20120282 Ver 2_Shoreline Stabilization_20141230

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PM'% State of North Carolina
TMAID 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
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I. Applicant Information [15A NCAC 02H .0502(a)]
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1. Owner Information DEC 3 0 2014
Name: Bear Lake Heaven, LLC (% Keith Rudman)
Mailing Address: 401 N. Wabash Ave., Unit 48E DEENR BUFFER PERMITTING
NG
Chicago, IL 60611
Telephone Number: 773 - 383 -6000 Fax Number: NA
E -mail Address: [e-mail]
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 pd f) must be attached if the Agent has signed this application form.
Name: William L. Owen
Company Affiliation:
Mailing Address:
Telephone Number:
E -mail Address:
Person to receive the
Owen Grading
1407 Wolf Mountain Road
Tuckasegee, NC 28783
828 -507 -0655 Fax Number: NA
[e-mail]
Certification Approval: William L Owen
I1. Project Information 1`15A NCAC 02H .0502(a) & (b)l
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,
FORM- SSGP 10 -2013 Page 1 of 3

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: Sylva, NC
Subdivision name or site address (include phase /lot number): Pin no. 7586 -45 -2681
Directions to site - please include road names and numbers, landmarks, etc.: From Hwy.
107 in Tuckasegee turn onto Shook Cove Rd., SR1135. Continue to the end of pavement.
Continue on gravel road to the end of SR1135. Continue on private road for 1.3 miles - -pass
Bear Lake Dam and continue .5 miles. Cot is on left.
Latitude (in decimal degrees) 35.237844 Longitude (decimal degrees) - 83.071228
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential
6. Property size (acres): 30.8
7. Lake/ river/ ocean adjacent to property: Bear Creek Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Shoreline stabilization because shoreline is eroding.
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: 3,900 sq. ft.
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: 8,750 sq. ft.
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 10 trees
V,U �V "�, December 24, 2014
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 2 of 3

To: William L. Owen, Owen Grading
From: Keith Rudman, Bear Lake Heaven, LLC
Date: December 23, 2014
Subject: Agent Authorization Letter
William, you have my approval to act as my agent regarding:
• Signing application materials related to Duke Energy's shoreline stabilization permits.
• Signing application materials related to DENR's Division of Water Quality permits for
lake and reservoir activities.
Keith Rudman, Bear Lake Heaven, LLC

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