2502-0240 EXCEPTION APPLICATION CBPEC25.06 An application for Exception is required for new, non-water-dependent development, redevelopment, and construction within 50 of the Resource Protection Area (RPA). A Water Quality Impact Assessment is required for review of ALL activity in the RPA. APPLICANT/AGENT INFORMATION: Name: Alistair SVowgoy LS. PC Phone: ($04) 824-9374 Mailing Address:, 7319 Maviin Stypet, Suitdle City/State/Zip: Guester VA 230el Email: CysCyO ajrswey AM PROPERTY OWNER INFORMATION: Name: Snamb.Aavson Phone: Contact Agent Mailing Address: 744L John flaytn Memeial tdnuay City/Statç/ Zip: Glouster WA 7300l Email: Wtoct Aqent PROPERTY INFORMATION: Tax Map or RPC: 2427D E911 Street Address: 7444 Tonn Mautn Wewaridl Hay Date Lot Recorded: 4/8120S Nearest Water Body: bowerdon Suomp Distance to Feature: 55.4' Sq Ft. of Encroachment: 2,3088E DETAILS OF REQUEST: Existing bam to be vemad and raphad Wiha layou Stotwre DIRECTIONS TO THE PROPERTY: Adinountt Rode14 Tohn /V Cayton Wewial 1C Jau Mecr Mouix Stveet 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 issuc a permit if the information requested is not provided. CERTIFICATION: I am hereby applying for all permits typically issued by Department of Environmental Quality, Virginia Marine Resource Commission, U.S. Army Corps of Engincers, Chesapcake Bay process, and/or Local Boards for the activities I have described hercin. I agree to allow the duly authorized representatives of any regulatory or advisory agency to enter upon the premises of the project site at reasonable times to inspect and photograph site conditions, both in reviewing a proposal to issuca 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 or persons who manage they system or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate. and complete. am: aware that there are significant penaltics for suemiftingfalse informatian, including the possibility of fine and imprisonment for knowing violations. ALIsTAiR Jlarsay 212812025 Printed Name Signature Date CAGENT) Reviscd 2/2025 FOR GRANTING EXCEPTION (Sec. 5.5-14) Required by Code - please provide any input as to how your project complies. . Requirements, shall be minimum necessary to afford relief. lephcinegy existy Doy Vet MAPOVIAAS is aslight yeductn frm existing. 2. Reasonable and appropriate conditions arc imposed, as warranted, that will prevent the allowed actixity from causing a degradation of water quality, Vropsod Shicwe has homund fm u fivst 50' bo the Scoond5D' 3. Granting waiver will not confer applicant any special privileges that are denied to other property owners subjcct to, its provisions and arc similarly situated. Yune ahciparcer 4. Waiver is in harmony with purpose and intent of Ordinance and not of substantial detriment to water quality. Since theve is Qveduchiw un imporuicus and Mercase - Unveptadun Mahrqally will be impoveel 5. Waiver not based selfimposcd/ereated conditions or leplcoat ar Ksingsmcwe mtTmitad spaa pve-haulot 6. Other findings, as appropriate and required by Gloucester, County. me prpoidod At MAD 0 SibmssIL Please use additional sheets if necessary for completing the questions above. Revised 2/2025 Project #: - WATER QUALITY IMPACT ASSESSMENT Required for all development/redevelopment in the Resource Protection Area; CBPO 5.5-1 1 A site drawing, which shows the following, must be attached to this water quality impact assessment: D Location of the components of the RPA, including the 100' buffer area; Location and nature of any proposed encroachment into the buffer area, including type of paving material, areas of clearing or grading, location of any structures, drives, or other impervious cover, sewage disposal systems or reserve drain field sites, and wells; Type and location of proposed best management practices to mitigate the proposed encroachment; Location of existing vegetation onsite, including the number, type of trees, caliper, and other vegetation to be removed in the buffer to accommodatc the encroachment or modifications; and Type, size, and location of replacement vegetation. Setbacks in accordance with Zoning regulations. APPLICANT/AGENT INFORMATION: Name: Alistoir J. Dawysow LS R Phone: 1804) 824-9374 Mailing Address: 1314 Wovtn Sireet, Sutl City/State/Zip: bluastur VA 2371 Email: Aramsayody Surey.cmm PROPERTY OWNER INFORMATION: Name: Shavon D. layson Phone: Lintact Aqant Mailing Address: 744L Johy Laytn Memwial liqiwyy City/State/Zip: Glastor VA 230lal Email: AintaetAqpnt PROPERTY INFORMATION: Tax Map or RPC: 29270 E911 Street Address: 7446p Tnnlautanllwrial Huy Date Lot Recorded: 4/51205 Ncarest Water BorBeauerdaw Sunyp Revised 2/2025 Site Conditions (ofs site and adjacent lands): Existing topography: 2104 poxeont Slopos Hydrology: Wellto molutugiwibavud Soils: 1B7,14B,246.270 Geology: Sandy Soils Fill Materials (source and composition): Sand Qud Shuclwal fL Total Amount of Disturbed area (sq ft): 12,0DDSE Total Amount of Cleared Area (sq ft): MIA Existing Vegetation: Total Amount ofUnderbrush Removed (sq ft): 231D5F. Types: byossos Number of Healthy Trees Removed: MI4 Types: Number ofTrees Limbed or Pruned: M/A Types: Number of Ded/Dying/Dseased Trees Removed: MA Types: Proposed Vegetation Mitigation Measures: Number of New Canopy Trees Proposed: Types: Aner Pubtum/Raapke Number of New Understory Trees Proposed: 2 Types: lornius Fndia Flulering, Number ofNew Shrubs Proposed: 3 Types-lley Glvbal Summslcad Tnuoeny Holly Proposed Erosion & Sedimentation Control Practices: Silt Fencing Temporary Construction Entrance Straw Bale Barrier(s) Inlet Protection Dempoary/Pemanent Sceding Mulching Tree Protection Sediment Trap Other: Proposed Best Management Practices: D Dry Well(s) Infiltration Trench(es) J Vegetated Filter Strip(s) Grass Swale(s) J Other: * AIL Veqetatuw Wolhin ubuer will he ve-establiskad Revised 2/2025 Wastewater (Septic) Element: Attach legible, clean copy ofHealth Department approval information to include calculations and dimensions. Description of potential impacts of the proposed wastewater systems including and proposed mitigated measures for these impacts: 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 ofthe 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 Engincers, Chesapcake Bay process, and/or local Wetlands Boards for the activities I have described herein. I agrce 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 were 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 those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I: am aware that there are significant penalt.ics for submitting false information, including the possibility of finc and imprisonment for knowing violations. Ausrie J - brsay 2/2812025 Printed Name (AGENIT) Signature Date Reviscd 2/2025