WQ0029893_Application_20230124

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources
I5A NCAC 02T .0600 — SINGLE-FAMILY RESIDENCE
WASTEWATER IRRIGATION SYSTEM —RENEWAL
FORM: SFRWWIS-R 02-21
Pursuant to 15A NCAC 02T .0107(b), if the application does not include all required information and the necessary supporting
documentation, the application shall be returned. The application and attachments shall be prepared in accordance with 15A
NCAC 02T .0100, 15A NCAC 02T .0600, and Division Policies. For more information, visit the Water Quality Permitting
Section's Non -Discharge Branch website. The Applicant shall submit an electronic copy of the application and attachments
uploaded as a single Portable Document Format (PDF) file to htt s://edoes.de .ne. ov/Forms/NooDischar e-Branch-Subniittal-
Form-Ver2, or emailed to Non-Discharee.Reparts{ ncdenr.gov if less than 20 megabytes (MB).
SECTION I — APPLICANT INFORMATION
1.
Applicant: Alexander M. Heitbrink and Laura J. Haskin
2.
Permit No.: WQ0029893
3.
Signature authority: Alexander M. Heitbrink
Title: Owner
4.
MaiIing address: 1125 Crowell Dairy Rd
City: Indian Trail
State: NC Zip: 28079-
5.
Contact person: Alexander M. Heitbrink
Primary phone number: [phone] Select
Email: [e-mail]
Secondary phone number: ( } - Select
6.
Secondary Contact person: Laura J. Haskin
Primary phone number: [phone] Select
Email: [e-mail]
Secondary phone number:
SECTION II — FACILITY INFORMATION
1. Physical address: 1125 Crowell Dairy Rd. County_ Union
City: Indian TraiI State: NC Zip: 28479-
SECTION III — BILLING INFORMATION
I. Billing address: 1125 Crowell Dairy Rd.
City: Indian Trail State: NC Zip: 28079-
2. Verify the Applicant does not have any overdue annual fees:
h s:llde .nc.gov/al_lout/divisioiislwater-resources/water-resources- er its/w -e a ments
Pursuant to 15A NCAC 02T .0120(c), permits for renewing facilities shall not be granted if the Applicant or any affiliation has
an unpaid annual fee.
FORM: SFRWWIS-R02-21 Page 1 of

SECTION IV — OPERATION AND MAINTENANCE AGREEMENT
Permit No.: WQ0029893 County: Union
Permittee: Alexander M. Heitbrink and Laura 3. Haskin (i.e., all deeded property owners)
The Perm ittee agrees to operate and maintain the single-family residence wastewater treatment and irrigation system as
follows:
I _ Inspect the septic tank annually, and pump out solids as needed.
1 Inspect and clean the septic tank effluent filter annually. Qf applicable)
3. Inspect the tablet chlorinator weekly_ Add wastewater grade chlorine tablets (e.g., calcium hypochlorite) as needed.
Swimming pool grade chlorine tablets are not acceptable. (if applicable)
4. Inspect the ultraviolet disinfection unit weekly. Clean or replace the lamps and quartz sleeves as needed. (if
applicable)
5. Inspect all storage tanks, pumps, and alarms monthly. Remove the floating scum layer in all pump/storage tanks
when pumping the septic tank solids out.
6. Inspect the spray irrigation system monthly to verify: proper operation of the spray heads; that there are no leaks;
that vegetative growth does not obstruct the spray heads; that the irrigated wastewater is not ponding in or running
off the designated irrigation area; and that there are no objectionable odors. (if applicable)
7. Inspect the drip irrigation system monthly to verify: proper operation of the drip lines; that there are no leaks; that
vegetative growth does not obstruct the drip emitters; that the irrigated wastewater is not ponding in or running off
the designated irrigation area; and that there are no objectionable odors. (if applicable)
S. Maintain a set of Division -approved engineering plans and specifications.
9. Pay the required annual fee_
10. Request renewal of this pennit on Division -approved forms no later than 180 days prior to expiration.
11. Sign and provide a Change_of Ownership appiicadon to any future owner of the single-family residence wastewater
treatment and irrigation system for their completion and submission to the Division of Water Resources.
I/We understand the above requirements and agree to these terms as part of the issued pennit.
Signature: _f,,� -­e-eo- Date: l 4 -C ;_,A
s
Signature: Date:
C.•
Signature: Date:
Signature: Date:
All deeded property owners shall sign this Operation and Maintenance Agreement
FORM: SFRW WIS-R 02-21 Page 2 of 4

ATTACHMENT A — SITE MAP
Was the facility originally permitted or had a major modification issued after September 1, 2006?
J9 Yes — Pursuant to 15A NCAC 02T .0105[d, submit a site map pursuant to the requirements in 15A_NCAC 02T .0604{d). These
requirements are-
❑ A scaled map ofthe site with topographic contour intervals not exceeding 10 feet or 25 percent oftotal site relief and showing
all facility -related structures and fences within the wastewater treatment, storage, and irrigation areas.
❑ Soil mapping units shown on all irrigation sites.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of all wastewater treatment, storage,
and irrigation sites.
❑ Delineation of the compliance and review boundaries per 15A NCAC 02L .0107 and .0108, and 15A NCAC 02T .0601.
❑ Setbacks as required by 15A NCAC 02T .0606.
❑ Site property boundaries within 500 feet of all wastewater treatment, storage, and irrigation sites.
❑ All habitable residences or places of public assembly within 500 feet of all treatment, storage, and irrigation sites.
❑ No -- Skip Attachment A.
ATTACHMENT B— SIGNATURE AUTHORITY DELEGATION
Does the signature authority in Section 1, Item 3 meet the requirements pursuant to 15A NCAC 02T .0106(b]?
4 Yes — Skip Attachment B.
❑ No — Submit a deteeation letter pursuant to 15A NCAC 02T .0106fc] authorizing the signature authority to sign.
ATTACHMENT C — FLOW REDUCTION
Does the existing permit include an approved flow reduction?
❑ Yes — Submit a copy of the flow reduction approval letter, as well as the measured monthly average amount of wastewater flow
contributed per unit for the 12 months prior to permit renewal. If any of these monthly averages are within 20% of the approved
flow reduction value, the Permittee shall provide a reevaluation of the reduced flow value pursuant to the requirements in 15A
NCAC 02T .0l 14ff).
No — Skip Attachment C.
ATTACHMENT D — EASEMENT, ENCROACHMENT, AND LEASE AGREEMENTS
Does the Permittee own all of the land associated with the wastewater collection, treatment, conveyance, and irrigation system?
Yes — Skip Attachment D.
❑ No — Pursuant to 15A NCAC 021' .011 b(c), provide a copy of all easements, lease agreements, and encroachment agreements
allowing the Permittee to operate and maintain the wastewater collection, treatment, conveyance, and irrigation system on
property not owned by the Penn ittee.
ATTACHMENT E — AFFILIATIONS
Are the Permittee's affiliations of record correct? Check affiliations.
❑ Yes — Skip Attachment E.
XNo --- Provide the corrected affiliations and their contact information.
ATTACHMENT F — COMPLIANCE SCHEDULES
Does the existing permit include any Compliance Schedules? (See Section I of the most recently issued permit)
4 Yes — Submit documentation that the compliance schedules have been met.
❑ No — Skip Attachment F.
FORM. SFRWWIS-R 02-21 Page 3 of

ATTACHMENT G — CIVIL PENALTIES AND OUTSTANDING VIOLATIONS
Does the Permittee have any existing civil penalties or outstanding violations?
❑ Yes (civil penalties) — Submit payment for the civil penalty, or proof of remission request.
❑ Yes (violations) — Submit a copy of your response to the Notice of Violation.
No Skip Attachment G.
ATTACHMENT H — SETBACK WAIVERS
Does the existing permit include setback waivers?
❑ Yes — Pursuant to 15A NCAC 02T .0606(cl, provide setbacks waivers that have been written, notarized, signed by all parties
involved, and recorded with the county Register of Deeds. Waivers involving the compliance boundary shall be in accordance
with 15A NCAC 02[, .0107.
No — Skip Attachment H.
I APPLICANT'S CERTIFICATION
1, Alexander M. Heitbrink
(Signature authority's name as noted in Section 1, Item 3)
that this application
has been reviewed by me and is accurate and complete to the best of my knowledge. 1 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 as incomplete. I further certify pursuant to 15A NCAC 02T .0120(b), that the applicant, or any
parent, subsidiary, or other affiliate of the applicant has: not been convicted of environmental crimes under; not previously abandoned
a wastewater treatment facility without properly closing the facility; not paid a civil penalty; not been compliant with any compliance
schedule in a permit, settlement agreement, or order; not paid an annual fee.
Note: The Applicant's Certification shall be signed pursuant to 15A NCAC 02T .0106(b]. An alternate person may be delegated as
the signing official if letter is provided pursuant to 15A NCAC 02T .0106(c). Pursuant to § 143-215.6A and § 143-215.6$, 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: I I Z 'V / Z 8 L 3
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email-
Non -Mischa ree.Repo rtsfa)nedenr.gov
Laserfiche Upload:
httys://edacs.deci.nc.i,av/Fo rm slNonDischarge-Branch-
Submittal-Form-Vert
FORM: SFRWWIS-R 02-21 Page 4 of

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Letter of
Transmitta�
To:
NCDEQ-Division of Water Resources
Water Quality Permitting Section -
NDPU
1617 Mail Service Center
Raleigh, NC 27699-1617
Piedmont Design Associates, P.A.
Suite 101 Westfield Center, 125 East Plaza Drive
Mooresville, NC 28115
Phone: [phone] Fax: [phone]
Email: ddecaron aapdapa.com
Website: www.pdapa.com
NCBELS License #: 1007
Job Number: 2006-01-08 - Hietbrink Surface Irrigation
Permit No. WQ0029893
Crowell Dairy Road, Union County, NC
DATE
January 29, 2019
COPIES
NO.
DESCRIPTION
1
Engineer's Certification
1
Physical Survey
1
As Built Drawing
These are transmitted
❑ For approval
❑ For your use
® As requested
❑ For review & comment
❑ FOR BIDS DUE:
REMARKS:
❑
Approved as submitted
❑
Resubmit ❑
❑
Approved as noted
❑
Submit ❑
❑
Returned for
❑
Return ❑
corrections
copies for app.
copies for dist.
corrected prints
Please let us know if any additional information is needed. If ORC contract is needed, Please call AQWA at
888-552-2792. Thanks.
Signed:
David M. DeCaron
cc: Todd Harrell, AQWA, ORC

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Water Resources
ENVIRONMENTAL QUALITY
November 2, 2017
ALEXANDER M. HEITBRINK AND LAURA J. HASKIN
6103 RoCKwELL DRIvE
INDIAN TRAIL, NORTH CAROLINA 28079
Dear Mr. Heitbrink and Ms. Haskin:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZRv1 ERMAN
Director
Subject: Permit No. WQ0029893
Crowell Dairy Rd. SFR
Single -Family Residence
Wastewater Irrigation System
Union County
In accordance with your permit change of ownership request received September 18, 2017, we are
forwarding herewith Permit No. WQ0029893 dated November 2, 2017, to Alexander M. Heitbrink and
Laura J. Raskin for the construction and operation of the subject single-family residence wastewater
treatment and irrigation facilities.
This permit shall be effective from the date of issuance until October 31, 2022, shall void Permit
No. WQ0029893 issued March 10, 2015, and shall be subject to the conditions and limitations as specified
therein. An extension shall be requested at least six months prior to the expiration of this permit.
Upon receipt of the request, the Commission will review the adequacy of the facility described therein and,
if warranted, will extend the permit for such period of time and under such conditions and limitations as it
may deem appropriate.
Please pay particular attention to the operation and maintenance requirements listed in Section III
for they may differ from the previous permit issuance. Failure to establish an adequate system for collecting
and maintaining the required operational information shall result in future compliance problems. Also note
that Condition VI.6. requires the Permittee to retain a set of Division approved plans and specifications for
the life of the facilities permitted herein.
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and binding.
-'Nothing Compares ----
State of North Carolina I Environmental Quality I Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-907-6332

Mr. Alexander M. Heitbrink and Ms. Laura J. Haskin
November 2, 2017
Page 2 of 2
If you need additional information concerning this permit, please contact David Goodrich at (919)
807-6352 or david.goodrich@a.,ncdenr.g ,
Sincerely,
Jay Zimmerman, P.G., Directo
Division of Water Resources
cc: Union County Health Department (EIectronic Copy)
Mooresville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
David DeCaron, PE — Piedmont Designs at [e-mail] (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules and Regulations
PERMISSION IS HEREBY GRANTED TO
Alexander M. Heitbrink and Laura J. Haskin
Union County
FOR THE
construction and operation of a 480 gallon per day (GPD) single-family residence wastewater treatment
and irrigation facility consisting of:
a 1,000 gallon baffled septic tank; a 1,000 gallon recirculation tank with an Advantex AX-20 treatment unit
and an Orenco 30 gallon per minute (GPM) recirculation pump; a 4,298 gallon storage/dosing tank with a
12.5 GPM dosing pump; an ultraviolet (LJV) disinfection unit; an Orenco control panel and headworks; a
rain sensor; a 0.19 acre drip irrigation area with approximately 4,200 linear feet (LF) of tubing with emitters
at 2 feet on center; and all associated piping, valves, controls and appurtenances
to serve the single-family residence at Parcel No. 08255011, Crowell Dairy Rd., Indian Trail, NC 28079,
with no discharge of wastes to surface waters, pursuant to the application received September 18, 2017, and
in conformity with the project plans, specifications, and other supporting data subsequently filed and
approved by the Department of Environmental Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until October 31, 2022, shall void Permit No.
WQ0029893 issued March 10, 2015, and shall be subject to the following specified conditions and
limitations:
I. SCHEDULES
1. Upon completion of construction and prior to operation of this permitted facility, a certification
(attached) shall be submitted from a licensed North Carolina Professional Engineer certifying that the
permitted facility has been installed in accordance with this permit, Division approved plans and
specifications, and other supporting documentation, including the location of all monitoring wells as
applicable. If this project is to be completed in phases and partially certified, the Permittee shall retain
the responsibility to track further_ construction approved under the same permit, and shall provide a
final certificate of completion once the entire project has been completed. Mail the Certification to the
Division of Water Resources, Water Quality Permitting Section, 1617 Mail Service Center, Raleigh,
NC 27699-1617. [15ANCAC 02T .0116]
2. The Mooresville Regional Office, telephone number [phone], shall be notified at least 48 hours
in advance (excluding weekends and holidays) of operation of the installed facilities such that an in -
place inspection can be made. Notification to the regional supervisor shall be made from 8:00 a.m.
until 5:00 p.m. on Monday through Friday, excluding State Holidays. [15A NCAC 02T .0108 (b)(2)]
WQ0029893 Version 2.1 Shell Version 151201 Page 1 of 7

3. No later than six months prior to the expiration of this permit, the Permittec shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal application.
[15A NCAC 02T .0105, 02T .0I09, 02T .0115(c)]
4. If a public or community sewage system is or becomes available, the subject single-family residence
wastewater treatment and irrigation facilities shall be closed and all wastewater shall be discharged into
the public or community sewage system within 180 days of its availability. Prior to the initiation of
these connection activities, appropriate Division approval shall be received. [15A NCAC 02T .0607]
H. PERFORMANCE STANDARDS
The subject non -discharge facilities shall be effectively maintained and operated at all times so there is
no discharge to surface waters, nor any contravention of groundwater or surface water standards. In
the event the facilities fail to perform satisfactorily, including the creation of nuisance conditions due
to improper operation and maintenance, or failure of the irrigation areas to adequately assimilate the
effluent, the Permittee shall take immediate corrective actions including Division required actions, such
as the construction of additional or replacement wastewater treatment or disposal facilities. [15A
NCAC 02T .0108(b)(1)]
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or surface
water resulting from the operation of this facility. [15A NCAC 02B .0200, 02L .0100]
3. Application rates, whether hydraulic, nutrient or other pollutant, shall not exceed those specified in the
following table:
TABLE 1— APPLICATION LIMITATIONS
Field Parameter Hourly Rate Yearly Max Units
1 01284 — Non -Discharge Application Rate 0.21 33.46 inches
[15A NCAC 02T .06050)]
4. The subject facility has been approved to land apply wastewater effluent on the following fields:
TABLE 2 — IRRIGATION AREA INFORMATION
Field Owner
I Alexander M. Heitbrink and
Laura J. Haskin
[G.S. 143-215.11
County I Latitude I Longitude I Net
Union 135,1532980 j-80.5686020 1 0.19
Dominant
CmB — Cid Channery silt
loam
5. The Operation and Maintenance Agreement (attached) between the Permittee and the Division of Water
Resources is incorporated herein by reference and shall be a condition of this permit. Noncompliance
with the terms of the Operation and Maintenance Agreement shall subject the Permittee to all sanctions
provided by North Carolina General Statutes § 143-215.6A to § 143-215.6C for violation of or failure
to act in accordance with the terms and conditions of this permit. [15A NCAC 02T .0115 (2)]
6. The irrigation system shall be connected to a rain or moisture sensor, which shall indicate when effluent
application is not appropriate in accordance with Conditions IH.4. and II1.5. of this permit. [ 15A NCAC
02T .0605(o)]
7. The compliance boundary is established at the property boundary. Any exceedance of standards at the
compliance boundary shall require action in accordance with 15A NCAC 02L .0106. [15A NCAC 02L
.0107(i)]
WQ0029893 Version 2.1 Shell Version 151201 Page 2 of 7

8. The review boundary is established midway between the compliance boundary and the effluent disposal
area. Any exceedance of groundwater standards at the review boundary shall require action in
accordance with 15A NCAC 02L .0106. [15A NCAC 02L .0108]
9. The Permittee shall apply for a permit modification to establish a new compliance boundary prior to
any sale or transfer of property affecting a compliance boundary. [15A NCAC 02L .0107(c)]
10. The facilities permitted herein shall be constructed according to the following setbacks:
a. The setbacks for irrigation sites permitted under 15A NCAC 02H .0200 shall be as follows (all
distances in feet):
i. Any habitable residence or place of public assembly under separate ownership: 100
ii. Surface waters: 50
iii. Any well with exception of monitoring wells: 100
iv. Any property line: 50
v. Public right of way: 50
[15A NCAC 02H .02190)]
b. The setbacks for storage and treatment units permitted under 15A NCAC 02H .0200 shall be as
follows (all distances in feet):
i. Any well with exception of monitoring wells: 100
ii. Any property line: 50
[15A NCAC 02H .02190)]
M. OPERATION AND MAINTENANCE REQUIREMENTS
1. The facilities shall be properly maintained and operated at all times. The facilities shall be effectively
maintained and operated as a non -discharge system to prevent the discharge of any wastewater resulting
from the operation of this facility. The Permittee shall maintain an Operation and Maintenance Plan
pursuant to 15A NCAC 02T .0604(f). [15A NCAC 02T .0604(f)]
2. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the subject non -discharge facilities, in accordance with 15A NCAC 08G .0200 the
Permittee shall designate and employ a certified operator in responsible charge (ORC) and one or more
certified operator(s) as back-up ORC(s) unless otherwise stated in 15A NCAC 08G .0304. The ORC
or their back-up shall visit the facilities in accordance with 15A NCAC 08G .0200, and shall comply
with all other conditions specified in the previously cited rules. [15A NCAC 02T .0117]
3. A suitable year-round vegetative cover shall be maintained at all times, such that crop health is
optimized, allows for even distribution of effluent and allows inspection of the irrigation system. [15A
NCAC 02T .0108(b)(1)]
4. Adequate measures shall betaken to prevent effluent ponding in or runoff from the irrigation sites listed
in Condition 11.4. [15A NCAC 02T .0605(o)]
5. Irrigation shall not be performed during inclement weather or when the ground is in a condition that
will cause ponding or runoff. [15A NCAC 02T .0605(o)]
6. Only effluent from the single-family residence at Parcel No. 08255011, Crowell Dairy Rd., Indian Trail,
NC 28079 shall be irrigated on the sites listed in Condition II.4. [G.S. 143-215.11
7. No automobiles or machinery shall be allowed on the irrigation sites except during equipment
installation or while maintenance is being performed. [15A NCAC 02T .0108(b)(1)]
WQ0029893 Version 2.1 Shell Version 151201 Page 3 of 7

8. Public access to the irrigation sites and wastewater treatment facilities shall be prohibited. Fencing
shall be provided to prevent access to the irrigation site (minimum 2-strand wire) and treatment units
shall be secured with locks on all tank accesses and control panels. [15A NCAC 02T .0605(i)]
9. The residuals generated from the wastewater treatment facilities shall be disposed or utilized in
accordance with 15A NCAC 02T .1100. [15A NCAC 02T .1100].
10. Diversion or bypassing of untreated or partially treated wastewater from the treatment facilities is
prohibited. [15A NCAC 02T .0605(f)]
11. Pump/dosing tanks shall have audible and visual alarms external to any stmeture. [15A NCAC 02T
.0605(n)]
12. Any excavation into bedrock shall be lined with a 10 millimeter (mm) synthetic liner. [15A NCAC
02T .0605(d)]
13. A water -tight seal on all treatment/storage units or minimum of two feet protection from the 100-year
flood plain elevation shall be provided. [15A NCAC 02T .0605(g)]
14. The Permittee is responsible for the operation and maintenance of the entire treatment and disposal
system including, but not limited to, the following items:
a. The septic tank shall be checked annually and pumped out as needed. The septic tank effluent filter
shall be checked and cleaned at the same frequency as the septic tank. [15A NCAC 18A .1900,
02T .0605]
b. The ultraviolet disinfection unit shall be checked weekly. The lamp(s) and quartz sleeve(s) shall be
cleaned or replaced as needed to ensure proper disinfection. [15A NCAC 02T .0605(1)]
c. The storage, pump, and alarm systems shall be inspected monthly. The scum layer in the pump
tanks shall be removed at the same interval as the septic tank is cleaned out. (I 5A NCAC 02T
.0108(b)(1)]
d. The system shall be inspected monthly to make certain of the proper operation of the drip lines,
that the system is free of leaks, that the vegetative growth allows a proper drip pattern, that the soil
is assimilating the disposed treated wastewater with no surface runoff, and that no objectionable
odors are being generated. [ 15A NCAC 02T .0108(b)(1)]
WQ0029893 Version 2.1 Shell Version 151201 Page 4 of 7

IV. MONITORING AND REPORTING REQUIREMENTS
V.
1. Any Division required monitoring (including groundwater, plant tissue, soil and surface water analyses)
necessary to ensure groundwater and surface water protection shall be established, and an acceptable
sampling reporting schedule shall be followed. [ 15A NCAC 02T .0108(c)]
2. Noncompliance Notification:
The Permittee shall report by telephone to the Mooresville Regional Office, telephone number (704)
663-1699, as soon as possible, but in no case more than 24 hours, or on the next working day following
the occurrence or first knowledge of the occurrence of any of the following:
a. Any process unit failure (e.g., mechanical, electrical, etc.), due to known or unknown reasons,
rendering the facility incapable of adequate wastewater treatment.
b. Any facility failure resulting in a by-pass directly to receiving surface waters.
c. Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
d. Ponding in or runoff from the irrigation sites.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone]. Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
betaken to ensure the problem does not recur. [ 15A NCAC 02T .0105(1)]
1. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
wastewater treatment and irrigation facilities. [15A NCAC 02T .0108(b)]
2. The Pcrmittee or their designee shall inspect the wastewater treatment and irrigation facilities to prevent
malfunctions, facility deterioration and operator errors resulting in discharges, which may cause the
release of wastes to the environment, a threat to human health or a public nuisance. The Permittee shall
maintain an inspection log that includes, at a minimum, the date and time of inspection, observations
made, and any maintenance, repairs, or corrective actions taken. The Permittee shall maintain this
inspection log for a period of five years from the date of the inspection, and this log shall be made
available to the Division upon request. [15A NCAC 02T .0108(b)]
3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the wastewater treatment and irrigation facilities
permitted herein at any reasonable time for the purpose of determining compliance with this permit;
may inspect or copy any records required to be maintained under the terms and conditions of this permit,
and may collect groundwater, surface water or leachate samples. [G.S. 143-215.3(a)(2)]
VI. GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to an
enforcement action by the Division in accordance with North Carolina General Statutes 143-215.6A to
143-215.6C. [G.S. 143-215.6A to 143-215.6C]
2. This permit shall become voidable if the permitted facilities are not constructed in accordance with the
conditions of this permit, the Division approved plans and specifications, and other supporting
documentation. [ 15A NCAC 02T .0110]
WQ0029893 Version 2.1 Shell Version 151201 Page 5 of 7

3. This permit is effective only with respect to the nature and volume of wastes described in the permit
application, Division approved plans and specifications, and other supporting documentation. No
variances to applicable rules governing the construction or operation of the permitted facilities are
granted, unless specifically requested and approved in this permit pursuant to 15A NCAC 02T .0105(n).
[G.S. 14.-215.1]
4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules in
15A NCAC 02B .0200; erosion and sedimentation control requirements in 15A NCAC Chapter 4 and
under General Permit NCG010000; any requirements pertaining to wetlands under 15A NCAC 02B
.0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of Chapter 143 of the
General Statutes. [15A NCAC 02T .0105(c)(6)]
In the event the permitted facilities change ownership or the Permittee changes their name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate property ownership documentation and other supporting
documentation as necessary. The Permittee of record shall remain fully responsible for maintaining
and operating the facilities permitted herein until a permit is issued to the new owner. [15A NCAC
02T .0104]
6. The Permittee shall retain a set of Division approved plans and specifications for the life of the facilities
permitted herein. [15A NCAC 02T .0108(b)(1)]
The Permittee shall maintain this permit until all permitted facilities herein are properly closed or
permitted under another permit issued by the appropriate permitting authority. [15A NCAC 02T
.01050)]
8. This permit is subject to revocation or unilateral modification upon 60 days' notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T .0110. [ 15A NCAC 02T .0110]
9. Unless the Division Director grants a variance, expansion of the permitted facilities contained herein
shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC 02T .0120(b). [15A
NCAC 02T .0120]
10. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to pay
the annual fee accordingly shall be cause for the Division to revoke this permit. [15A NCAC 02T
.0105(e)(3)]
Permit issued this the 2" day of November 2017
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Jay Zimmerman, P.G., Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0029893
W00029893 Version 2.1 Shell Version 151201 Page 6 of 7

Permit No. WQ0029893
Alexander M. Heitbrink and Laura J. Haskin
Crowell Dairy Rd. SFR
❑ Partial ® Final
Single -Family Residence Wastewater Irrigation System
November 2, 2017
Union County
ENGINEERING CERTIFICATION
In accordance with 15.A NCAC 02T .01 16, 1, Donald L. Munday, PE , as
a duly registered Professional Engineer in the State of North Carolina, having the Permittee's authorization
to ® periodically ❑ weekly ❑ fully observe the construction of the permitted facility, hereby state to the
best of my abilities that due care and diligence was used in the observation of the construction, such that
the facility was built within substantial compliance and intent of this pennit, the Division approved plans
and specifications, and other supporting documentation,
® Any variation to this permit, the Division approved plans and specifications, and other supporting
documentation has been documented in the attached as -built drawings, and shall serve as the
Perminee's minor modification request to amend the permit accordingly.
Provide a brief narrative description of any variations: The following changed horizontal location per the
approved plans: Tank locations and layout schematic, driveway, house location. All were shown in the new
location on the attached as built plan prgyLdecl on Physical Survey by_]ames Lynn Strome PLS dated-11/28/2018.
Field Dosingp Orenco PF200511_(1/2 HP/115 V-L-lPh) UV now located in i Qt side Pump Tank. UV model
is now Orenco UV-125/31. Unit is gravity fed, not pressure dosed.
Donald_L. Munday,_PE
Professional Engineer's Name
Engineering Finn --��-� ���� 'oFEss►o;/�
125 East Plaza Drive, Suite 101 =1 E,�lt
Mailing Address _ _ _ _ _ _ %,27
Mooresville NC 28115 %0
4, l p?�`
City - State Zip ''�����►iiii►M`�?``
704 664-7888 [e-mail]
Telephone E-mail NC PE Seal, Suture & Date
THE COMPLETED ENGINEERING CERTIFICATION, INCLUDING ALL SUPPORTING
INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
ey CaurierlSpecial Delivery:
512 N. SALIS B URY ST.
RALEIGH, NORTH CAROLINA 27699-16I7 RALEIGH, NORTH CAROLINA 27604
WQ0029893 Version 2.1 Shell Version 151201
Page 7 of 7

From, Wessner,Alice alict;vessrertarr•den1.gcv 6?
Subject- application forms for ownership change
Date, July 20, 2017 at 10:36 AM
To: mheitbrillkC�s,carolina.rr-crm
Good morning,
i; �`f l �'FP ���,'�I;
SEP 18 2017
�Or�-DISCO,urge
Perm
ttting 1-.1nit
Attached are the forms that you requested. One is the instructions for filling out the
application and the application itself and the other is the operations and maintenance
agreement that will need to be filled out by the ri w :ivo n&V.
Please keep in mind that we will need proof that the property is in your son's name as
noted in item C of the application.
If you have any questions, }Tease contact us.
NDPONC 06-16
(3).docx
5tatc „1 NVIC111 CatVhrul
Mpar'lmrrs! of Eurituttinval wad Nmura! Revwr<r.
DI: tisiutY 03i Vlstct Rr+etlrcc•w
DWR
15A Nt AC011 .CNOW - SINGLE-F MILI RESIDENCE N%ASTE*%:iTER IRRIGATION SYSTEMS
(1PERILTIOS AND MAtNTENANC EAGREENIFNI
Dfvf+l�rt of FORNL SFR%NIN L� C1&NI 119-1k
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lLt tfltt:,1:1:."k J1-:nE..I1tl:' 11::!1 shall ht di�!,kcc a%eck.) ih, 1,imri-1 and qu,tfll I.. st,l
t,I rtlil��t4 t�.:r llre Thal`,. ai,ink:
. .� . rnrn- Jr11i .1.,IF111 1,-I,11I- -h II.' : II, :1,,.,',•li'Iran1h'

f. Ehc ttrtgatiort s4stcmi shall lac inspected mutxthiv it) ensurc that the %ystcm is fTec of leake, Ghat Al trrmgulwn
cgrlipmcnt is operattng as designed, thw vt ctatave growth docs wl tmertcrr with the systcni tnsprown or
operation. That the sail is assimilating the dispascd trtatcd wastewater with no vislHc runcv f or pandinq, and
that no nhiccttcenable odors arc htiinp generated.
Failure le pay tlsc arntial tc%: shall he cause l'or tlic 11a+tsion In rclukr tltl permit 1l :.rrsuant to IS:A `4UAC 421
.01 (t5[e II 3).
l hw i'vrnl:ticC'ti tal[Urt tll VulTwnv cep Cr.lii ;his 5j mcm is ,uhtca t0 i penal:N' up to pc; da-.,
4. 1-.111111'C tO MUt the permt t:il'Ellmili1., 'ii of it," �;atit•'ti sL!NoLe V, JICr lrr 1:rroatnit4 altr rc_L'uh:ii)nti Ma_y load
Else permit.
All U n The 1l- revorM mvcrtil! tit Qgrrilligg gj NfaintmAnce Allrermial
1. WC uridcrst and he f ho? e tcqutrcmcwt -0 F3prcc to thnw terms ds pari of the issu<d perImY �}
O}vncr slerlatttrc• - � --xc. 13atr ly Il
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Owner 44��nattt*t;
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Information to be added North Carolina Department of Environmental Quality
Noted in RED below Division of Water Resources
Permit Number: WQ0029893
Permit Type: Single -Family Residence Wastewater Irrigation
Facility Name: 1125 Crowell Dairy Rd. SFR
Facility Addressi: 1125 Crowell Dairy Rd
Facility Address2:
City, State & Zip: Indian Trail, NC 28079
Owner Information Details:
MUST submit a Change of Name/Ownership form to DWR to make any changes to this Owner information.
(Click here for "Change of Name/Ownership"form)
Owner Name: Alexander M Heitbrink
Owner Type: Individual Owner Type Group: Individual
*** Legally Responsible for Permit ***
(Responsible corporate officer/principle executive officer or ranking elected official/general partner or proprietor;
or any other person with delegated signatory authority from the legally responsible person.)
Owner Affiliation: Alexander M Heitbrink Title: Owner
Addressi: 1125 Crowell Dairy Rd
Address2:
City, State & Zip: Indian Trail, NC 28079
Work Phone: Fax:
Email Address: [e-mail]
*** Permit Annual Fee Billing ***
Billing Month: October
Invoice Number Invoice Date Invoice Due Date Invoice Amount Invoice Status
Owner Contact Person(s)
Contact Name Title Address Phone Fax
Email
Laura J. Haskin Owner �25 Crowell Dairy Rd. [phone]
[e-mail]
Alexander M. Heitbrink Owner Indian Trail, NC 28079 [phone]
[e-mail]
Facility Contact Person(s)
Contact Name Title Address Phone Fax
Email
Permit Contact Person(s)
Contact Name Title Address Phone Fax
Email
Same as above
Permit Billing Contact Person(s)
Contact Name Title Address Phone Fax
Email
Alexander M 1125 Crowell Dairy Rd, Indian Trail, NC [phone]
[e-mail]
Heitbrink Owner 28079
Laura J. Haskin C)wner-- (f 51) bl 1-bb44
Ljhaskingvt.edu
Persons with Signatory Authority
Type Contact Name Title Address Phone Fax
Email
Same as abo..
1/24/2023

Permit Number: WQ0029893
Permit Type: Single -Family Residence Wastewater Irrigation
Facility Name: 1125 Crowell Dairy Rd. SFR
Facility Addressi: 1125 Crowell Dairy Rd
Facility Address2:
City, State & Zip: Indian Trail, NC 28079
Designated Operators
If the designated operators listed below are incorrect or no longer associated with the collection system, the information can be updated by su
a completed 'Operator Designation Form" (Click Here for ORC Designation Form). Please provide specific details as to the changes requested, A
the addition/removal of designated operators. For a// other operator questions or issues, please call 919-807-6353.
Facility Classification:
Operator Name
AQWA
Role Cert Type Cert Status Cert # Effective Date
This information should be on record.
Please advise if additional information is needed in order to update.
1/24/2023 Page 2