"Pre-application Meeting Form" - Montana

Pre-application Meeting Form is a legal document that was released by the Montana Department of Environmental Quality - a government authority operating within Montana.

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MONTANA DEPARTMENT OF ENVIRONMENTAL QUALITY
Pre-Application Meeting
Name of proposed development:
Location:
City:
County:
Geocode:
Legal description:
¼
¼
of Section
Township
Range
Date Requested:
Date Scheduled:
Time Meeting Began:
Time Meeting Ended:
Attendees
Owner (name/address/email/phone):
Owner’s Consultant (name/address/email/phone):
Reviewing Agent (DEQ/County):
Items Discussed:
_____ Onsite Water
_____ Onsite Wastewater
_____ Storm Drainage
_____ Public Water or Wastewater
_____ Legal Documents (Easements, User Agreements)
_____ Forms (application, fees, lot layout)
_____ Surveys (COS, Plat, Exemptions)
_____ Other approvals (Board of Health, DNRC,
_____ Review Time-lines/Procedure
Platting, Sage Grouse, Discharge Permits,
_____ Lot History
DPHHS, MDT)
_____ Physical constraints (groundwater monitoring,
_____ Nondegradation
floodplain
Attached: Drawing ______
Well Log ______
Plat/COS ______
Current COSA EQ#_________
Comments:
EQ # Assigned by DEQ:
Notice: Attending a pre-application meeting does not, in any way, guarantee the applicant to a water right, nor does the
meeting guarantee pre-approval of the resulting application. Application will be reviewed in accordance with the rules in place
at the time of receipt.
MONTANA DEPARTMENT OF ENVIRONMENTAL QUALITY
Pre-Application Meeting
Name of proposed development:
Location:
City:
County:
Geocode:
Legal description:
¼
¼
of Section
Township
Range
Date Requested:
Date Scheduled:
Time Meeting Began:
Time Meeting Ended:
Attendees
Owner (name/address/email/phone):
Owner’s Consultant (name/address/email/phone):
Reviewing Agent (DEQ/County):
Items Discussed:
_____ Onsite Water
_____ Onsite Wastewater
_____ Storm Drainage
_____ Public Water or Wastewater
_____ Legal Documents (Easements, User Agreements)
_____ Forms (application, fees, lot layout)
_____ Surveys (COS, Plat, Exemptions)
_____ Other approvals (Board of Health, DNRC,
_____ Review Time-lines/Procedure
Platting, Sage Grouse, Discharge Permits,
_____ Lot History
DPHHS, MDT)
_____ Physical constraints (groundwater monitoring,
_____ Nondegradation
floodplain
Attached: Drawing ______
Well Log ______
Plat/COS ______
Current COSA EQ#_________
Comments:
EQ # Assigned by DEQ:
Notice: Attending a pre-application meeting does not, in any way, guarantee the applicant to a water right, nor does the
meeting guarantee pre-approval of the resulting application. Application will be reviewed in accordance with the rules in place
at the time of receipt.
SUBDIVISION REVIEW JOINT APPLICATION FORM
Montana Department of Environmental Quality
Local Government Joint Application Form
Parts I, II, III, IV, and Checklist
Section 76-4-129, Mont5ana Code Annotated (MCA), provides that this Subdivision Review Joint
Application Form may be used to apply for Montana Department of Environmental Quality (DEQ)
approval of subdivisions under the Sanitation in Subdivision laws and for subdivision approval by local
governments under the Subdivision and Platting Act. The form replaces DEQ Form E.S. 91 and local
preliminary plat approval forms. Landowners thus are relieved from the burden of providing similar
information on different forms under two separate laws. Please consult with your local planning board,
health department, or DEQ regarding the proper submittal of this application and supporting materials.
A.
When applying for subdivision review by the planning board and local governing body, the
following parts of this form must be completed and submitted to the governing body or its
designated agent.
1.
Part I must be completed for all subdivisions required to be reviewed and approved by the
local governing body.
2.
Parts I, II, and III must be completed for all subdivisions for which local subdivision
regulations require submittal of an environmental assessment.
B.
When applying for review of subdivisions by DEQ, Parts I and II of this form must be completed
and submitted to DEQ. If the proposed subdivision is located in a county contracted to perform the
review of subdivisions, the application must be submitted to the local health department.
C.
When applying for concurrent review of the subdivision by the local governing body and by DEQ,
the following parts of this form must be completed and submitted to the local governing body or its
designated agent, or to DEQ:
1.
Parts I and II must be completed for all subdivisions for which concurrent review is
requested.
2.
Parts I, II and III must be completed for all subdivisions for which local subdivision
regulations require submittal of an environmental assessment.
D.
Although not a requirement of this Joint Application, it is highly recommended that the applicant
complete Part IV - Subdivision Checklist and submit the checklist with Part I and the information
required by Part II. The checklist identifies the application items (with references to applicable
rules and technical circulars) that are typically required by the reviewing authority. Depending on
the technical complexity of the proposed subdivision, the checklist may not necessarily identify all
of the required application items. However, it does provide general guidance to assist the applicant
in preparing a more complete application so as to expedite the review/approval process by the
reviewing authority.
Copies of this Joint Application Form are available from:
-
Montana Department of Environmental Quality, Permitting and Compliance Division;
-
Montana Department of Commerce, Economic and Community Development Division;
-
Local health departments and sanitarians; and
-
Local planning offices.
MONTANA DEPARTMENT OF ENVIRONMENTAL QUALITY/
LOCAL GOVERNMENT JOINT APPLICATION FORM
PART I. GENERAL DESCRIPTION & INFORMATION
Name of proposed development:
Location:
City:
County:
Geocode:
Legal description:
¼
¼
of Section
Township
Range
Type of Review
Type of water supply system
________ Division of Land, Boundaries Relocated, or
________ Individual well
Removal of Restrictions
________ Individual surface water supply or spring
________ Condominiums/Townhomes/Mobile
________ Cistern
Homes/Recreational Vehicles
________ Shared well (2 connections)
________ Rewrite – No Boundaries Changing,
________ Multiple-user (3-14 connections & < 25 people)
Aggregation, Change of Use
________ Service connection to multiple-user system
________ Modified Site Plan
________ Service connection to public system
________ Extension of public main
Descriptive Data
________ New public system (15+ connections or serving
________ Number of lots
25+ people)
________ Number of condominiums, townhomes, or
Type of wastewater treatment system
spaces
________ Total acreage of lots being reviewed
________ Individual wastewater treatment system
________ Shared wastewater treatment system (2
Indicate the proposed/existing use(s)
connections)
________ Residential, single family
________ Multiple-user (3-14 connections & < 25 people)
________ Residential, multiple family
________ Service connection to multiple-user
________ Type of multiple family structure
________ Extension of multiple-user main
(e.g. duplex) ________________________
________ Service connection to public system
________ Planned unit development
________ Extension of public main
________ Condominium/townhomes
________ New public system (15+ connections or serving
________ Mobile home park
25+ people)
________ Recreational vehicle park
________ Commercial or industrial
________ Other (please describe)
Name of solid waste (garbage) disposal site:
Designated representative, if any (e.g., engineer, surveyor)
I designate
of
Print name
Print Company Name
as my representative for purposes of this application.
Address:
Street or P.O. Box, City, State, Zip Code
Email:
Phone:
Owner
Name:
Signature of all owners of record
Print name of owner (s)
Address:
Street or P.O. Box, City, State, Zip Code
Email:
Phone:
Enter Date Here
Date: _______________________________________
Revised 5/2017
Page 1/2
Reviewer
Applicant
Yes
Initials
Page(s)
Missing
in
ELEMENT DESCRIPTION
NA
Report
General
Application form provided & signed by owner, plus contact info for consultant.
Filled out fee sheet & check made out to DEQ
Completed & signed copy of Part 4 Checklist
Vicinity Map Provided
Copy of plat or COS (or deed if aliquot parts or proposing Aggregation of lots)
4 copies of lot layout sheet(s); Facilities labeled as Existing or Proposed.
Copy of any existing COSA for reviewed lot(s)
Floodplains shown on drawings & any applicable documentation provided (LOMAs).
Onsite Wastewater
Copy of any existing WWTS permits for reviewed lot(s).
Proof of pumping for septic tanks within last 3 years, unless system less than 5 years old.
Soil profile descriptions
Seasonal high groundwater addressed (results or letter indicating in process)
Non-degradation
Nondegradation info IF new development proposed, if expansion of existing development
proposed, or for change in use (residential to commercial, etc.)
Onsite Water
Copy of any existing well logs for wells on reviewed lot(s), for wells sampled, & for wells
used for hydraulic conductivity estimates
Information about water quality, quantity & dependability (water tests & aquifer well logs)
Public Water or Sewer
If extensions or connections to existing public water/wastewater proposed, “will serve”
letter or copy of current bill from public facility owner if connected
Stormwater
Stormwater drainage report & plans
Other documents
Special Requests - Prior to full design (waivers, deviations, water availability analysis, non-
degradation predetermination, etc.)
Sage Grouse documentation provided
Copy of submittal to DNRC requesting Water Rights review or, if available, review letter
from DNRC.
Modified Site Plan
Copy of This checklist AND
(circle one)
Enter Date Here
Complete Letter
COMPLETE LETTER or INCOMPLETE LETTER sent on: _________________
_____________
REVIEWED BY: _________________________
____AGENCY:___________
______________
Revised 5/2017
Page 2/2
PART II
R
I
S
S
S
EQUIRED
NFORMATION FOR A OF
UBDIVISIONS UNDER
ANITATION IN
UBDIVISIONS
L
(e.g., parcels less than 20 acres, trailer courts, RV parks, condominiums)
AWS
All applications must include the information required in ARM 17.36.101-805 and the appropriate
circulars. In order to facilitate review, the application should be organized in the same manner as this
application form and follow closely the submittal requirements in the rules and circulars.
A.
Physical Conditions
Provide the following attachments.
1.
A vicinity map showing the location of the proposed subdivision in relation to the nearest
town, highway(s).
2.
Soils survey map and most recent interpretations of soil suitability for the proposed land uses.
3.
Topographic map of the development with contour intervals meeting the preliminary plat
requirements of the local subdivision regulations.
4.
A copy of a preliminary plat* (a minor subdivision plat, if applicable) prepared in accordance
with local subdivision regulations, or a final plat, show the location of:
a.
Any rock outcroppings.
b.
Any areas subject to flood hazard or, if available, 100- year floodplain studies. (The
local floodplain administrator or the Floodplain Management Section of the Water
Resources Division of the Department of Natural Resources and Conservation may be
contracted for assistance in determining flood hazard locations.)
c.
Any natural water systems such as streams, rivers, intermittent streams, lakes or
wetlands. (Also indicate the names and sizes of each).
d.
Any man-made water systems such as wells, ponds, canals, ditches, aqueducts,
reservoirs and irrigation systems. (Also indicate the names, sizes and present use of
each).
e.
Any existing or proposed utilities located within or adjacent to the subdivision,
including electrical power, natural gas, telephone service, and water and sewer
pipelines or facilities.
*Submit a preliminary plat or certificate of survey with complete and accurate legal description
adequate for DEQ to initiate and complete its review of the subdivision.
B.
Water Supply
1.
Where an individual water supply system is proposed or existing for each parcel
a.
For a proposed system, provide all information required in ARM 17.36.328 – 336,
indicate the distance to the nearest public water system.
b.
If an existing system will be used, provide all information required in ARM 17.36.335.
c.
Attach four copies of the lot layout showing the proposed or existing location of each
water supply source (spring, well, or cistern) and indicating the distance to existing or
proposed wastewater treatment systems.
2.
Where a multiple user water system is proposed or existing
a.
If an existing system will be used:
1)
Identify the system and the person, firm, or agency responsible for its operation
and maintenance.
2)
Indicate the system's capacity to handle additional use and its distance from the
development.
3)
Provide evidence that permission to connect has been granted.
4)
Provide three copies of the following attachments:
a)
Map or plat showing location, sizes, and depth of any existing water
supply lines and facilities that may directly serve parcels within the
proposed development.