offk ll Signa4re Date
?0 G l S` cm ncLv-r-a
Title ofUgning Official
Page 2 of 6 ME 10•18

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section 11 where Available
Capacity is < 0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Plow (C) accounts for
% and MGD of the Available Capacity () in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or.
d. The following applies:
Davis -Martin -Powell and Associates, on behalf of the City of High Point submitted a permit
modification for the Waterview Pump Station that was approved on April 22, 2020. This
increased the pump station to 2.232 MGD (1,550 GPM). Davis -Martin -Powell is currently
designing a new force main that would increase the lift station to 2,550 GPM. "this could be
conioleted within 6 months from the notice to proceed.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification
to allow this flow to be permitted, without a significant likelihood of over -allocating capacity in
the system infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S.
143-215.67(a) which prohibits the introduction of any waste in excess of the capacity of the
waste disposal system.
Signing
i Zo2'
Date
Page 3 of 6
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STATE OF NORTH CAROLINA
COUNTY OF Guilford Permit No.
DEVELOPER'S OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (d1) and entered into this day of
by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
Windsor Investments, LLC , a corporation/general partnership registered/licensed to do
business in the State of North Carolina, hereinafter known as the DEVELOPER.
WITNESSETH:
1. The DEVELOPER is the owner of the certain lands lying in Guilford County, upon
which it is erecting and will erect dwelling units and other improvements, said development to be known
as Williard Place Subdivision Phase 1 (hereinafter the Development).
2. The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater treatment
works, and/or disposal facilities (hereinafter Disposal System) to provide sanitary sewage disposal to serve
the Development on said lands.
3. The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct, maintain, and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units,.other improvements
and lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C or 47F of the North Carolina General Statutes.
The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration, Williard Place Homeowners Association (hereinafter
Association), a non-profit corporation organized and existing under and by the virtue of the laws of the State
of North Carolina, for the purpose, among others, of handling the property, affairs and business of the
Development; of operating, maintaining, re -constructing and repairing the common elements of the lands
and improvements subject to unit ownership, including the Disposal System; and of collecting dues and
assessments to provide finds for such operation, maintenance, re -construction and repair.
6. The COMMISSION desires to assure that the Disposal System of the Development is properly constructed,
maintained and operated in accordance with law and permit provisions in order to protect the quality of the
waters of the State and the public interest therein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions and law.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Resources has inspected and approved of the facilities. In order to change the name
of the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws and Declaration.
3. The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility for
the operation and maintenance of its Disposal System until a permit has been reissued to the DEVELOPER's
successor.
FORM: DEV 03-19 Page 1 of 2

4. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
operated in conformity with law and the provisions of the permit for construction. operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treanncrit, collection and disposal system as it common element which will receive the highest priority for
expenditures by the Association except lot Fedcral- State and local taxes andinsurance.
�. The DI-V6LOPER shall provide in the Declaration and Association Bylaws that the Disposal S)siem kill
be maintained out of the connnon expenses. In order to assure that thcrc shall be funds readily available to
repair, maintain or construct the Disposal System.. beyond the routine operation and maintenance expenses.
the Declaration tan([ Association Bylaws shall provide that a 'fund be created out of the common expenses.
Such 'fund shall be separate from the routine maintenance funds allocated for the facility and shall be part
of the yearlybudget.
6, hi the event the common expense allocation and separate fund are not adequate for the construction, repair.
and maintenance of the Disposal System. the Declaration and Association Bylaws shall provide for special
assessments to cover such necessary costs. There shall be no limit on the amount of such assessments, and
the Declaration and Bylaws shall provide that such special assessments can be made as necessary at any
time.
7. If it wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town, village, county.. water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit mayrequire as condition of accepting the Development's wastewater.
8. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the continued
proper maintenance, repair and operation of its Disposal System; the DEVELOPER shall provide in the
Association Bylaws that the Association shall not enter into voluntary dissolution Without first having
transferred its said system and facilities to some person, cot poration or other entity acceptable to and
approved by the COMMISSION by the issuance of apermit.
9. The agreements set forth in numbered paragraphs I, 2, 3, 4, 5, 6, 7, and 8 above shall be conditions of any
permit issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System,
10. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration is
filed and in the offices of the Secretary of State of North Carolina with the .Articles of Incorporation of the
Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR T1I E EN V IRONM ENTA L
MANAGIiSMENT COMMISSION
S. Daniel Smith
Director, Division of Water Resources
(Date)
Windsor Investments, LLC
Name E ELOPE
Bv:
(Signature
David B. Michaels, Registered Agent
Print Name and Title
September 4, 2020
(Date)
P01RN,l DEV 03-19 Pace 2 of")

9/4/2020
North Carolina Secretary of State Search Results
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Limited Liability Company
Legal Name
Windsor Investments, LLC
Information
Sosld: 0577550
Status: Current -Active O
Date Formed: 1/17/2001
Citizenship: Domestic
Annual Report Due Date: April 15th
Registered Agent: Paracorp Incorporated
Addresses
Reg Office
176 Mine Lake Ct #100
Raleigh, NC 27615
Mailing
P O Box 9147
Greensboro, NC 27429
Reg Mailing
176 Mine Lake Ct #100
Raleigh, NC 27615
Company Officials
Principal Office
5603 New Garden Village Dr
Greensboro, NC 27410
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager Manager
Thomas Hall David Howard
P0Box 9147 PO Box9147
hftps://w .sosnc.gov/online_services/search/Business_Registration—Results 1/2