25020242 PECEIVEA EXCEPTION APPLICATION CBPEC 25.07 FEB AR apdlicalign for Exception is required for new, non-waterdependent development, redevelopment, and BRuwee construction within 50' of the Resource Protection Area (RPA). pa.2,ps125 APPLICANT/AGENT INFORMATION: Name: Southern Lahapingladt,laa Ma BloomPhone: 904-7954242 Mailing Address: RO.Box 376 Ciry/State/Zip: Shacklefords, VA 23156 Email: Soland coninela gmail.com PROPERTY OWNER INFORMATION: Name: Alicia Moosally Phone: B04-519-4009 Mailing Address: 5104 Sylinn Road City/State/Zip: Ridamond VA 23285 Email: alicia / monsa lly Q gmall com PROPERTY INFORMATION: Tax Map or RPC: 17617643375 E911 Street Address: 11369 WaterVew 2 Place Date Lot Recorded: Nearest Water Body: Pianka tank River within the Distance to RPA Feature: ZAmy 5DPERPASA Fr. oflincroachment, 1228 SF DETAILS OF REQUEST: Afher the Pactpermit Borperviaus patlo DIRECTIONS TO THE PROPERTY: East ar7 VA 33,continue an VA 198 East, torn left tn Slayon VAI9BEast, trn left onto Rt. 608, Continue wrn onto rignt onto Water View Place, lestination 15 on the lefta Covyy Dirtlane MAMACYACTSEATANMINTI of public record Information provided in the Chesapeake Bayapplication will be used in the once the application is filed. Disclosure of the reyuested information is but it permit revicw prcuss and is: a matter permit application or to issuc a permit if the information requested is not provided. voluntary. may not be possible to evaluate the CERTIFICANTION: I am hereby applying for all permits rypically issued by of Environmental Commission, U.S.. rmy Corps of Engincers, Chesapeake Hay prucess, and/or DDepartment Lacal Wetlands Boards Quality. Virginia Marine Resource agrce to: allow the duly: authorized representatives or for the activities I have described hercin.I times toi inspect and photograph site conditions, both ofanyr in regulatory advisory agency te unter upon the premises of the project site at reasomable with the permit. In addition, 1 cerify under penalry oflw reviewinga that this ducument proposal to issue all a permit and: after permit issuance to determine compliance in accordance with a system designed to assure thar qualificd personnel and: attachments and were prepared under my direction or supervision inquiry of the person or persons who manage they system or those persons pruperly gather evaluate the information submitted. Based on my submitted is, to the best of my knowldge and belief, true, accurate, and dirctly I am rexponsible for gathering the information, the information false information, including the possibility of fine and imprisonment for knowing complete. vinlations. aware that there are significant penalties for submitting MO BLo SON C - Mu Pw 2/7/25 Printedl Name Signature Date Revision 2/2034 2 CONDITIONS FOR GRANTING EXCEPTION (Sec. 5.5-14) Required by Code - please provide any input as to how your project complies. 1. Requirements shall be minimum necessary to afford relief. Size ofprjpctyadluced to minimum encmachment. 2. Reasonable and appropriate conditions are imposed, as warranted, that will prevent the allowed activity from causing a degradation of water quality. Mitiqn Hion plantings With mulch will border He project 3. Granting exception will not confer applicant any spccial privileges that are denied to other property owners subject to its provisions and are similarly situated. No tree removal or vegeta tion removalvillhe needed for this requpeted Varianke, 4. Exception is in harmony with purpose and intent of Ordinance and not of substantial detriment to water quality. hedesignof mitigation plantings willabsorb anypassibie run OfE from he piaert. VA conhbolled cover of A Fiscue VI ghassSpecies turf Surround-the praect beuend nitiga-tion plahtings 5. Exception not based on self-imposed/created conditions or circumstances. An excephion requestis oeing requested toc allon pelialcoverafan aea adjacent to Structure Andallaince for pervious paversto be placedon Avea 5 Hnt turf did not grow. 6. Other findings, as appropriate and required by Gloucester County. This reque 09t is naing madeand- he mitinationnllbe exercised to ensue proper Stab bilization of the pawer request which willcontrol any natural ruA Off, Please use additional sheets if necessary, for completing the questions above. Revision 2/2024 Project #: - WATER QUALITY IMPACT ASSESSMENT Required for all Amdhpmsm/saaeymsen in the Resource Protection Irea; CBP)5.5 11 A. site drawing, which shows the following. must be attached to this water quality impact assessment: 1. Location of the components of the RPA, including the 100'buffer area: 2. Location and natureofany proposed encroachment into the buffer uren, including ypeof paving materal, areas of clearing or grading, location of any structures, drives, or other impervious cover, sewage dispo isal sysiems o1 reserve drainfield sites, and wells: 3. Type and location ofpropos sed best management practices ta mingate the proposed encroachment: +. Location of existing vegetation onsite, including the number, typeofirees. caliper. and other vegetation to be removed in the buffer to accomme sdate the encroachment or medificationstand Type. size, and location of replacement vegetation. APPLICANT/AGENT INFORMATION: NameSothem Landscapingà Cmat,laaaBhom-ae 804-786 4242 Mailing Address: 7.0. Box 275 Ciry/State/Zip: Shacklet fordsVA 23156 Email: Sclandconine Qgmakcom PROPERTY OWNER INFORMATION: Name: Alicia Mocsally Phone: BD4-519-2004 Mailing Address: 5104 Sylvan Road Ciry/State/Zip: Richmend, VA 23225 Email: alicia. mupsallyOgmanil.ton PROPERTY INFORMATION: Tax Map ur RPC: 176176 43375 E9115 Strect Address: 11864 WaterVein Place Date Lor Recorded: ? Nearest Water Gloue. Bod VA 23001 Piankatank River RslvDer Site Conditions fofsite and adiacent lands): Absorbhion factor ofsandylouin Existing topography: Flat lawn N6 slepes Hydrology: tapminnsorhs ater, ineretaetDere 7500 ninoff, Soils: Sandy lam Geology: Tnc uisalsirahnsallow. permability aundl mmedlate ansorbtion Hrough the e Fill Matcrials (source and composition): A tapsoil layersin the Silhsnil Ruinfdisdon Total Amount of Disturbed area (s4 ft): 1729: 5F Total Amount of Cleared Area (sq ft): A Existing Vegetation: Total Amount ofUnderbrush Removed (sq ft): Types: Number of Healthy Trees Removed: Types: Number ofTrees Limbed or Pruned: C Types: Number of Dead/Dying/Diseased Trecs Removed: 6 Types: Proposed Vepetation Mitigation Measures: Number of New Canopy Trees Proposed: (4"C. Types: Riverbirch Number of New Understory Trees Proposed/B) 4' Types: Daqwod Number of New Shrubs Proposed: (36) 18" Types: Shore Voniper * wiln Proposed Mulch Erosion AL Hadwood & Sedimentation Control Practices: Silt Fencing Temporary Construction Entrance Straw Bale Barrier(s) Inlet Protection Tempori/Permanent Sceding Mulching Trec Protection Sediment Trap Other: immediate Mitigation Plantings $ Gceding withstraw. Proposed Best Management Practices: Dry Well(s) Infiltration Trench(es) Vegetated Filter Strip(s) Grass Swale(s) existing lawn areas Other: Straw bales with Properspeojes, A Shnady, imix ot Fescuet Rye. Revised 3/3124 Wastewater (Septic) Element: Attach legible, clean copy of Health Department approval information = to include calculations and dimensions. Description of potential impacts of the proposed wastewater systems including and proposed mitigated measures for thesc impacts: Not on Waterside of hause PRIVACY ACT STATEMENT: Information provided in the Chesapcake Bay application will be used in the permit review process and is a matter of public record once the application is filed. Disclosure of the requested information is voluntary, but it may not be possible to evaluate the permit application or to issue a permit if the information requested is not provided. CERTIFICATION: I am hereby applying for all permits typically issued by the DEA, VMRC, U.S. Army Corps of Engineers, Chesapeake Bay process, and/or local Wetlands Boards for the activities I have described herein. I agree to allow the duly authorized representatives of any regulatory or advisory agency to enter upon the premised of the project site at reasonable times to inspect and photograph site conditions, both in reviewing proposal to issue a permit and after permit issuance to determine compliance with the permit. In addition, I certify under penalty of law that this document and all attachments werc prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system or thosc persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belicf, truc, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Mu Ploxm Mu owxon 7/27/25 Printed Name Signature Date Revised 3/2024 OFFICE USE ONLY Project #: Received by: Fee Paid: Receipt #: Date Received: Reviewing Authority: Hearing Date: Lot recordation date verified with Clerk's Office YES Date: COMMISSION DECISION: APPROVED: Approval is valid for 36 months from the date of approval Conditions/Comments/Findings Met: DENIED: "*Please be advised that you may appeal the Chesapeake Bay Preservation & Erosion Commission's decision, in writing, to the Circuit Court of Gloucester County within 30 days of the date of this Commission's decision. Comments: Commission Chairman or Environmental Staff Signature Date Mitigation plan required: YES NO square foot minimum Mitigation plan approved: Entitled: Dated: Date mitigation completed: Inspected by: Amount of surety required: Date posted: Receipt #: Payor Name: Phonc #: Payor Address: Date surety released: Lyvision 2/2024 7 STAFF ANALYSIS (OFFICE USE ONLY) Staff responses to applicant information provided on reverse page 1. 2. 3. 4. 5. 6. Reviewed by: Date: Revision 3/3024 Alicia Moosally 11269 WWater View Place so1 GlowoesterVA 23061 - ERPA Exception MitigahonPlantPla - : SCALE:1"=15 COP a/an/95 50 7/00 5 DU EXISTNS PAVI Z40 sf AR2 Soon (246) DW / * V DY 14oA4 a PO NEW - 2 PAVER A a STTa EXI5TI 33 EXISTNF 364 SF) A PAVar PAVENS 7677, 7 - 6/ L4) BMEKBIROY 864SF - 6 DOShE2D 41 2WSHORE JUNRE r7 EX/STIWS AVERS 1244 SF Landscaping & Construction Class A Contractors License #2701 034192A Residential o Industrial o Commercial REDET AFTER F7 ECZPTN Licensed & Insured * SOUTHERN PEMIT LANDSCAPING & CONSTRUCTION INC. MO BLOXOM President P.O. Box: 275, RL 33 & 14 P.O. Box 426 TOTR 7A Shackielords." VA 23156 Wiliamsburg. VA23187 Office: (804) 785-4242 MITIs (757)874-4644 CAL - CMETN Fax: Cel: (804) (804) 785-4241 366-1999 Email: solandcamintgmakcom: www.slandcon.cor 1228 S/