20221647 Ver 1_Shoreline Stabilization_20221122

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 11/17/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Ogburn Family Rev Living Trust/ Nick Ogburn
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
14015 Cooley Road
Address Line 2
City
Princess Anne
Postal / Zip Code
21853-3247
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
MD
Country
US
Name: * Randy Jordan
Company Affiliation: * Lyfe Marine, Inc
Email: * [e-mail]

Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
19109 West Catawba Avenue
Address Line 2
Suite 200
City State / Province / Region
Cornelius NC
Postal / Zip Code Country
28031 US
A signed and dated copy of the Agent Authorization letter:*
Ogburn Agent Auth + Catawba Riparian.pdf 1.69MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Ogburn Shoreline Project
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
Property Address Lookup: *
Latitude: *
35.632234
Street Address
218 Penicillin Point
Address Line 2
City State / Province / Region
Troutman NC
Postal / Zip Code Country
28166-7624 US
Longitude: *-80.933280
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*
Ogbum DWR Diagram.pdf 159.26KB
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.)
Oburn photo 1.pdf 3.39MB
Ogburn photo 2.pdf 15.85MB
Ogburn photo 3.pdf 10.37MB
Ogburn photo 4.pdf 3.24MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Troutman
County: * Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: *
Directions to site: *
Lakeview Acres
Include phase/lot number
Perth Rd to R onto State Park Rd to L onto Morrison Farm to L onto
Penicillin Pt.
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: *
Existing rip rap shoreline, dock, and residential dwelling
Residential, undeveloped, etc.
6. Property Size .66
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Push down existing rip rap along 258 LF of shoreline. Add Class "B" Rip
Rap for maintenance.
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.)
1548
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.)
258
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)
Grassy yard
Sketch: Ogburn DWR Diagram.pdf 159.26KB
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
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Randy Jordan
Signature:
&gkiok loco/am
Submittal Date: 11/17/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number: * 20221647 Version: * 1
Select Reviewer: * Andrew Pitner:eads\ahpitner
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?* $240.00
$570.00

AG -ENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: ,�, �� PLAN NO:
STREET ADDRESS:
PARCEL
ID
Please print:
Property Owner.
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Randy Jordan , of Lyfe Marina, Inc.
(Cbntractor/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 Owners Address (if different than property above):
Telephone:
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Ilk
Authorized signature
r/ %
Date
Authorized Signature
Date

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: `" ��` �` �t;�,^� County.- ham
Owner: Alzee
Print
Contractor/agent.,
Print
n :fie ix�z 3
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. f 15A NCAC
02H .0506 and 15A NCAC 02B _0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be removed.
Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6)]
Benching and grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243
(6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division. There are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
A►�vfedgement of ?Notification
17
hereby state that i have been informed of the Catawba
Riparian Buffer Rule."Aiiy work conducted in the buffer, not specifically stated in the application and approved
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials.
��, Signature (owner):- -u-`�t gate_

Owner/Agent's Signature* Printed Name Date
[15A NCACO2H .CS02tf)I
*Agent's signature is valid only if an authorization letter from the owner is provided.
Lake
(At Full Pone{/Normal Water Level)
Full Pond/
Normal Water Level
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as 30 ff 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.
S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
G. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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Owner/Agent's Signature* Printed Name Date
[15A NCACO2H .CS02tf)I
*Agent's signature is valid only if an authorization letter from the owner is provided.
Lake
(At Full Pone{/Normal Water Level)
Full Pond/
Normal Water Level
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as 30 ff 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.
S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
G. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3