20181729 Ver 1_Shoreline Stabilization_20181219

State of North Carolina
Department of Environment and Natural Resources
DWK
Division of Water Resources
it
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM SSCP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the apl
to:
Division of Water Resources /
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617 \
g
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Diane Berlin
Mailing Address: 18345 se cassia lane Tequesta, FI. 33469
n fee should be sent
201.81728
Telephone Number: 954-519 iX ` 1Fax Number:
E-mail Address: [e-mail]
II
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form clan be downloaded here:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Peimits/SAMPLE AGENT AU-
ORIZATION FORM.pdf) must be attached if the Agent has signed thi%application form.
Name: Diane Berlin
Company Affiliation:
Mailing Address: 18345 se cassia lane Tequesta, Florida
Telephone Number: 9544&83�'I
4
%;Fax Number:
FORM: SSGP 10-2013 (
1
Page 1 of 3

8. Describe proposed work (include discussion as to how
avoided, or why it is necessary): riprap/stack/docl
9. Will work be conducted from land? *QI/ From w
10. Total amount of disturbance (including all excavation, backs
below the normal pool lake level/ Normal Water Level in sq
11. Total amount of disturbance (including all clearing, back fill,
walls, etc.) above the normal pool lake level/ Normal Water
square feet or acres: 160 sq ft
12. Please describe the vegetation above the normal pool lake 1
50 feet landward to be impacted (number of trees, for insta
f
Owner/Agent's Signature` [15A NCAC 02H .0502(f)1 C
`Agent's signature is valid only if an authorization letter from the owner is
FORM: SSGP 10-2013
shoreline has been
I
ip, retaining walls, etc.)
ft or acres:
Jon, rip rap, retaining
nd 50 feet land -ward in
:)rmal Water Level and
Page 3 of 4

0
E-mail Address: [e-mail]
Person to receive the Certification Approval: diane berlin
11.
Project Information f 15A NCAC 02H .0502(a) & (b)]
1.
Attach a vicinity map (i.e. street map) clearly showing the loci
tion
f the property with
respect to local landmarks such as towns, rivers, and roads.
2.
Provide a detailed site plan showing property boundaries and
pro '
sed locations of
vegetation clearing, structures (buildings, retaining walls, docls,
i
ervious surfaces,
etc.), rip rap, excavation or dredging below Full Pond/ Normal
Water
Level elevations,
and construction access corridors. You may use the diagram provic
ed at the end of this
application form.
3.
Attach a photograph of the shoreline/ buffer proposed to be
stabil'
ed. (Include a scale
of -some sort- a yard stick, shovel handle, etc.)
i
t
4.
Location of the property (where work is to be conducted)
County: jackson Nearest Town: C
ashiEs
Subdivision name or site address (include phase/lot number):
I
Ior 3 sunset shores sub
Directions to site - please include road names and numbers, Iandrn
irks, etc.: hwy 107 to
Norton rd make right turn at blue ridge school stay on Norton
for
.5 miles make right
turn on finley forest trail stay on for 3 miles to end of state rd
mat
e far left turn on
sommersong lane for 600' make left on sunset shores drive first
ho
ne on ri ht. Home
green w bei a trim
i
Latitude (in decimaidegrees) 35* 09" 50" Longitud
(deci
aidegrees)83.08"47
5.
Describe the existing land use or condition of the site at the One
o
this application
(residential, undeveloped, etc.): residential
6.
Property size (acres): 1.41 acres
7.
Lake/ river/ ocean adjacent to property: lake
FORM: SSGP 10-2013 I
Page 2 of 4

On��l
riiq
r
Full Qnd�------
Norm I Water Level
horeline
La ke
(At Full Pond/ Normal
P,7) c -)L
r—r--
Please approximately sketch the following information on this plan I�ovi
dimensions for each
iterrl, such as 10 ftx 100 ft)*:
1.
All proposed vegetation clearing
"
2.
Location of rip rap or fill to be placed above the Full Pond/ Normal
W
3ter Level elevation
3.
Location of rip rap or fill to be placed below the Full Pond/ Normal
,
ter Level elevation
4.
Location of any proposed structures such as buildings, retaining
walls,
docks, etc.
5.
Location of any excavation or dredging below the Full Pond/ No
al
Vater Level elevation
6.
Location of construction access corridors
FORM: SSGP 10-2013j Page 4 of 4
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