2504D35D DECEIVEN - APR 29 2025 Ronee COPEC 25-144 CHESAPEAKE BAY PRESERVATION ORDINANCE Exception Process Guidance & Application For CBPEC Activities in the Resource Protection Area (RPA) Property owners interested in working in the Resource Protcction Area (RPA) may be requircd to request a buffer reducrion through the Exception process. The following are general guidelines and are not intended TO represcnt every possible activity within the RPA. Please contact the Deparrment ofl Environmental Programs tor spccific inquiries at 804-693 1217, or stop by the officc, 6489 Main Strcct, Gloucester, or VIsit our website hups: Lasbuccseragw/minoomemulpograms Excepiion Process (Preservation & Erosion Commission), defined in Scc. 5.5-14; for variance to requrements for Scc. 5.5. 7B and 5.5-9C, requiring Public Hcaring: $275.00 application fcc. Mecuings held the 2nd Wednesday of cach month, application deadline the last working day of the month. Applications availableonline or in the Department of Environmental Programs. 1. New construction on an undeveloped, non-conforming lot (existing beforc October 15, 1991) with buildable arca outside of the Resource Protection Area. 2. Construction of, additions to, accessory structures (garages, pools, sheds, pads; impervious area, rade alteration, etc.). 3. Construction of, additions to, principal structures within the scaward 50' ofRPA (bctwcen 0' -50). 4. Revicw's, waiye er appeals, and violarion. A Wacr QQuality Impact Asscssmentisn requircdfor reviecofAllactihin: inthe RPA (Scc. 5.5-11). Revi.a3/2125 EXCEPTION APPLICATION CBPECZ54 An application for Exception is requircd for nçw, non- -water-dependent development, redevclopment, and constructon within 50' of the Resource Protection Arca (RPA). A Water Quality Impact Assessment is required for revicw of MLactivity in the RPA. APPLICANT/AGENT INFORMATION: Name: Donall R. 4 Dana H. Black Phone: 804- 301-0612 Mailing Address: 8415 Oy5TEC Cove Rd. Ciy/Statc/Zip: Hayes VA 03072 Email: dhhack5egmail Com PROPERTY OWNER INFORMATION: Name: Donall R + DanaH.B/Ack Phone: 204-301-D 612 Mailing Address: 8415 Love RJ. City/Statc/ Zip: 23072 47 Hayes Email: PROPERTY INFORMATION: Tax Map or RPC: 17821 B911 Srrect Address: 8415 DysTec Cove Ri. Date Lot Recorded: 11 1991 Nearest Water Body: Sanak Creek Distance to Feature 57 Syl.oflincwchment: 10S053 DETAILS OF REQUEST: Pavexs asound pool - DIRECTIONS TO THE PRoppRr.Guines RL to Maakline to Ron LiHle England- Right on Dystr Lovele. - House is on curve - Addrss manked- 2 Brickpilars PRIVACY ACPSTATEMENT! Information provided in the Chesapcake Bay applicatinnwilll be used in the permit review process and IS n materi fpoble recorience the application IS filed. Disclosure ut the requested information is voluntary hut i may not be possible ln evaluate the pemul application or (es issue a pennit i the mtommaton requested 1S not precided. CERITHCATION: lum hereby applying for all permits sypicaily issued y Deparment ot Tinvironmentl QQualits. Virgina Marme Resuuree Commission, L S. Irmy Gps ofl lingineers, Chesapeake Bay pricess, and/or Local Boards for the: activites Ihave des scribed herem. 1: agree tn allow the duly authorzed representatiesafane reyulton er advisory agency to enter upon the premises ol the project site at rensonable times to inspcct and photograph sie conditions, both in revicwinga proposal tes IssuE a pemit and after permit issuance t0 determine compliance with the perL In addinon, 6 ccrtifi under penalky of law tha this docume nt and ail aachments were prepared under my direction u supervision in accordance with I system designed th assure chat qualified personnel properly atherand cvaluate the intormation submitted. Based on m inqury of the or persons who manage they system or those persons directly responsihle for athering the infommation. the information submitted 15, tothe hest ol my knovlesie and belief, true, accurate. and complete. am: aware that thereares sagnificant penalties tor submitting false informaton. inu luding the possibility t fineantimprisumment for knewing violatons. Do R. Black - - 04la6l2s Printed Name Signgure Date DAMA A. BIACk Douat Blacke Revised 2/2025 FOR GRANTING EXCEPTION (Sec. 5.5-14) Required by Code - please provide any input as to how your project complics. 1. Requirements shall be mmmun nccessary to afford relicf. 2. Reasonable and appropriate conditions arc imposed, as warranted, that will prevent the allowed activity from causing a degradation of water quality; Sit fencingio pesenetty Sinstalleb Maupldags (Hunits) will I beaddid fosik. No distucbanceak nahural areas is eppeck d 3. Granting waiverwill not confer applicant any spccial privileges that are denicd to other propcrty owners sybject toi its provisions and arc similarly situated. Multipk Sumdhepastice hawe poelsand achos WHLM the RpA-Tlrasheut Tu nllorhe. 4. Waiver is in harmony with purpose and intent ofOrdinance and not of substantial detriment tO water quality. This Remamshruc W lave oM Saab Crcekaud aidait Jlu besT water qualily 5. Waiver not based on elfimposad/creed conditions or circumstinces. 6. (Other findings, as appropriate and required by Gloucester County. ngilthn trenches Istalled. Pleasc usc additional shects if necessary for completing che questions above. Reva3/2025 Projcct #: WATER QUALITY IMPACT ASSESSMENT Required for all eelepmeu/rdeaepnen in the Resource Protection Area; CBPO 5.5-11 - A site drawing, which shows the following, must be attached to this water quality impact assessment: Location of the components of the RPA, including the 100' buffer area; Location and nature ofany proposcd cncroachment into the buffer arca, including type of paving material, arcas of clearing or grading, location of any srructures, drives, or other impervious cover, scwage dispo osal systems or reserve drain ficld sites, and wells; Type and location of proposed best management practices to mitigate the proposed encronchment; Location of existing vegctation onsite, including the number, typc oftrees, caliper, and other vegetarion to bc removed in thc buffer to accommodate the cneroachment or modificationssand Type,size, and location of replacement vegetation. Scthacks in accordance with Zoning regulations. APPLAICANI/AGENT INFORMATION: Name: Phone: Mailing Address: City/Statc/Zip: Email: PROPERTY OWNER INFORMATION: Name: Phone: Mailing Address: City/Statc/Zip: Email: PROPERTY INFORMATION: Tax Map or RPC: E911 Strect Address: Date Lot Recorded: Ncarest Water Body: Revised 2/2025 Projcct #: WATER QUALITY IMPACT ASSESSMENT Required for all edlepmamy/declepnen in the Resource Protection Arca; CBPO 5.5-11 A site drawing, which shows the following, must be atached to this water quality impact assessment: a Location of thc components of the RPA, including the 100' buffer area; 3 Locationand nature ofany proposed encroachment into the buffer arca, including wypc oft paving matcrial, areas ot clearing or grading, location ofany strucrures, drives, or other impervious cover, sewage disposal sistemsor reserve drn fick sites, and wells; - Typecandlocation: of proposcd best management practices tO mitigate the proposcd encroachment; Location of existing vegetation onsitc, including che number, type of trees, caliper, and other vegeration to be removed in the buffer to accommodate the cncroachment or modifications; and Mplsawranw vegetation. Setbacks in accordance with Zoning regulations. APPLICANT/AGENT INFORMATION: Name: DonallR+Dan H. BlAck Phone: 804- 301-06/2 Mailing Address: 8415 Cave Ad. City/Statc/Vip: 23072 D Hayas Email: olhk blazksegntlcm PROPERTY OWNER INFORMATION: Name: Donald L. + Dana H. BIAck Phone: 804 301-0612 Mailing Address: 8415 Oyater Cave Rd. Ciry/State/ Zip: Hayes, VA 23073 mail: Ahblaksagmalm PROPERTYINFORMATION: Tax Map on RPC: 17871 E911 Strcct Ackhress: - SI5Dsrrlow Ri Date Lou Recorded: 07/2/014 Nearest Water Body: SARAH CRETE Site Conditions.(ofsite and: adjacent lands): Revised 3/3 3025 Existing topography: Flat laww area Hydrology: Soils: SandyLoam Gcology: Fill Matcrials (source and composition): AE heigthecféan backral using 57 Stones For PAV ver BASE Total Amount of Disturbed arca (sq f): 1050'spft. Total Amount of Clcarcd Arca (sq ft): Existing. Vegetation: Toral Amount of Underbrush Removed (sq ft): Types: Number of Healthy Trecs Removed: Types: Number of Trecs Limbed or Pruned: Types: Number of Demd/Dying/Diseaed 'T'rees Removed:_O Types: Proposed Vegetation Mitigation Mcasurcs: MuST Currenty 4units Beinshuled. Number of New Canopy Trees Proposcd: Types: Evergreew Number of New Understory'Trees Proposed: Typcs: EVeISpser Number of New Shrubs Proposed: Typesé Eregreen! Decidious Proposed Erosion & Scdimentation. Control Practices: Silt 'encing Temporary Construction Entrance Straw Bale Barricr(s) Inlet Protection Tempoaty/Pemmanent Sceding Mulching Trec Protcction Scdiment Trap Other: Proposcd Best Management Practices: Dry Well(s) Ai Infiltration Trenchesz Vegetated FilterSrrip(s) Grass Swale(s) Other Area afdisTuBAnce is very flat.Ekistins lawn & parineler planfings are dense and will not B disturbed. Additional Planfisbule set disturbed area. * Ailekishng plants arouni Screened pmekfpeat area) witm Hhe RPA, have been Tamphtaiaiswkn Wastewater (Septic) Element: Revised 2/2025 Attach legible, tlean copy of Health Department approval information - to include calculations and dimensions. Dseripimnfpuemial impacts of the proposed wastewarer systems including and proposcd mitigated mcasures forrhese impacis: Noinapacz to our wastwaker Syskn We-are eypanding, the pecvious pavers ohpebmit 0' shape tho 710 all aouno the Poolacca PRIVACY ACTS STATIEMEAT: Infrrmation provided I) the Chesapeake Bay applicaton will be used in the permt review process and is a maiter of public recondoncethe: application IS filed, Disclosure ofthe resuested mformation IS voluntary. but 1 may not be possible t0 evaluate the permit application oT to issue aperma it the information requested IS net provided, CERTIFICNTION: I am hercby applying tor all permits typically issued by the DEA, VMRC, u.S. Army Corps ot Engineers, Chesapeake Bay process, and/or local Wetlands Boards for the acuivities E have described herein. I agree t0 allow the duly tuthorized representatives of any regulatory or advisory agency to enier upon the premised ot the projeci sile at reasonable times 1n inspect and phougmph s11C conditions, both in reviewing proposal to ssue a permit and after permit issmance 10 determne comphance with the permi. In addition, I certity under penaliy of law that this document and all attachments were prepared under my dircctio n or supervasion 1 accordance with a system designed to assure that qualified personnel properly gather and evalrate the information submitted. Based on my mqury nfihe person or persons who manage the system or those persons directly responsible for gachering the information, the information submitted is, tothe best ofm knevtedge and belief, truc, accurae, and complcte. I mm aware that there are significant penalties for submitting false information, including the possibilny offine and mmprisonment for kucwingvilatons. Dana H.BlAck Douaf # Black Donald R.BlAck 0412515 Printed Name Signature Date OFFICE USE ONLY Revised - 55 Project #: Rcccived by: Fee Paid: Reccipt #: Datc Reccived: Reviewing Authority: Lot recordation datc verificd with Clerk's Office YES C Date: Projcct Meets Zoning Setbacks: Yes No Datc Verificd: STAFF DECISION: APPROVED: (Approval is valid for 36 months from the date of approval) CODE REFERENCE/COMMIENTS: DENIED: *Please be advised, you may appeal the Staff decision, in writing, and apply for Exception to be heard in fromt of the Chesapeake Bay Preservation & Erosion Commission (new application and fees apply) CODE REFERENCE/COMMIENTS: Environmental Staff Signaturc Date Mitigation plan requircd: YES NO square foot minimum Mitigation plan approved: Entiticd: Datcd: Date mitigation completed: Inspected by: Amount of surcty required: Date surety released: Datc posted: Reccipt #: Payor Name: Phone #: Payor Address: Revised 2/3025 Site Conditions (of site and adjacent lands): Existing topography: Hydrology: Soils: Gcology: Fill Matcrials (source and composition): Totl Amount ofl Disturbed arca (sq fi): Total Amount of Cleared Arca (sq ft): Existing Vegctation: Total Amount of Underbrush Removed (sqy ft): Types: Numbero(Healthy Trees Removed: Types: Number ofTrees Limbed or Pruncd: Types: Number of Dem/D,ing/Diseascd Trecs Removed: Types: Proposed Vegetation Mitigation Mcasures: Number of New Canopy Trees Proposcd: Typcs: Number of New Uinderstory Trces Proposcd: Types: Number ofNew Shrubs Proposed: Types: Proposed Erosion & Sedimentation Control Practices: Silt Fencing Temporary Construction Entrance Straw Bale Barricr(s) E Inict Protecrion Temporary / Permanent Sceding Mulching OFrec Protection Sediment Trap Other: Proposed Best Management Practices: a Dry Well(s) Infilration T'rench(es) Vegctated Filter Strip(s) Grass Swalc(s) OOther Revised 13/2025 Wastewater (Septic) Element: Attach legible, clcan copy of Hlealth Department approval linformation t0 include calculations and dimensions. Description of potential impacts of the proposed wastcwatcr sysiems including and proposcd mitigated measures for thesc impacts: PRIVACY ACTSTATEMENT: Information provided in the Chesapcake Bay application will be used in the permit revicw process and is a matter of public record once cheapplication is filcd. Disclosure ofthe requested information is voluntary, but it may not bc possible to evaluatc the permit application or (0) ISSuIC a permit if the mlormation requcsted is not provided. CERTIFICATION: I am hereby applying for all permits typically issued by the DEA, VMRC, U.S. Army Corps of Engincers, Chesapeakc Bay process, and/orl local Wetlands Boards for the activites I havedescribed hercin. agrce tO allow the duly authorived representatives ofany regulatory or advisory agency to enter upon rhe premiscd of the project site at reasonable mmcs 10 inspect and photogmaph site conditions, hoth 1n reviewing proposal Da ISSE: a permit and after permit issuance t) determine compliance with thc permit. In addition. I cerrify under penalty of law that this document and all attachments were preparcd under my dircction or supervision in accordance with a system designed to assure that qualificd personnel properly gather and cvaluate the information submitted. Based 011 myi inquiry of the person or persons who manage the system or thosc persons dircctly responsible forgatihe ring thc information, the information submitedis, to the best of my knowledge and behef, truc, accurarc, and complerc. I an awarc that there are significant penalt.ics for submitting falsc information, including the possibiliry of line andi imprisonment for knowing violations. Printed Namc Signature Datc Revised 2/2025 STAFF ANALYSIS (OFFICE USE ONLY) Staff responses to applicant infmmaimpronilalom reverse page 1. 2. 3. 4. 5. 6. Reviewed by: Date: Revised 2/2025 OFFICE USE ONLY Projccr #: 25D4035D Rcccived by: Reneene Rcccipt #: 202091395 m275C0 Date Recie14-29-75 Reviewing Authority: StAEEICBREC lot recordation date verificd with Clerk's Office YES 4 Date: 429-25 Projcct Mccts Zoning Setbacks: Yes X No Date Verificd: 4-29-25 STAFF DECISION: APPRONED: (Approval is valid for 36 months from the date of approval) CODI REPERENCE/COMMIENTS: DENIED: **Please be advised, you may appeal the Staff decision, in writing, and apply for Exception to be heard in front of the Chesapeake Bay Preservation & Erosion Commission (new application and fees apply) CODE REERENCE/ COMMIENTS: Envivonmental StaffSignature Date Mitigation plan required: YES ONO squarc foot minimum Mitigation plan approved: Enticled: Dated: Dare mitigation complered: Inspccted by: mount of surery required: Date surery relcascd: Dateposted: Reccipt #: Payor Name: Phonc #: Payor Address: Revset 35