20170811 Ver 1_Shoreline Stabilization_20170629

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
Division of Water Resources RECEIVED
401 & Buffer Permitting Unit JUN 2921
j
1617 Mail Service Center 7 Q 8 1 DENR-LAND QUALITy
Raleigh, NC 27699-1617 STOR"WATER PERIb1171'1NG
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Penny Richenberg
Mailing Address: 24672 Strand Dr
Albemarle. NC 28001
Telephone Number: [phone] Fax Number:
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAM PLE_AGENT_AUTH
nD1_7Ar1nn1 Unonn ., ) must be attached if the Agent has signed this application form.
Name: N/A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
II. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 3

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: Stanly Nearest Town: Albemarle
Subdivision name or site address (include phase/lot number): River Haven (Lot 3 sectionll)
Directions to site - please include road names and numbers, landmarks, etc.:
From the Lowes Home Improvement Store in Albemarle NC. NC 24 27 Byp E/NC-27/NC-
24/NC-73. Turn right onto E Main St/NC-27/NC-24/NC-73. Continue to follow NC-27/NC-
24/NC-73 go 5.15 miles. Turn left onto River Haven Dr. go 0.43 Turn slight left onto Strand
Dr. miles go 1.25 miles. 24672 Strand Dr, Albemarle, NC 28001-7602, is on the right.
Latitude (in decimal degrees) 35.326364 Longitude (decimal degrees) -80.085455
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential, developed.
6. Property size (acres): 0.82 acre
7. Lake/ river/ ocean adjacent to property: Lake Tillery
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Current block retaining wall/seawall is eroding and failing,
land behind wall is eroding
9. Will work be conducted from land? ® From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres: Disturbance
to existing block wall to replace with filter cloth barrier and rip rap, approximate 3 feet
shoreline to land, approximate 98 foot shoreline
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: Disturbance to existing block wall to replace with filter cloth barrier
and rip rap, approximate 3 feet shoreline to land, approximate 98 foot shoreline
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance): Grass with 4 trees
Owner/Agent's Signature [1115, A NCAC 022 .050 (f!
Date
FORM: SSGP 10-2013 Page 2 of 3

-Agent's signature is valid only if an authorization letter from the owner is provided.
Full Pond/
Normal Water Level
SI
La ke
(At Full Pond/ Normal Water Level)
-!ease approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
3. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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ConnectGIS Feature Report
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Printed June 23, 2017
See Below for Disclaimer
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his map is prepared for the inventory of Real Property found within this jurisdiction, and is compiled from recorded deeds, plats and other public records and c
sers of the map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on
ap. The Stanly County Geographic Information Systems Division of the Office of Information Technology assumes no legal responsibility for the information conta
n this map. Also, when the deeds and or plats are viewed for a parcel, the Stanly County Register of Deeds Office makes no guarantees regarding the collet
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