20141315 Ver 1_401 Application_20141214

05 A
&ce Use Only
J Corpseaction_ID.no.
DWQ project no
Form Version 14 January 2009
01 A A • A A a
U4A TLC,i
A.
Applicant Information
1
Processing
la
Type(s) of approval sought from the Corps
❑ Section 404 Permit ❑ Section 10 Permit
05 A
&ce Use Only
J Corpseaction_ID.no.
DWQ project no
Form Version 14 January 2009
01 A A • A A a
Page 1 of 10
PCN Form - Version 14 January 2009
I D4 M 0
DEC 1 7 2014
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Pre - Construction Notification (PCN) Form
A.
Applicant Information
1
Processing
la
Type(s) of approval sought from the Corps
❑ Section 404 Permit ❑ Section 10 Permit
1b
Specify Nationwide Permit (NWP) number % or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps? f-; 4 �[��� �-
Yes El No
1 d
Type(s) of approval sought from the DWQ (check all that apply)
❑ 401 Water Quality Certification - Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification - Express ❑ Riparian Buffer Authorization
1e
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification
❑ Yes ❑ No
For the record only for Corps Permit
I<es ❑ No
1f
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program
❑ Yes EPI-01
1g
Is the protect located in any of NC's twenty coastal counties If yes, answer 1 h
below
❑ Yes M.R<
1 h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes 1;K0O
2
Project Information
2a
Name of project
,Soon I'-, c err o-r ` j-i ,2n.b�rr
2b
County-
�Rpyt,n
2c
Nearest municipality / town
ur k� wn , — �� Qw►'l Ga1�
2d
Subdivision name
2e
NCDOT only, T I P or state project no
3
Owner Information
3a
Name(s) on Recorded Deed
3b
Deed Book and Page No
-i- -1 of aZ Ci O
3c
Responsible Party (for LLC if
applicable)
C
c>vLn lid
3d
Street address
M r� 5 YYt AA OvcL,A
3e
City, state, zip
AQ
3f
Telephone no
L 41-r— v r 7 J1c:l - YO .A-
3g
Fax no
Cl, -- L1Tcc - 6,,,v(
3h
Email address
Si V_ co "<J'tco_. C_4uv} -c'-- , c
Page 1 of 10
PCN Form - Version 14 January 2009
I D4 M 0
DEC 1 7 2014
r�
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4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent
then -sw-�q
4b
Name
q 4c
Business name
(if appl cable)
4d
Street address
4e
City, state, zip
4f
Telephone no
4g
Fax no
4h
Email address
5
Agent/Consultant Information (if applicable)
5a
Name
Y' L
S rYtt t'-
5b
Business name
(if applicable)
p
C p
f p
5c
Street address
333)
�r j
5d
City, state, zip
�-
Q U a
5e
Telephone no
q ( — 15 6
_ 4 VF4 a
5f
Fax no
iq —f 6
Z — G,�a r
5g
Email address
r- y _ L ,
t S. to qr
aGe,
Page 2 of 10

B.
Project Information and Prior Project History
1
Property Identification � \ [ } ku-e -r�-s fy-V 94 Q<J t,"v
1a
Property identification no (tax PIN or parcel ID)(
2.-
1b
Site coordinates in decimal degrees)
(
Latitude rc
O 2 -roS ---90 %Z Longitude 4 �� Z©
1c
Property size
acres ' L
2
Surface Waters
2a
Name of nearest body of water to proposed protect
p
2b
Water Quality Classification of nearest receiving water
f-
2c
River basin
ry @r'
3
Project Description
3a
Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application �, �1� l�r' 2. `~ P, P �L
(—r Y, VO F— CY r a r n a + -� 6-1 [40 P red 4A-t" i-a "Ai- ' )v
r,5 2 S— �E? Q zi (wvvi e S
3b
List the total estimated acreage of all existing wetlands on the property
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property (V £jt,t
3d Explain the purpose of
P T the proposed project
L �rrm v0�r- d iiox - Aedg ro v a J 'O'n -QS
r C'vtiQL- PM E r l L s rYMp a- --
3e
Describe the overall project in detail, including the type of equipment to be used
4
Jurisdictional Determinations
4a
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Yes ❑ No ❑ Unknown
Comments `
3W.wn<,s C� � r
4b
If the Corps made the jurisdictional determination, what type
of determination was made?
L
❑Preliminary Q'Flnal
4c If yes, who delineated the junsdi itional areas?
me (if ar C9Y" S
Agency /Consultant Company
Other Phi '
4d
1 y hs a da—gf the Corps jurisdictional determinations or State determinations and attach documentation
S CA-e_
5.
Project History
5a
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes No ❑ Unknown
5b
if yes, explain in detail according to "help file" instructions
6
Future Project Plans
6a
Is this a phased project?
❑ Yes No
6b
If yes, explain
Page 3 of 10
PCN Form — Version 14 January 2009

C Proposed Impacts Inventory
1 Impacts Summary
1 a Which sections were completed below for your project (check al/l that apply)
❑ Wetlands ❑Streams - tnbutaries ❑Buffers ❑ O,ROAVaters ❑ Pore onstruction
2 Wetland pacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted
2a
Wetland impact
number
Permanent (P) or
Temporary
2b
Type of impact
2c
Type of wetland
2d
Forested
2e
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f
Area of
impact
acres
W1 -
Choose one
Choose on
W2 -
Choose one
Choose one
Yes /No
-
W3 -
Choose one
Choose o
Yes /No
W4 -
Choose one
Ch a one
Yes/
-
W5 -
Choose one
Choose one
Yes /No
-
W6 -
Choose one
Choose one
Yes /No
-
2g Total Wetland Impacts
""��
2h Comments s+V r ,nC \ V-) fir- ra,- l� & C��U�v�l lo f o 2 'J.,Q
62 4-C4eA:;(- --- , C--rc- " +,Ar- 4e,
3. Stream pacts E �r- t-r— AVS Yv -,42, �Of-
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, tp�n complete this
question for all stream sites impacted
3a
Stream impact
number
Permanent (P) or
Temporary (T)
3b
Type of impa'Ist.
3c
Stream name
3d
Perennial (PO�) or
intermi (INT)?
3e
Type of
jurisdiction
3f
Average
stream
width
(feet)
3g
Impact
length
(linear
feet)
S ' -
Choose one
-
- Go JDs
S2 -
Choose one
-
-
S3 -
Choose one
S4 -
Choose one
-
-
S5 -
Choose one
-
S6 -
Choose one
-
-
3h Total stream and tributary impacts
31 Comments
Page 4 of 10
PCN Form - Version 14 January 2009

4 Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U S then indiv ually list all open water impacts below
4a
Open water
impact number
Permanent (P) or
4b
Name of waterbod ,
(if applicabl
4c
Type of impact
4d
Waterbody
type
4e
Area of impact (acres)
—Temporary
01 -
Choose one
Choose
02 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f Total open water impacts
4g Comments
1 /r
f
5 Pond or Lake Constru tion
If and or lake construction r osed, then complete the chart below
5a
Pond ID number
5b
Proposed u e or
purpose of
5c"'
/ Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose ne
5f Total.
5g Comments
5h Is a dam high hazard permit required?
❑ Y\&,,,, ❑ No If yes, permit ID no
51 Expected pond surface area (acres)
51 Size of pond watershed (acres)
5k Method of construction
6 -Bu erlmpacts (for DWQ)
I or will impact a protected riparian buffer, then complete the chart below If yes, then individually list all buffer impacts
below If any impacts require mitigation, then you MUST fill out Section D of this form
6a. Project is in which protected basin?
❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other
6b
Buffer Impact
number–
Permanent (P) or
Temporary
6c
Reason for impact
6d
Stream name
6er,
Buffer
mitigation
required?
6f
Zone 1
impact
(square
feet )
6g
Zone 2
impact
(square
feet
61 -
Yes /No
B2 -
Yes /No
B3 -
Yes /No
B4 -
Yes /No
B5 -
Yes /No
B6 -
Yes /No
-- 6h Total Buffer Impacts
61 Comments
Page 5 of 10

D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ Yes kf<O
2b If yes, mitig ti on is required by (check all that apply)
❑ DWQ ❑ Corps
2c If yes, which mite tion option will be used for this
project?
El bank %
El Payment to in -lieu fee program
❑ Permittee Responsible itigation
3. Complete if Using a Mi ation Bank
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt a letter)
Type ChoXone
Type Cho
Type Cho
Quantity
Quantity
Quantity
3c Comments
4 Complete if Making a Payment to In -lieu Fe o ram
4a Approval letter from in -lieu fee program is ached
❑ Yes
4b Stream mitigation requested
linear feet
4c If using stream mitigation, stream t9APerature N
Choose one
4d Buffer mitigation requested (DW only)
square feet
4e Riparian wetland mitigation r quested
acres
4f Non - riparian wetland mite tion requested
acres
4g Coastal (tidal) wetlan itigation requested
acres
4h Comments
5 Complete if U ing a Permittee Responsible Mitigation Plan
5a If using a p rmittee responsible mitigation plan, provide a description of the pro osed mitigation plan
Page 6 of 10
PCN Form —Version 14 January 2009
IM

6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by//DWQ
6a Will the project result in an impact within a rot ected riparian buffer that requires
Yes , El o
buffer mitigations � /
6b If yes, then identify the square feet of impact each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
6c
6d
6e
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square fee
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
15
6f otal buffer mi ation required-
6g If buffer mitigation is required, discuss wh type of mitigation is oposed (e g , payment to private mitigation bank,
permittee responsible riparian buffer res ration, payment into an proved in -lieu fee fund)
6h Comments
Page 7 of 10

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
la
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes o
within one of the NC Riparian Buffer Protection Rules?
lb
If yes, then is a diffuse flow plan included? If no, explain why
❑ Yes ❑ No
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
0
2b
Does this project require a Stormwater Management Plan?
❑ Yes o
2c
if this project DOES NOT require a Stormwater Management Plan, explain why
Srvr, er"
2d
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan
2e
Who will be responsible fo the review of the Stormwater Management an?
3
Certified Local Governm nt Stormwater Review
3a
In which local government's u diction is this ro ect?
❑ Phase II
3b
Which of the following locally- implem man ement programs
❑ NSW
❑ USMP
\tedormwater
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management PIa`h with roof of approval been
El Yes E] No
attached
4 DWQ Stormwater Program Review
❑Coastal counties
❑HQW
4a
Which of the following state - implemented stor water mana programs apply
❑ORW
\ement
(check all that apply)
❑Session Law 2006 -246
[:]Other
4b
Has the approved Stormwater Managem nt Plan with proof of appr val been
❑ Yes ❑ No
attached?
5 DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management Plan meet the appropriate requirements
❑ Yes ❑ No
5b
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form —Version 14 January 2009

F. Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1a
Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes o
use of public (federal /state) land?
1b
If you answered "yes" to the above, does th roject require prepararon of an
environmental document pursuant to the require nts of the N tonal or State
❑Yes El
(North Carolina) Environmental Policy Act (NEPA/S )?
1 c
If you answered "yes" to the above, has the docum revs been finalized by the
State Clearing House? (If so, attach a copy oft EPA or EPA final approval
❑ Yes ❑ No
letter )
Comments -
2
Violations (DWQ Requirement)
2a
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500), Isolated
Wetland Rules (15A NCAC 2H 1300), DWQ Surface Water or Wetland Standards,
El Yes o
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after - the -fact permit application?
El Yes U140
2c
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s)
3
Cumulative Impacts (DWQ Requirement)
3a
Will this project (based on past and reasonably anticipated future impacts) result in
El Yes No
additional development, which could impact nearby downstream water quality?
3b
If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy If you answered "no," provide a short narrative description
4
Sewage Disposal (DWQ Requirement)
4a
Clearly detail the ultimate treatment methods and disposition (non - discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility
Page 9 of 10
PCN Form — Version 1 4 January 2009

5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
❑ Yes
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes
impacts
5c If yes, indicate the USFWS Field Office you have contacted
-
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat9
❑ Yes No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7 Historic or Prehistoric Cultural Resources (Corps Requirement)
7a Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes o
status (e g , National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b What data sources did you use to determine whether your site would impact historic or archeological resources
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA - designated 100 -year floodplain?
❑ Yes No
8b If yes, explain how project meets FEMA requirements
8c What source(s) did you use to make the flood lain determin ti n?
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SR'nAc&
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Applicant/Agent's Printed Name
Date
Applicant/Agent' ign re
(Agent's signature is valid y dan onzato
letter from the applicant is rovide
Page 10 of 10
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
PAT MCCRORY
GOVERNOR
December 9, 2014
Mr Jerry Wrightenberry
Mrs Sandra Wrightenberry
14106 Hwy 501 North
Rougemont, NC 27572
ANTHONY J TATA
SECRETARY
A few weeks ago I looked at a cross -line pipe that outlets onto your property on the East
side of US501 Mrs Wrightenberry was inquiring whether they could tie in to NCDOT
drainage structure so that they could fill in a ditch on their property to alleviate the danger
of their horses being inured NCDOT has no problem with tying into our drainage
structure but recommends that they use NCDOT approved pipe of equal size in diameter
and that a pre -cast drainage structure be used to tie the pipes together(extstmg and new) I
would also recommend that a clean out be placed midway of the ditch in case there is
blockage in the pipe future, it would allow access to the pipe to remove or flush out the
debris If you need any additional information feel free to contact me at 919 - 477 -2814
Ashley Pilkington
Durham County Maintenance Engineer
NCDOT, Division 5, District 2
Durham County Maintenance, 1069 Prison Camp Road, D -drham, NC 27705
(919) 477 -2814 Telephone [phone] Facsimile

=cod COUNTY OF DURHAM
NOFFICE OF THE TAX ADMINISTRATOR
PO BOX 3397
1 ' DURHAM NC 27702 -3397 n r
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ADDRESS SERVICE REQUESTED
2012 PROPERTY TAX NOTICE
#BWNNNHZ
WRIGHTENBERRY, SANDRA W
14106 ROXBORO RD
ROUGEMONT NC 27572 -7303
, 2012
a ADDITIONAL INFORMATION I, piloted on the ,evetse side
OFFICE LOCATION 200 East Main Street
Administrative Complex, First Floor '
Durham, NC 27701
OFFICE HOURS Monday - Friday 8 30 am - 5 00 pm
PHONE NUMBERS Tax Department (919) 560 -0300
Fax [phone]
WEBSITE http / /tax durhamcountync gov
DURHAM COUNTY E- SERVICE
TAX PAYMENT KIOSK Cash and Credit Card payments can
be made at a touch screen machine located at Northgate Mall,
(next to DMV) 1058 W Club Blvd , Durham, NC during mall hours
ELECTRONIC CHECK http / /tax durhamcountync gov
go to on -line payments
CREDIT CARD Call 1- 919- 277 -2231 OR 1- 866 - 892 -0656
A processing fee applies
VISA I aim
- -- ' Any payment(s) made by yow 1Wortvvtg-
Comnanv /Lender are rofle(Aed in the
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Pre - Construction Notification (PCN) Form Instructions
The PCN form is required for applicants seeking the following approvals Corps 404 or Section 10 Permit, or
DWQ 401 Certification, Buffer Authorization, Isolated /non -404 Wetlands Permit
PURPOSE:
The PCN — Pre - Construction Notification form helps regulators from the state and federal agencies in North
Carolina better understand and evaluate the impacts of activities that you propose to do in or around streams,
wetlands, or other waters that may affect water quality, the health of the aquatic ecosystem, or water access or
flow, in the immediate or nearby drainage area
The PCN is a combined effort by the US Army Corps of Engineers (USACE- known as the "Corps ") and the
NC Division of Water Quality (DWQ) to coordinate regulatory requirements for work in (or affecting)
wetlands, streams, riparian buffers, and waters within North Carolina By accurately completing the PCN
form, we can determine if you meet requirements to proceed with your protect as proposed We can
evaluate the measures you propose to take to avoid or mitigate for any damage to the environment Our
review of your completed form will provide us with necessary information about your protect to determine if
we can allow you to begin your protect without the time, expense or uncertainty involved in going through a
major permit process
Many Corps Nationwide permits and some general permits require the applicant to complete and submit a
PCN form before starting any work in an area that may impact streams, wetlands or other waters Activities
that require a NC General Water Quality Certification, a stormwater permit, or a buffer permit within
protected watersheds, use the PCN form The responsible state or federal agencies will review your
application for completeness within 30 days of receipt We will notify you if we need additional information to
process your request You may not begin work until your application is complete Onceyour application is
COrC1nIP _fP__t17P_rtT,utOlcN rc+�' cn a_.,ft.._er_ a -__� r- rte- ti = -- - DWQ will
_. r"vm me q rmi'nrr7"'I IIB'F07Pi
JERRY D WRIGHTENBERRY
SANDRA W WRIGHTENBERRY
PH 919 - 477 -9262
14106 US HIGHWAY 501 N
ROUGEMONT, INC, 27572 -9695
9240
66- 112/631 lual Water
BRANCH BANKING AND TRUST COMPANY
1- 800 -BANK BST BUT can
Jymwa, r,
1■05310LL2Li:00052L It, 2L87 3i& 9 2 0
..� —� �— _ _ _�_ _
V .Y -fi3M C18tk0ywll k.+a_ — .
�' id how you
,. -nation is
_ N and will be
instructions
tifications
Major water quality applications. Greater than or equal to
$57000
on acre of wetlands /waters AND /OR Greater than or equal
01 50 feet of streams (whether intermittent or perennial)
Minor water quality applications: Less than one acre of
lands/waters AND Less than 150 feet of streams
$24000
%F
((whether intermittent or perennial)
Checks should be made out to the "NC Division of Water Quality ", with the specific name of the protect or
applicant identified on the check Please staple your check to the' front of the application package
Version 12 PCN Help File Page 1 of 26 12/29/2008
r �
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co COUNTY OF DURHAM
OFFICE OF THE TAX ADMINISTRATOR
°i PO BOX 3397
i g DURHAM NC 27702 -3397
0 ADDRESS SERVICE REQUESTED
2012 PROPERTY TAX IV ®TICE
#BWNNNHZ
WRIGHTENBERRY, SANDRA W
14106 ROXBORO RD
ROUGEMONT NC 27572 -7303
T 2
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I
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1, 20
a ADDiTIGNAL li`!t (1i= MAI ION I- it, iced , i u`
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OFFICE LOCATION 200 East Main Street
Administrative Complex, First Floor
Durham, NC 27701
OFFICE HOURS Monday - Friday 8 30 am - 5 00 pm
PHONE NUMBERS Tax Department (919) 560 -0300
Fax [phone]
WEBSITE http / /tax durhamcountync gov
DURHAM COUNTY E- SERVICE
TAX PAYMENT KIOSK Cash and Credit Card payments can
be made at a touch screen machine located at Northgate Mall,
(next to DMV) 1058 W Club Blvd , Durham, NC during mall hours
ELECTRONIC CHECK http / /tax durhamcountync gov
go to on -line payments
CREDIT CARD Call 1- 919 - 277 -2231 OR 1- 866 - 892 -0656
A processing fee applies
VISA
JANUARY 7, 2013
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Y
ST
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
PAT MCCRORY
GOVERNOR
December 9, 2014
Mr Jerry Wrightenberry
Mrs Sandra Wrightenberry
14106 Hwy 501 North
Rougemont, NC 27572
ANTHONY J TATA
SECRETARY
A few weeks ago I looked at a cross -line pipe that outlets onto your property on the East
side of US501 Mrs Wrightenberry was inquiring whether they could tie in to NCDOT
drainage structure so that they could fill in a ditch on their property to alleviate the danger
of their horses being injured NCDOT has no problem with tying into our drainage
structure but recommends that they use NCDOT approved pipe of equal size in diameter
and that a pre -cast drainage structure be used to tie the pipes together(existing and new) I
would also recommend that a clean out be placed midway of the ditch in case there is
blockage in the pipe future, it would allow access to the pipe to remove or flush out the
debris If you need any additional information feel free to contact me at 919- 477 -2814
Ashley Pilkington
Durham County Maintenance Engineer
NCDOT, Division 5, District 2
Durham County Maintenance, 1069 Prison Camp Road, Durham, NC 27705
(919) 477 -2814 Telephone [phone] Facsimile