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SWM Permit Application Page 1 of 6 Note: This permit is separate from any permits required by the Montana Department of Environmental Quality. A State Stormwater Construction Permit is required for all land disturbance activities equal to or greater than one acre or for land disturbance activities less than one acre that are part of a larger common plan of development or sale that would disturb one acre or more. **No land disturbance is permitted on any project site without an approved City of Kalispell Stormwater Management Permit** Contact Information Project Owner: Contact Person: Company: Mail Address: City: State: Zip: Phone: Email: Fax: Mobile: Other: Contractor: Contact Person: Company: Mail Address: City: State: Zip: Phone: Email: Fax: Mobile: Other: Engineer: Contact Person: Company: Mail Address: City: State: Zip: Phone: Email: Fax: Mobile: Other: Project Information Project Address : Lot Number: Subdivision (if applicable): Project Size: (Land Disturbance) LESS than one acre $10.00 GREATER or equal to one acre $45.00 Nature of Construction Check the appropriate box(es) or provide a brief description that indicates the general nature of the construction activities. Subdivision Multi-Family Residential Utility Commercial/Industrial Highway / Road Other (describe): Description of proposed work: Stormwater Management Permit Application For office use only: Permit Number Date Final Stabilization Date Public Works Department 201 1st Ave East Kalispell, Montana 59901 (406) 758-7720 GREATER or Equal to One Acre ---PAGE BREAK--- Pre-manufactured drop inlet protection Riprap to prevent erosion at outlets Straw wattles Other Not applicable (explain Temporary seeding Preservation of existing vegetation Mulching/straw/compost Other Not applicable (explain Site Map Stormwater Management Checklist For office use only: Permit Number Date Final Stabilization Date GREATER or Equal to One Acre Applicant must provide a site map(s) that includes the following: Project boundary, North arrow, and adjacent streets Direction(s) of stormwater run-on and runoff Public and private stormwater infrastructure on or adjacent to site Receiving waters on or adjacent to site Material storage and spoil area(s) Equipment staging area(s) All BMPs selected in Section 5 Inlet/Outlet protection: Inlets and outlets receiving site runoff require BMPs that filter stormwater before flowing into underground infrastructure and BMPs that prevent erosion at outlets. Check BMPs from each list that will be used and show location(s) on map. Stabilization and erosion control of disturbed areas: Disturbed areas require BMPs that prevent erosion of barren ground. Check BMPs that will be used and show location(s) on map. Soil binders Embankment protector Surface Roughening Perimeter control: Project boundaries require BMPs that contain stormwater flowing from disturbed areas. Check BMPs that will be used and show location(s) on map. Silt fence Fiber roll Other Not applicable (explain Vegetated buffer Required Stormwater Controls SWM Permit Application Page 2 of 6 Inlet protection: Outlet protection: ---PAGE BREAK--- Sediment control: Sediment trap Check dams Fiber rolls De-silting basin Street sweeping - Other Not applicable (explain Sediment and stockpile control: Sediment and stockpiles require containment and BMPs that prevent erosion and displacement of loose material. Check BMPs from each list that will be used and show location(s) on map. Stockpile control: Straw wattle Silt fence Cover/tarp Watering Tracking control: Travel and exit points require BMPs that prevent tracking of debris off-site onto the right-of-way and meet the City of Kalispell's Standards for Design and Construction. Check BMPs that will be used and show location(s) on map. Stabilized construction entrance/exit Stabilized construction roadway Other Not applicable (explain Waste management, spill prevention, and general pollution prevention: Construction activities create waste and pollution and require BMPs to prevent contamination of local waterways. Check BMPs that will be used and show location(s) on map. Concrete washout area Saw cutting and grinding controls Enclosed waste collection Sanitary waste facilities - minimum of 15 feet from storm drain and water bodies Other Not applicable (explain Spill prevention and control measures Covered storage of chemicals, paint, petroleum, fertilizer, and pesticides Wind erosion control: Wind can erode barren land and stockpiles and requires BMPs to reduce erosion. Check BMPs that will be used and show location(s) on map. Watering Seeding Other Not applicable (explain SWM Permit Application Page 3 of 6 ---PAGE BREAK--- Temporary slope drain Drainage swales Other Not applicable (explain Run-on protection: Sites below slopes may have issues with run on and require BMPs to prevent run on from eroding the site. Check BMPs that will be used and show location(s) on map. Permanent erosion control: Disturbed land related to the project activities require BMPs before final occupancy of structures to prevent erosion. Check BMPs that will be used. Landscaping/vegetation Seeding Hydroseed Other Not applicable (explain Hydromulch Sod SWM Permit Application Page 4 of 6 Post-Construction BMPs: Disturbed land related to the project activities require stormwater treatment and management BMPs. Check BMPs that will be used. Detention pond(s) Retention pond(s) Dry well(s) Other Not applicable (explain Drainage swales Infiltration system(s) ∑Identify staff responsible for: ϭ͘ tŚŽŶĞ͗ ͺͺͺͺͺ__ͺͺͺͺͺͺͺͺͺͺͺͺͺͺ Ϯ͘ tŚŽŶĞ͗ _ͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺ Site inspections and record keeping Daily cleanup of construction site to ensure all litter is contained in appropriate enclosure or container ---PAGE BREAK--- Certifications Applicant agrees to: Install applicable BMPs prior to the start of land disturbing activities. Utilize clearing techniques that retain natural vegetation and drainage patterns. Keep this permit posted on-site and updated to reflect current site conditions. Inspect and maintain all control measures at the end of EACH workday. Stabilize or cover soil stockpiles at the end of EACH workday. Stabilize soil within fourteen (14) days of clearing or inactivity of construction. Contain and dispose of all pollutants generated by local, state, and federal regulations (i.e. form oil, oils/greases, fuel, masonry wash water, concrete cutting slurry, exposed aggregate waste wash water, asphalt sealant, paint, and all other pollutants hazardous to the environment). Maintain a spill kit on-site, which includes, at a minimum, absorbent material, cleanup tools, and covered waste container. SWM Permit Application Page 5 of 6 No Pending Issued Yes If yes, is a permit: If yes, is the site/ will the site be: Delineated Staked Perimeter BMPs installed Project Schedule Start Date: Completion Date: Final Stabilization Date: Water bodies and Storm Conveyance Systems List water bodies within 200’ of project Streams: Lakes: Wetlands: Rivers: Sloughs: Other: List storm conveyance systems within 100’ of project Ditches: Swales: Detention Facilities: Storm Drain Inlets: Pipe Inlets/Outlets: Gutter: Are any water bodies that receive stormwater runoff from the project impaired? Yes If yes, what are the impairments: Sediment Nutrients Other: Dissolved Oxygen Temperature Flood Plain: Is the project in a flood plain? No Required ---PAGE BREAK--- Stormwater Management Permit Application For office use only: Permit Number Date Final Stabilization Date Acknowledgment Certificate I certify that I am the Owner or Owner’s authorized agent. If acting as an authorized agent, I further certify that I am authorized to act as the Owners agent regarding the property at the above-referenced address for the purpose of filing applications for decisions, permits or review under the City of Kalispell Ordinance 1600 and have full power and authority to perform on behalf of the Owner all acts required to enable the City to process and review such applications I certify that the information on this application is true and correct and understand that I shall not start this project until this application is approved. I shall comply with the laws of the State of Montana and the ordinances of the City of Kalispell. Date Signature of Legally Responsible Person (Submission must include original signature) Name (printed) **For Official Use Only** City By Date Field Visit Approval Comments: GREATER or equal to one acre Received MT Stormwater Discharge Permit (NOI) Yes No Yes No Site Map showing BMPs Yes No Yes No MT Stormwater Discharge Permit (NOT) SMP Checklist Yes No SMP Plan Yes No SMP Map Yes No Payment-$45.00 Yes No New construction subject to impact fees Yes No Title SWM Permit Application Page 6 of 6 GREATER or Equal to One Acre