HomeMy WebLinkAbout7_MFEformfillable MONTANA DEPARTMENT OF ENVIRONMENTAL QUALITY
MUNICIPAL FACILITIES EXCLUSION
Subdivision Name: ________________________________ Number of lots/parcels/units: __/__/__
Geocode: ___________________________ (this can be found at http://svc.mt.gov/msl/mtcadastral)
Are main extensions necessary to serve the subdivision? Yes No If yes, have plans for the mains been submitted
for review? Yes No
How will construction of the facilities be financed? ________________________________________________
Owner Information:
Owner(s) Name: _____________________________ _____________________________________
Print name of owner(s) Signature of all owners of record
Address: ________________________________________________________________________________
Street or PO Box, City, State, Zip Code
Email: ____________________________________________ Phone: _____________________________
Consultant Information:
Company and Address: _____________________________________________________________
Email: _________________________________________ Phone: __________________________
Eligibility Requirements: All of the following 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 1st or 2nd 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)
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Submittal Requirements: All of the following 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. The Plat, COS, Am Plat or Unit
Declaration 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 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