20201894 Ver 1_Shoreline Stabilization_20210113

Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to viewthe form.
Attach documentation of Pre -Filing Meeting Request here:
Rudmen MR.pdf 829.67KB
Pre -fling Meeting or Request Date 12/6/2020
ID# 20201894 Version 1
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email * [e-mail]
Rease provide an email address for payment and requests for pure information here.
Owner Information:
Name:* Keith Rudman
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
919 HE Rd
Address Line 2
City
State / Frovince / Region
Winnetka
IL
Fbstal / Zip Code
Country
60093-3928
Us

Is there an agent working on the
project? *
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:*
Email:
Phone Number:*
Mailing Address:*
F Yes
r No
Chad Ens ley
Ensley Properties and Excavating, LLC
censley23@aoLcom
[phone]
(xxx)xxx-xxxx
Address
756 Shook Cove Road
Address Line 2
City
Tuckasegee
Fbstal / Zip Code
28783
Asigned and dated copyof the Agent Authorization letter:*
Rudman 97.pdf 394.95KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Rudman97
State / Province / Region
NC
Country
US
If your project has a formal name please use this. If your project does not hake a formal name, please identify your project by
the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that have been used to identify the project in the past.
1. Provide 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.*
r Upload File
r Lookup address
Upload Map: RudmanVM.pdf
Latitude:* 35.236000
Longitude:*-83.070000
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 under section 12.normal pool lake level/normal water level*
Rudman SP.pdf 904.38KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%2OLayout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a
yard stick, shovel handle, etc.)*
Rudman Pics.pdf 4.01MB

4. Location of the property (where work is to be conducted)
Nearest Town:* Tuckasegee
County:* Jackson
Lake/ river/ ocean adjacent to Bear Lake
property:
Subdivisions name or site address:* Bear Lake Reserve Lot 97
Include phasellot nunber
Directions to site:*
From Hwy 107 turn onto Shook Cove Rd. go 3 miles turn right into Bear
Lake Reserve Lake Forest Dr. go 2.5 miles turn left onto Eagles way the
lot will be on the right.
Rease include road nar es and nunbers, landnarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential
Fbsidential, undeveloped, etc.
6. Pro pertySize .90
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Shoreline stabilization using a seawall with creek rock rip rap in front of
the wall. Erosion damage in need of repair.
8. How will the work be done? * PF From Land
r From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
1000
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
2000
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunber of trees, for instance)
5-6 trees will be impacted
Sketch: Rudman tree.pdf 500.55KB
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
o $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the

best of my knowledge and belief
o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act');
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
0 1 understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Keith Rudman
Signature:
C)6;;P� If

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201894
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Kaylie Yankura:eads\kyankura
Asheville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 7 PLAN NO.
PARCEL ID: 75K& -,55 2 75(
STREET ADDRESS: `�� � �7f 7 'Cej tt-' T/Vi TL (mil
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
, of 5i�- & plw6l- 7,4FJ -44e .i7L r
(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: % 7 3 �w -� - E�--t)p
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: ax-) C
�
Authorized Signature
Date: ��,� "i U 2-1

a
/
E
2
_

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
Lake
(At Full Pond/ Normal Water .Level)
5" aw i 5 r,✓.gC /�Gs2�fX %
(/1/414-lm �� J
Full Pond/ Normal Water Level ,/ X
Shoreline \. \
Plan View
Full Pond/ Normal Water Lew
v n oreriin® ® —
2i.150k
aC6ticrH1 [iemirg
• A rveccsuy
E
Plan View
f s)7� 4,,- a) l
�1
�vvST/Guc• %��
LOT 97
Lake
tft FuHPOr` tH—dW `�L-4) Existing Dock
/30ft%7ft
i�i3� i~s~i�
AMPLE
C4 0 CV��
44C54
FORM: SSGP 02-2017 Page 3 of 4

5-64
La ke
I
(At FulI Pon / Normal Water Level)
L 0
O i
Z Ln
Side View
U-
3 ft. belovr full pond vvater level 4 ft. awe full pond water level 2 ft. additional clearing
"if necessary
I
i
Existing bank
10 ft. bank ea
FORM: SSGP 02-2017 Page 4 of 4

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15 7 P FTC AW P.O. WX 17335 —VALLE, NC 28816
y� p�LA��•�' PONE [phone] FAX (628) 225-G) -
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ID#* 20201894 Version* 1
Regional Office * Asheville Regional Office - [phone]
Reviewer List* Kaylie Yankura
Pre -Filing Meeting Request submitted 12/6/2020
Contact Name *
Chad Ensley
Contact Email Address*
[e-mail]
Project Name*
Lot 97 Bear Lake Reserve
Project Owner*
Bear Lake Heaven, LLC Keith Rudman
Project County*
Jackson
Owner Address:
Street Address
PO Box 249
Address Line 2
City
State / R-ovince i Rxj on
Tuckasegee
NC
tbstal / Zip Cade
Country
28783
United States
Is this a transportation project?* r Yes (-- No
Type(s) of approval sought from the DWR:
* 401 Water Quality Certification - F 401 Water Quality Certification -
Regular Express
r Individual Permit F Modification
* Shoreline Stabilization
Does this project have an existing project ID#?*
r Yes r No
Do you know the name of the staff member you would like to request a meeting with?
Kaylie Yankura
Please give a brief project description below.*
To do shoreline stabilization. due to the shoreline erosion.
Please give a couple of dates you are available for a meeting.
12/9/2020

12/16/2020
Please attach the documentation you would like to have the meeting about.
pdf oily
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
Submittal Date 12/6/2020
Reviewer Meeting Request Decision
Has a meeting been scheduled?* r Yes r NO