20221173 Ver 1_Shoreline Stabilization_20220831

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Quality
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TIME
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 *
[e-mail]
Please provide an email address for payment and requests for more information here.
Pre -Filing Meeting Date Request was 8/29/2022
submitted on: *
Owner Information:
Name: * STEVEN BARTNISKI
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
5769 MEADOWLARK PL
Address Line 2
City
CARMEL
Postal / Zip Code
46033
State / Province / Region
IN
Country
US
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * TAMARA HAGER
Company Affiliation: * LAKE PERMIT LLC/ RENEGAR
Email: * [e-mail]

Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
PO BOX 5335
Address Line 2
City State / Province / Region
MOORESVILLE NC
Postal / Zip Code Country
28117 US
A signed and dated copy of the Agent Authorization letter:*
BARTNISKI AUTH.pdf I.38MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
BARTNISKI
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: BARTNISKI SURVEY.pdf 1.5MB
Latitude:*
35.604886
Longitude: *-80.937729
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*
BARTNISKI SKETCH.pdf 815.76KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%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.)
BARTNISKI PIC.pdf 763.84KB
4. Location of the property (where work is to be conducted)
Nearest Town: * MOORESVILLE
County: * Iredell
Lake/ river/ ocean adjacent to NORMAN/CATAWBA
property:

Subdivisions name or site address: *
PINNACLE SHORES LOT 21
Include phase/lot number
Directions to site: *
FROM MARSHALL STEAM STATION TRAVEL HWY 150 E 2.5
MILES, TURN RIGHT ONTO MARINER POINTE LN .20 MILES,
PROPERTY ON LEFT.
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 .969
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
RIP RAP SHORELINE FOR STABILIZATION
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.)
0
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.)
0
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)
NONE BY BARGE
Sketch: BARTNISKI SKETCH.pdf 815.76KB
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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
a I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
a 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.
a 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");
a 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");
a I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
0 I intend to electronically sign and submit the Shoreline Stabilization online form.

Full Name:* STEVEN BARTNISKI
Signature:
gAMSe
Submittal Date: 8/29/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221173 Version:* 1
Select Reviewer: * Doug Perez:eads\djperez
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* ( No Payment Needed
C Fee Received
C• Need Fee - send electronic notification
What amount is owed?*
C• $240.00
C $570.00

PrOlect rilemi 1131 addLtraggt �►LT Lrff
Print SionatOr _
Print sisna-
The approval is for the purpose and design described in your application. lmpads not irldicated in the
application is a violation oftha Buffer Rule.Site specific work should be provided in the application. 11 5A WC AC
02H.0505 end 15A NCAC 07B.07 3(8)1
Trees ere not elloww ed to be removed from 7o n r 1 of the Buffer(within 30 r u'of the full pond elevation), unless
approved.EltCCption:chose trees ehatare severely undermined along the immediate shoreline can be removed.
Minimal Shaping and sloping clomp the immediate shoreline is allowed.1:15A.NCAC 02 .0243(6)1
Benching, grading in the buffer is not allowe .aacessitive disturbance of ground cover.ElM NCAC OZB.0243(6)]
Beaches,impervious patios,le It ,►.]eraliov trial eways,etc.are not allowed in the buffer unless specifically approved
by the Division. There are.limitation on size for decks.i35A 1`CdCO2B.0743(4)and(5)]
Work to be conducted from land must indicate an access and indicate any trees that ere to be removed. The
work corridor should be described.The cpprov_d eCCe_s corridor shell be restored.t zing,spoil, constructior:
material must be outside the buffer. (15A NCAC a _0502 and 15A NCAC 07B.074° .-P-L (5), (8.))
Storrftweter cannot be piped or channeled for direct disther®e to the Jeke. AD constructed etor:av✓eter
discher es must be et the natural =levetion and diseh-reed prior to entering the buffer directeed es diffuse or
sheet flow et non-erosive velocities to the lake. CiSA NCAC 02B.0743(5);(ai1
Acknowledgement of�PVoottReci±iiogj, •
�8 p� 6A t7?,J.S -J hereby stele that I have been ir1Fo m ed of the Catawba
Riparian Buffer Rule. Anywork conducted in the 6.19 ,riot eoeeii`Iceiiy ste cd in the application end approvni
by the Division of Water.Resources(D%4'P), la a violation and subject to enforcement. Due diligence will o'e
taken such that the constructian will be built within substantial a e o !! i iia
e7illplterlOid and �� ilea
Quality Ccrtificetloil end Buffer Rules,the approved plants)and_pecificattlon(s),and other supportlne
materials.

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Lake
(At Full Pond/Normal Water Level)
70
Full Ponds 12) LO�'I��{
Normal We ��
tee-Leve itir
Shoreline �� Q; u `*)—`11.14teie.. 44pso tv 'awl,-,"
•a' 1 t��-ri0�l"
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Please approximately sketch the following information on this plan (provide dimensions for each
item,such as 10 ft x 10o 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 3 of 3

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Lake
(At Full Pond/Normal Water Level)
70
Full Ponds 12) LO�'I��{
Normal We ��
tee-Leve itir
Shoreline �� Q; u `*)—`11.14teie.. 44pso tv 'awl,-,"
•a' 1 t��-ri0�l"
fOt7 1i- E S 1 nnc���
1 .N L b is if ty-ir
a r3ic,te12
c1
T
Please approximately sketch the following information on this plan (provide dimensions for each
item,such as 10 ft x 10o 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 3 of 3