20141331 Ver 1_Shoreline Stabilization_20141230

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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
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
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617 IDE
I. Applicant Information [15A NCAC 02H 0502(a)]
1 Owner Information
Name: Mark Mariana
Mailing Address: 5034 NW 24th Cir., Boca Raton, FI 33431
Telephone Number- 1- 561 - 654 -6565 Fax Number:
E -mail Address mark mariani @gmail com
2 Agent/ Contact Person Information
DEC
EC 3 0 2014 r` I
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 /SAMPLE AGENT AUTH
ORIZATION FORM pd f) must be attached if the Agent has signed this application form.
Name: Chad Ensley, Ensley Properties and Excavating, LLC
Company Affiliation: Owner
Mailing Address: 6327 Hwy 107, Cullowhee, NC 28723
Telephone Number: 1- 828 - 421 -2025 Fax Number:
E -mail Address: censley23 @aol com
FORM SSGP 10 -2013 Page 1 of 3

Person to receive the Certification Approval- Chad Ensley
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,
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: Jackson Nearest Town- Tuckasegee
Subdivision name or site address (include phase /lot number)- 440 Shoreline Dr.,
Tuckasegee, NC 28783 Bear Lake Reserve Lot 290
Directions to site - please include road names and numbers, landmarks, etc : Turn off
Hwy 107 onto Shook Cove Rd , turn right into Bear Lake Reserve (Lake Forest Dr.) go 4 miles
turn left onto Harbor Ridge dr., go % mile turn left onto Shoreline Dr go % mile to end., last
lot
Latitude (in decimal degrees) 35.239005 Longitude (decimal degrees)83 058163
5 Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential, home
6 Property size (acres): .86 ac.
7 Lake/ river/ ocean adjacent to property Bear Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary) Shoreline stabilization — trees, roots, soil eroding away _
9 Will work be conducted from land? 40 From water? ❑
FORM SSGP 10 -2013 Page 2 of 4

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 -
1000 square feet
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- 2600 square feet
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): Approximately 5-
7 trees that have been eroded under.
5 Dec 2014
Owner /Agent's Signature' [15A NCAC 02H 2(f)] Date
'Agent's signature is valid only if an authors a on letter from the owner is provided
FORM SSGP 10 -2013 Page 3 of 4

_ -
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL
j /DESCRIPTION. °� f j J6 / C�
LOT NO ��= PLAN NO PARCEL ID: ! � {:� ` LY6 °
STREET ADDRESS V -iy0,ZE4 Af A,
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Please print. _
Property Owner:
Property Owner
The undersigned, r
owners of the above noted property, do hereby authorize
4f AZ 62 Le y , of &&EX :rr5S 44.6 E,�`� 1 %�; ; LtC
(Conrractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this` permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above).
Telephone: /56 J 651" 6-165
d
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge
- 11�5ell-e( .-41 .�
Aut onzed Signature
Date -5�dc- -c

Lake
(At Full Pond/ Normal Water Level)
Full Pond/ CA"4TL4k r
Normal Water level
MA VM
Shoreline
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Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10ftx 100ft) *:
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.
5. 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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This map is prepared for inventory of real property within Jackson County. It is compiled from recorded deeds, plats, and public data records.
Users of this map are hereby notified that the aforementioned public information sources should be consulted for verification. Jackson County o
any County representative assumes no legal responsibility for the contents of this map. PriD + ied _ Dec 10, O , ZO 1 4
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