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Revised 10-01-21 Page 1 of 5 City of Whitefish Planning & Building Dept 418 E 2nd St │PO Box 158 Whitefish, MT 59937 Phone: (406) 863-2410 Fax: (406) 863-2409 WATER QUALITY PROTECTION CHECKLIST FEE ATTACHED $ The water quality protection area checklist is a required submittal prior to development within 200-feet of a lake, wetland, stream or the river. The City has water quality protection area resources to help you complete this form, such as maps and the Critical Lands Report. The City also maintains a list of qualified professionals that may be hired to provide any necessary analysis. These can be found on the city’s webpage at: www.cityofwhitefish.org or at the Planning & Building Office. Another resource is the Natural Resource Information System, which is at: www.nris.mt.gov. INSTRUCTIONS: ❑Submit the application fee, completed application and appropriate attachments to the Whitefish Planning & Building Department prior to development. ❑After receipt of a completed application, city staff will review the materials, conduct a site visit and provide a written response to the owner/applicant. A. PROJECT INFORMATION: Project Address: Assessor’s Tract No.(s) Lot No(s) Block # Subdivision Name Section Township I hereby certify that the information contained or accompanied in this application is true and correct to the best of my knowledge. The signing of this application signifies approval for the Whitefish Staff to be present on the property for routine monitoring and inspection during the approval and development process. Owner’s Signature** Date Print Name Applicant’s Signature Date Print Name Representative’s Signature Date Print Name File Date: Intake Staff: Check Amount: Date Complete: **May be signed by the applicant or representative, authorization letter from owner must be attached. If there are multiple owners, a letter authorizing one owner to be the authorized representative for all must be included. (see current fee schedule) SIGN SIGN SIGN ---PAGE BREAK--- Revised 10-01-21 Page 2 of 5 B. APPLICATION CONTENTS: Attached ALL ITEMS MUST BE INCLUDED - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED ❑ One printed copy and one electronic copy of the application and supplemental materials. ❑ Vicinity Map ❑ Site Plan, drawn to a suitable engineering scale (such as showing: • boundaries of the subject property; • all existing and proposed improvements (buildings, parking and storage, driveways, decks, patios, wells, septic systems, drainfields, fuel tanks, utilities, easements, and areas to be cleared or graded); • name of adjacent rights-of-way with width, type of surface, sidewalk, curb, gutter, etc.; • accurate location of critical stormwater conveyances, rivers, streams, wetlands, or lakes on property or within 200-feet; and • topography of the site at two-foot contour intervals, with slopes 10% or greater highlighted. ❑ Erosion Control Plan, an erosion control plan will be required if the proposed development: • Requires a city building permit; or • Greater than 5 cubic yards of material is disturbed, stored, disposed of or used as fill, • Any activity where the area disturbed exceeds one thousand (1,000) square feet, • Clears land within 100-feet of a stream, lake, river or wetland. If required, submit the erosion control plan along with this completed form along with applicable fee ❑ Drainage Plan, if the proposed development includes greater than 10,000 square feet of developed area (new and existing impervious area). For single-family residential, the threshold is greater than 15,000 square feet of total impervious area and more than 30% lot coverage. Submit applicable fee. ❑ Any other additional supporting information relevant to the project. (See Part III of this application) ---PAGE BREAK--- Revised 10-01-21 Page 3 of 5 C. OWNER/APPLICANT INFORMATION OWNER(S) OF RECORD: Name: Phone: Mailing Address: City, State, Zip: Email: APPLICANT (if different than above): Name: Phone: Mailing Address: City, State, Zip: Email: OTHER TECHNICAL/PROFESSIONAL: Name: Phone: Mailing Address: City, State, Zip: Email: APPLICABLE FEES: check off all reports to be submitted and calculate the total fee ❑ Water Quality Protection Area Report (see Part III, $200.00 ❑ Geotechnical Letter: (See Part III, $200.00 ❑ Water Quality Plan (see Part III, $200.00 ❑ RUE - Single family/duplex: $660.00 ❑ RUE - Multi-family, Commercial, Industrial: $1,980.00 ❑ Variance: $396.00 ❑ Erosion Control: Single family/duplex: $100.00 ❑ Erosion Control: Single family/duplex (minor addition): $0.00 ❑ Erosion Control: Multi-fam, Com., Indust: $200.00 ❑ Erosion Control: Multi-fam, Com., Indust (minor addition): $100.00 TOTAL: ---PAGE BREAK--- Revised 10-01-21 Page 4 of 5 PART I: This is the initial screening tool for critical areas. Applicants for all proposed projects within 200-feet of a wetland, stream, lake or the river in the city limits are required to complete PART I unless it is exempt. 1. Is the site within 200-feet of a wetland, stream or lake? ❑YES (then go to Part II, question ❑NO 2. Will development occur within 75-feet of the Whitefish Lake? ❑YES (then go to Part III, question ❑NO 3. Is the project within 200-feet of the Whitefish River and on a parcel that abuts the River? ❑YES (then go to Part II, question ❑NO 4. Is there a mapped critical stormwater conveyance area on the property? (review city maps: www.cityofwhitefish.org or Whitefish Planning & Building office) ❑YES (then go to Part II, question ❑NO 5. Will development occur on slopes 10% or greater? ❑YES (then go to ❑NO a. If YES, will development occur within 200-feet of a wetland, stream or lake? ❑YES (then go to Part III, #5 and provide required information) ❑NO If you answer ‘no’ to all the questions in Part I, then your critical area review is complete. PART II: (ONLY ANSWER IF REQUIRED BY PART I) 1. Are standard buffers for the lake, stream or wetland being met? ❑YES (show dimensions on site plan, review complete) ❑NO (then go to Part III, #1 and provide required information) 2. Is the standard Whitefish River buffer being met? ❑YES (then go to Part III, #2 and provide the required information) ❑NO (then go to Part III #1 and #2 and provide the required information) 3. Is the project 15-feet or more from the conveyance? ❑YES (show dimensions on site plan, review complete) ❑NO (then go to Part III, #3 and provide the required information) ---PAGE BREAK--- Revised 10-01-21 Page 5 of 5 PART III: (ONLY ANSWER IF REQUIRED - SEE PARTS I and II) 1. Wetlands, Streams, River, Lakes: For projects not proposing to meet standard buffers and setbacks, submit one of the following: ❑Critical Area Report (check all that apply to the project): □ Buffer Restoration: §11-3-29C(3) □ Buffer Averaging: §11-3-29C(4) □ Critical Area Reports - General: §11-7-10 □ Wetland Information for Critical Area Report: §11-7-10F & G ❑Reasonable Use Exemption [must meet criteria outlined in §11-3-29B(5)] request to the Planning & Building Director 2. Whitefish River: For projects located on a parcel that abuts the Whitefish River and will have building(s) within 200-feet of the buffer, submit the following information to determine the appropriate setback from the buffer, but no less than 20-feet: ❑Geotechnical Letter: §11-3-29D(1) 3. Critical Stormwater Conveyance: For projects less than 15-feet from a mapped critical stormwater conveyance, submit the following item: ❑Reasonable Use Exemption [must meet criteria outlined in §11-3-29B(5)] request to the Planning & Building Director 4. Whitefish Lake: For projects developing within 75-feet of the Ordinary High Water Mark for Whitefish Lake, submit the following item: ❑Water Quality Plan: §11-3-29C(1)(f) 5. Slopes and Geologic Instability: For development with a slope 10% or greater and within 200-feet a lake, stream or a wetland, submit the following: ❑Geotechnical Letter: §11-3-29D(1)