20141117 Ver 2_Shoreline Stabilization_20191028

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State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be senti to,:"
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Inff mation [15A NCAC 02H .0502 a
1. Owner Ihfot`mation �1
Name: �
Mailing Address:
Telephone Numbed
E-mail Address: a
2. Agent/ Contact Person Information
OCT 2'8 2019
\ T 4r flag ,::arcs
Number. �—" 1�
N �, A n %'1 �\ %
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
htto://www,saw.usace.armv.mii/Portals/59/docs/reRulatorv/reRdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation: RE DE Mailing Address: p�R
Telephone Number: Fax Number:
E-mail Address: Itrmidl sectp.-41
B. Project Information [15A NCAC 02H .0502(a) & (b)j
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, buildings, retaining walls, docks, impervious surfaces, 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.
FORM: SSGP 02-2017
Page 1 of 3

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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. Locatio oaf property (where work is to be conducted
County: T 7-j Nea est Town: _
Lake/ river/ ocean a jacent to property:
Property size (acres)5-T 3
Su division Me or site address (include p ase/lot numbe .LYN
Direction to site - please incluclrckad names and u bers, landma
etc..
V�
-IV %'L_
�1\T'Etatitu e (ran dsecim�a\ldeMe Longitude (decimal degreesP2,2DA'C�;-,--�A
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Describe proposed work (inclkdf as to h" hardening of shoreline has been
avoided, or why it is necessar
�`�
7. Will work be conducted from land. From water? ❑
8. Total amount of impacts below the normal pool lake level/ mal�Level
'J�,
p /
er anent impact (includifig al Oxca
Temporary impacts in square feet:
on, backfill, rip rap, retaining walls, etc.) in square feet:
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
n��P anent impacts including -back fill, va�tion, ri rap, retaining walls, etc.) in square feet:
11 �( Temporary impacts temporary cle ing, construction corridor) in square feet:
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50
v feet landward to be impacted (number of trees, for instance):
d
w V�V--Up,,Signa
Owner Age s Signature` [15A NCA H .0502(f)] Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Full Pored/ Normal Water Levu
i loreline
Full Pond/ Norr
Y. ftt.WJdid
Jf[,x1Mft.
• t ice nary
Plan View
tl I r \fit
Lake
(at HA P,x,d/. N.—I s'vw, L-11
Existing Dock
7+)@x7.aG
tali }xsndj pm
B�f rvFBN �z16 3�Wm?,N _ U t ft� 150 k
Riprap n, c nb,hf,,Ilf—J,uw1
i
� "11 1 p,�p�Nll
�„ mt3 �.
FORM: SSGP 02-2017 Page 3 of 4

MGM
Side View
FORM: SSGP 02-2017 Page 4 of 4

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Printed October 21, 2019
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lerford County Geographic Information Systems (GIS) Data Distribution Disclaimer The County of Rutherford acquires, develops, maintains and uses GIS d<
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https://rutherfordcounty.connectgis.coin/Download File.ashx?i=_ags_mapfffdc0l135b64b31ba5bc977e67d7bdbx.htm&t=print Page 1 of 2

Kenneth S. Tanner 111
10661331, 11611146
PB 36/187
N05' 19'42 "E
g6' William a. (:ampbell Existing iron r - 10.00'
and wife s`e' tia:
26 Mortho Y Cornpbeli o�� S 84-40''1S 4 p,1ern1_n;
885 f.`. I O 65. 16' 8 ' E
13' i Lot r. �Gj� �� Existing iron 14� 2' S -
PB .''. o
N50-57'36"E
68.03'
N50'17'19"E _
42.08'
Found 3/4" pip
Found 3/4" pipe 1
f
Found 3/4" pipe LOT 1 (Revised)
I pond 3/4" pipe > 2 ` 2.4 6 ACRES
TOTAL AFTEP. RECOMBINATION
S 84'21 '54" E
�45.11'
found 3/4" pipe
S84'4 ' 18,,E
159.57' `,
r � i
Raymond McClinton
and wife
Susan H. McClinton '
7681301, 11651143
Lots 1, 2 and part of Lot 8
PB 74123, 34/78, 36/187 L 1
Tax Map: 1652344 PP L2
427.65'
S 84 � 2'04.. E
LOT 3
1. 16 ACRES
5051480 and 1
Tax Pin: 1604814
432.20'
NB4-54'04"E,- coi, /P
wdr0 L27 �1
Howe
16 o.q <<
Fouh'bk,jr<
E.58 0,
Found 3/4" pipe �°`
/ v
N32'22'56"E ✓ M
63.30' LOT 4 Found 3/4" pi Sg'
Found 3/4" pipe 1.16 ACRES 553$ 10.20'
Wcat�'es> r)!
f oker I ufe
4" W
� � 568/423 3
4' 4
Tax Pin: 1606256 34A5,13• �o� `a \Found 3/4 pipe
' pipe
Z'27"E
. 2 0'.
f Ciund ,3/4" pipe
0 PEf1
Found 1/2" pipe
Pond
L9
I
unoer my supervilsino c9
in Deed Cook `568 !'acics 1'
not surveyed are Clearly indis.(
information found in E oo> -
the ratio of precision as cif
it
that this plat was preparca
47-30 as amended. Witne -s r
-_5th ---- day of
I
�1
Signaturei`�
S84'40'18"E Land Surve.
1.00' Licensure• Numbe
Existing iron
w
s� Umbore
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17L15L13
0 Waters of
1_22 Loke Lure
t 23
Thomas E. Hannah
Revocable Trust \
11291293
Lot 1, PB 17/43 \
Casa H. Bacot Subdivision
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-1-10 Waters of
Lake Lure = SEAL
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LS
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11.71
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11'00'04" E
18.70,
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4.01
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116.88
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05.43 22 W
121.29
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19'33'49" w
148.39
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S 35-38.52" W
30.1 C
L_13
S 67'03 40" W
10.16
L_14
N 87-24 25' W
11.39
1. 15
S 43'00 40" W
14.32
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N 80'56 55 W
3.01
L_17
S 73'05'46" W
14.01
l 18
S 47'S1 56 W
7.72
L19
S 19'36'12' W
13.07
120
S 12'4337' E
9.30'
L21
S 48'32'53' W
10.76
_22
S 43'09 14' E
7.59'
_23
S 06-24 34' w
4.35'
_24
S 45'51 26' W
16.49
_25
N 4632 38 W
25.34
_26
S 43'27 22' W
16.24
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S 44' 1426' W
16.65
L29
S 25'01'07 W
12.68'
L30
S 59.57 11 W
45.79
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