HomeMy WebLinkAboutMFE_Stanley MONTANA DEPARTMENT OF ENVIRONMENTAL QUALITY
MUNICIPAL FACILITIES EXCLUSION
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Subdivision Name: PoRion of (E) ALDWORTHS REARR Number of lots/parcels/units: 1 �1 �0
GeoCode: 06-0799-18-4-42-11-1001 (this can be found at http://svc.mt.qov/msl/mtcadastral)
Are main e sion necessary to serve the subdivision?QYes�o If yes, have plans for the mains been submitted
for review?�Yes�No
How will construction of the facilities be firr�nced? n�a
Owner Information:
Owner(s) Name: Hal Stanley �/ _ ��_
�- �
Print name of owner(s) ` Signature o owners of recor
Address: 1727 Kenyon Drive, Bozeman, MT 59715
Street or PO Box, City, State, Zip Code
Email:
halstanlev(cr�,me.com Phone:
Consultant Information:
Company and Address: COnStruCtive ��luti011s InC 111 S Grand Ave, Suite 223, Bozeman, MT 59715
Ema�i: Phone: 40657O5O4S
EliqibilitY Requirements: All of the followinq criteria must be met:
� The project must be provided with adequate municipal water and sewer, solid waste disposal and the
municipality must review storm water plans.
�] All the mains necessary to serve the subdivision must be municipality owned, operated and maintained. Privately
owned mains or lift stations make the project ineligible for this exemption.
� The municipality must be a 15t or 2"d class municipality as described in MCA 7-4-111 or covered under a growth
policy pursuant to Title 76, chapter 1.
The project must be one of the following (check applicable box):
A new division subject to review under the Montana Subdivision and Platting Act, or
� Previously divided parcels recorded with Sanitary Restrictions prior to July 1, 1973 or
Divisions or parcels of land that are exempt from Montana Subdivision and Platting Act review
under 76-3-203 or 76-3-207 (1) (a), (b), (d), (e), or(f)
Form continues on next page _�
Submittal Requirements: All of the followinq items must be submitted:
� This form, signed by the property owner, and the municipalities' representative.
�Copy of Preliminary Plat, COS, Amended Plat or Unit Declaration or Exemption Certificate. The Plat, COS,
Am Plat or Unit Declaration or Exemption Certificate must contain the exemption 76-4-125 (1)(d)(i), (ii)or(iii).
If using item (iii), the Plat, COS, Am Plat or Unit Declaration or Exemption Certificate must also contain the
appropriate Platting Act exemption
� Vicinity map showing project location.
� Applicable zoning ordinances in effect �✓ on file
� Copy of growth policy, if applicable ❑✓ on file
� $120 processing fee
Certification:
I hereby certify that I am licensed to practice engineering in the State of Montana, I am employed directly or retained by the
municipality providing service and am authorized to sign on behalf of the municipality. In addition, I hereby certify that:
1. The existing water and wastewater systems are in compliance with the provisions of Title 75, chapters 5 and 6, and
2. The water and wastewater systems have adequate capacity to meet the needs of the project,and
3. The municipality has or will review plans to ensure adequate storm water drainage and adequate solid waste
disposal.
(Signature of Professional Engineer) (Date Signed)
Montana P.E. Number
PE Stamp
Send to: MTDEQ Subdivisions
PO Box 200901
Helena MT 59620-0901