20220026 Ver 1_Shoreline Stabilization_20220105

Submission Form
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*
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
[e-mail]
Please provide an email address for payment and requests for more information here.
Kurt Hartman
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
3140 West Andrews Drive Northwest
Address Line 2
City
Tuckasegee
Postal / Zip Code
28783
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
Chad Ensley
Ensley Properties and Excavating
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
United States

Mailing Address:*
Street Address
756 Shook Cove Rd
Address Line 2
City
Tuckasegee
Postal / Zip Code
28783
A signed and dated copy of the Agent Authorization letter:
Hartman Agent Form.pdf 20.82KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Hartman shoreline
State / Province / Region
North Carolina
Country
United States
If your project has a formal name please use this. If your project does not have 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.*
Upload File
Look up address
Upload Map: Hartman V Map.pdf
Latitude: * 35.235000
447.07KB
Longitude: *-83.057000
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*
Hartman SL Examples.pdf 757.54KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/ShoreIine%20Layout.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.)
Hartman Shoreline pics.pdf 2.41MB
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 283A
Include phase/lot number

Directions to site: *
Take Hwy 107 turn onto Shook Cove Rd. go 3 miles turn right into Bear
Lake Reserve go 5 miles turn left onto Harbor Ridge Dr go 1/2 mile turn
left onto Shoreline Dr. go 1/4 mile lot is on the right.
Please include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:
Residential
Residential, undeveloped, etc.
6. Property Size 2.48
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Shoreline stabilization to include seawall and creek rock. Erosion repair
and prevention are needed.
8. How will the work be done?* From Land
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.)
2,375
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.)
4,750
square feet
11. 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)
10-15 trees
Sketch: Hartman map trees.pdf 326.44KB
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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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:* Kurt Hartman
Signature:
Submittal Date: 1/1/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220026 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Kaylie Yankura:eads\kyankura
Asheville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT N0. "4 PLAN NO. PARCEL ID: �� r V30
STREET ADDRESS: / % Z 1f0 114IC—
Please print:
Property Owner: kt4x- r 17-*rid N
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
LZ or L �v�6eTM 440
(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):
x
Telephone: r- 5-02 - 2
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
T
Authorized Signature Authorized Signature
Date: Date:

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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
Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
h I nra+inn of rin ran nr fill to hp nlarpd nhnvp the FEdI 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
La ke
(At FL& Pond/ Normal Water Levell
Full Pond/ Normal Water Level x3c�
Shoreline X"I
S. � ' v`o,C/ &
Plan View
A
FORM: 55GP 02-2017 Page 1 of 3

3 ft_ below full pond water level 4 ft. above full pond waterle-M 2 ft. additional dewing
•ff messaryr
Existing bank
10 ft. bank
FORM: SSGP 02-20I7
Page 4 of 4

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FORM: SSG 02-2017 Page 4 of 4

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