20141330 Ver 3_Shoreline Stabilization_20151103

State of North Carolina
Department of Environment and Natural Resources
D,Wm
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 j 41
1 ,f
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
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: MAG Bear Lake LLC
Mailing Address: 15443 Knoll Trail Dr. Suite 130,
Dallas, TX 75248
Telephone Number: 972 - 715 -6421
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Fax Number:
E -mail Address: ajones @marlinatlantisgroup.com
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 /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) 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: 828 - 421 -2025 Fax Number:
FORM: SSGP 10 -2013 Page 1 of 3

E -mail Address: censley23 @aol.com
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): Bear Lake Reserve 503
Harbor Ridge Dr. Tuckasegee, NC 28783
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 4.5
miles and turn left onto Harbor Ridge Dr., go % mile to the end, past the Lake Club.
Latitude (in decimal degrees) 35.231719 Longitude (decimal degrees) - 83.051701
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): undeveloped recreation area.
6. Property size (acres): lac. +/-
7. Lake/ river/ ocean adjacent to property: Bear Creek Lake
FORM: SSGP 10 -2013 Page 2 of 4

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? X❑ 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:
2000
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: 5200
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): 8 -10 trees that have
been eroded under.
28 Oct 2015
Owner /Agent's Signature' [15A NCAC 02H .0502(f)) Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10 -2013 Page 3 of 4

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
PARCEL ID: 7591 — ✓ /' g 33�i
STREET ADDRESS: ZC
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Please print:
Property Owner: _�YfJ� (- . L L C �.�i9lLEly �%OAQ)
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
(_J IV OiVS615y . of Leif "6ca s W 6 Vl&c.j/1f�
(Contractor / 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: q 1 Z. - 1 L
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
11�4'al 4" —
Au horized Signature
Date:
Authorized Signature
Date: 9 �%

Full Pond/
Normal Water Level
Shoreline
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Please 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.
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 4 of 4

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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. Printed. Dec 1 0, 2014

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