DECEIVER 25030072 MAR q6 6 2025 EXCEPTION APPLICATION CBPEC 25.D8 BRN PAN application for Exception is required for new, non-woter-dependent development, redevelopment, and construction within 50' of the Resource Protection Area (RPA). APPLICANT/AGENT INFORMATION: 757-565-1677 Name: Wllam Fells Phone: Mailing Address: 205 Bulifanti Blvd Ste E City/State/Vip: illiomsburg. VA 23188 Email: wllam Olondk lech resources. com PROPERTY OWNER INFORMATION: Name: Petsworth Baptist Church Phone: Mailing Address: 7471 Hickory Fork RA. City/State/Zip: Glovcester, VA 23061 Email: Amckinneyz1ze gmail.cam PROPERTY INFORMATION: RPC: 2593L0 2471 Fork R2 Tax Map or RPC: 73-25 E911 Street Address: Hikory Date Lot Recorded: Q-29-1987 Nearest Water Body: Blanl Creek Distance to SF RPA Feature: Sq Ft. oflincroachment: +7,300 DETAILS OF REQUEST: Proposed clearing greding wihhin RPA fr rstallatron 6f bio- retention basin Bovtfall DIRECTIONS TO THE PROPERTY: 2471 Hickon Fork Ecad PRIV.C.Y. ACTSTATIEMIENT: Information provided in the Chesapeake Bay application will bc used in the permit review process and is: a matter of public record unce the application is filed. Disclosure of the neyuested information is voluntary. but it may not be possible to evaluate the permit application er to issuc a permit if the information requested is not privided. CEKTIFICANTION: 1 am hercby applying for all permits rypically issued by Department of Einvironmental Quality, Virginia Marine Resource Commission, US. mmy Corps of Engincers, Chesapeake Bay process, and/or lacal Wetlands Hoards for the activitics I have described hercin. I agree to: allow the duly authurized rpresentatives of any regulatury or advisory ageney tn enter upon the premises of the prngect site at reasonable times to inspect and photograph site conditions, both in reviewing: a propesal to issue a permit and: after permit issuance to determine compliance with the permit. In addition,l cenify under penalry oflw that this document and all attachments wen prepard under my direction ue supervision in accordance with a system designed to assuru that yualifivd persannel pruperly ather and evaluate the information submitted. Based on my inyuiry uf the person or persons who manage they system or those persons directly rexponsible for gathering the information, the information submitted is, to the best nf my knowledge and belicf, true, accurate, and complete. 1 an aware that there are significant penalties for submitting false information, including the possibility uf fine and imprisunment for kyying vinluny yk kllign 6 FeHs, zlzi/z5 lrinted Name Sagnsture Date Revision 2/3024 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. Dishurbance is propised to adequetely CONVEM ang treat stormualer Fram the site wihhal eKss Gl. Areos df deoriny are minim Fzed to I0 OAF hhe odfall and Hhe lmts of hhe bo-rekenhon Pono. * 2.54 acres oe be places urger conservation Case ment. 2. Reasonable and appropriate conditions arc imposed, as warranted, that will prevent the allowed activity from causing a degradation of water quality. Erosion anp Sebiment control m easures o propoel Jurng consineHon 67 Hç BM P Csee Water qValik fmpack assessmont) to prevent dearalaton df waler qualily Fllowine construrhren the BMP wll aot as ot filier fz pollhonls to im prove waler avally 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. Exisking areo rs mosHhy clegred Ond shall rehrn ha turf -goass upon comple Hon. No impecvious oreas are Proposel disturbance B for Stormwnker mereyenent FE 4. Exception is in harmony with purpose and intent of Ordinance and not ofsubstantial detriment to water quality. Pmposes bio-relention Aller N mtendel 6o Aler pollutonks and slow NDOAA frm Hhe Sile. No impervrous areos are proposed 5. Exception not based on self-imposed/created conditions or circumstances. Church bvilaing has exiklel on the Sile prar fo He implenentah of Hhe Chesapeake by Oclinantt. CChurch has been M opentton Since 1881), 6. Other findings, as appropriate and required by Gloucester County. Please use additional sheets if necessary. for completing the questions above. Resun 2/2124 Projeci #: WATER QUALITY IMPACT ASSESSMENT Required for all Aadpmam/aaayusan m the Resource Protection Iren: C BPO5.5. II A site drawing, which shows the following. must be atlached to this water quality impacl assessment: I. Location of the components of the RP 1, inclucng the Ion buffer area; 2. Location and naurcofany puepanalencachment Ito the huifer TCs, imcluding ypent par mg materal, areas of clearing or grading. location of any structures, dny es. or other mperv tous CoM er. sewage disposal systems or reserve drainfield sites, and wells: 3. peaadhamaufpmpmal hest magement pracices to minyate the poposed encrchment: +. Location of existing vegetation onsite, mcluding the number, mpe ofnees, calpet, and other vegetation t he removed in the buffer to accommodate heencrdmentat mwdificanonsand Type, size, and location oft replacement vegetation APPLICANT/AGENT INFORMATION: Name: 757-565-1677 Williann Fls Phone Mailing Address: 205 Bulifonts Blvd Sle E Ciy Stare Vip: W-llamsburg, VA 23188 Emai:, williom e la.Hesurcs.cem PROPERTY OWNER INFORMATION. Name: Petswockh Baphse Church Phones Manling Iddress: 2471 Arckory Fork RO. City State Zip: Gloucsher, VA 23061 Email: dockinnew 228 qmail.com PROPERTY INFORMATION: 23-25 2471 ar Fork R9. Tax Map RPC: E9113 Strcet Address Hickory Datelot Recorded: 9-29-1987 NeresWater Bodv Blond Creek sssci Site Conditions fofsite and adiacent lands): Existing See topography: Seeplan Hydrology: plar Soils: See plan Geology: See plan Fill Matcrials (source and composition): N/A Total Amount of Disturbed area (s4 ft): t 75,000sF Total Amount ofClearcd Area (sq ft): #13,650 SF Existing Vegetation: Total Amount ofUnderbrush Removed (sq ft): Types: Number of Healthy Trees Removed: f/0-15 Types: Harwoo& Number ofTrees Iimbed or Pruned: Types: Number of Dead/Dying/Diseased Trees Removed: Types: Proposed Vegetation. Mitigation Measures: Number of New Canopy Trees Proposed: Types: Number of Ncw Understory Trees Proposed: 8 Types: Varies Number of New Shrubs Proposed: 20 Types: Vories Note: Basin to be plankek Per DEG Stondards Proposed Erosion & Sedimentation Control Practices: - Silt Fencing Temporary Construction Entrance Straw Bale Barrier(s) Inlet Protection Tempori/Permanent Sceding Mulching Tree Protection Sediment Trap Other: Proposed Best Management Practices: Dry Well(s) Infiltration Trench(es) Vegetated Filter Strip(s) Grass Swale(s) dother Bio-retention flter Revised 1/3124 Wastewater (Septic) Element: Attach legible, clean copy ofHealch Department approval information = to include calculations and dimensions. Description of potential impacts oft the proposed wastewater systems including and proposed mitigated measures for thesc impacts: None propose Exisking Seplrc Aels aljacenl to RPA Rs proposel to be remel PRIVACY ACT STATEMENT: Information provided in the Chesapcake Bay application will be used in the permit revicw process and is a macter 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 accivities I have described herein. I agree to allow the duly authorized representatives of any regulatory or advisory agency to enter upon the premiscd of the project site at reasonable times to inspcct 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. Wlliam 5 fes z/2i125 I8t Printed Name Signature Datc Revied 3/3124 OFFICE USE ONLY Project #: 250300seial byBenee Fee Paid: Receipt #: Date Received: 34/25 Reviewing Authority: Hearing Date: 5-14-2025 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: Phone #: Payor Address: Date surety relcased: Revixion 2/21124 STAFF ANALYSIS (OFFICE USE ONLY) Staff responses to applicant information provided on reverse page 1. 2. 3. 4. 5. 6. Reviewed by: Date: Revsim 3/3024