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INFORMATION TO BE PROVIDED FOR MUNICIPAL FACILITIES EXCLUSION CERTIFICATION When a developer submits an application to the City of Whitefish for certification of a Municipal Facility Exclusion (MFE), the developer must provide the following information to the City: 1. Name of subdivision. 2. Location of subdivision: ¼, ¼, Section, Township, and Range. 3. Name and address of applicant. 4. Name and address of individual(s) or firm to whom correspondence is to be sent. 5. One copy of the preliminary (or final) plat. 6. Number of parcels in the subdivision. 7. Statement of the zone in which the subdivision is located and a copy of the applicable section of the zoning ordinance. 8. One copy of a site plan showing details of all proposed water and sewer facilities (including the accurate location of all existing improvements on the lot(s) and location of utility services to serve each separate lot). If a main extension is required, a report, plans, and specifications prepared by an engineer are required. This material must comply with City Standards and the Public Water Supply Act, Title 75, Chapter 6, Part 1, Montana Code Annotated. 9. Statement of how any required water and sewer construction will be financed (including cost of services to serve each separate lot). The State has developed a Municipal Facilities Exclusion Checklist that will be used for certifying MFE’s once the above information has been reviewed and approved. If you need assistance when applying for a MFE, contact the Senior Project Engineer at the City of Whitefish, telephone number 863-2450. ---PAGE BREAK--- Revised 07/03/2013 MUNICIPAL FACILITIES EXCLUSION CHECKLIST (formerly called master plan exclusion) Below, please find the information required under § 76-4-127 MCA regarding a municipal facilities exclusion for this subdivision within a growth policy area or first-class or second-class municipality. Use of this checklist is only appropriate when the municipality is providing the water and sewer main service and when the municipality's engineering staff is reviewing the plans and specifications prior to approval: 1. Name of 2. Name and address of the 3. Name and address of engineer: 4. Copy of the preliminary or final plat: Attached Number of parcels in the subdivision: 5. A copy of any applicable zoning ordinances in effect: 6. How construction of the sewage disposal and water supply systems or extensions will be financed (method of financing): 7. Certification that the subdivision is within a jurisdictional area that has adopted a growth policy or within a first-class or second-class 8. Copy of Growth Policy: On file Attached: 9. Location of the subdivision to the city or town, vicinity map attached: Yes No 10. Will the owner of the municipal facilities own, operate and maintain the water supply, sewage disposal, solid waste, and storm water facilities? Yes No 11. Will all water and sewer mains or extensions as defined in §76-4-102, MCA (a main or extension is any line that serves more than one building or living unit) be under the control and maintenance of the certifying municipality? Yes No 12. Will an extension of the existing sewer main(s) be necessary to serve this subdivision? Yes No 13. Will an extension of the existing water main(s) be necessary to serve this subdivision? Yes No 14. Exclusion Checklist review fee, ($100) included: Yes No 15. I certify that adequate municipal facilities for the supply of water and disposal of sewage and solid waste are available or will be provided within the time allowed under§76-3-610, MCA , and I certify that the governing body has reviewed and approved plans to ensure adequate storm water drainage. I further certify that I am authorized to sign this form on behalf of the governing body. Name Signature Dept Title City Phone Please sign and send with the $100.00 review fee to: MONTANA DEPARTMENT OF ENVIRONMENTAL QUALITY SUBDIVISION REVIEW SECTION, PERMITTING AND COMPLIANCE DIVISION PO BOX 200901 HELENA, MT 59620