Public Works Department 201 1 st Ave East Kalispell, Montana 59901 (406) 758-7720 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 (1) acre or for land disturbance activities less than one (1) acre that are part of a larger common plan of development or sale that would disturb one (1) acre or more. **No land disturbance is permitted on any project site without an approved City of Kalispell Permit** (1) Contact Information (a) Project Owner: (b) Contractor: (c) Engineer: (2) Project Information Project Address : Lot Number: Subdivision (if applicable): Project Size: (Land Disturbance) Permit Application LESS than one acre $10.00 Permit Number Date Submitted Final Stabilization Date GREATER or equal to one acre $45.00 (3) Nature of Construction Check the appropriate box(es) or provide a brief description that indicates the general nature of the construction activities. Single Family Residential Multi-Family Residential Utility Commercial/Industrial Highway / Road Other (describe): Description of proposed work: SWM Permit Application Page 1 of 5
(4) Site Map Checklist 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 best management practices (BMPs) selected in Section 5 (5) Required Stormwater Controls Permit Number Date Submitted Final Stabilization Date 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. Inlet protection: Outlet protection: Pre-manufactured drop inlet protection Riprap to prevent erosion at outlets Straw wattles Stabilization and erosion control of disturbed areas: Disturbed areas require BMPs that prevent erosion of barren ground. Temporary seeding Preservation of existing vegetation Mulching/straw/compost Soil binders Embankment protector Surface Roughening Perimeter control: Project boundaries require BMPs that contain stormwater flowing from disturbed areas. Silt fence Vegetated buffer Fiber roll SWM Permit Application Page 2 of 5
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. Sediment control: Sediment trap Check dams Fiber rolls De-silting basin Street sweeping - Frequency: 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. Stabilized construction entrance/exit Stabilized construction roadway Waste management, spill prevention, and general pollution prevention: Construction activities create waste and pollution and require BMPs to prevent contamination of local waterways. Concrete washout area Saw cutting and grinding controls Enclosed waste collection Spill prevention and control measures Covered storage of chemicals, paint, petroleum, fertilizer, and pesticides Sanitary waste facilities - minimum of 15 feet from storm drain and water bodies Wind erosion control: Wind can erode barren land and stockpiles and requires BMPs to reduce erosion. Watering Seeding SWM Permit Application Page 3 of 5
Run-on protection: Sites below slopes may have issues with run on and require BMPs to prevent run on from eroding the site. Temporary slope drain Drainage swales 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 Identify staff responsible for: _ (7) Water bodies and Storm Conveyance Systems (a) List water bodies within 200 of project Streams: Wetlands: Sloughs: Hydromulch Sod Site inspections and record keeping Daily cleanup of construction site to ensure all litter is contained in appropriate enclosure or container (6) Project Schedule Start Date: Completion Date: Final Stabilization Date: Lakes: Rivers: Other: (b) Are any water bodies that receive stormwater runoff from the project impaired? Yes No If yes, what are the impairments: Sediment Dissolved Oxygen Nutrients Temperature Other: (c) List storm conveyance systems within 100 of project Ditches: Swales: Detention Facilities: Storm Drain Inlets: Pipe Inlets/Outlets: Gutter: SWM Permit Application Page 4 of 5
(d) Flood Plain: Is the project in a flood plain? Yes If yes, is a permit: (8) Certifications Required If yes, is the site/ will the site be: Applicant agrees to: (9) Acknowledgment Certificate Permit Application Pending Initial: Install applicable BMPs prior to the start of land disturbing activities. Permit Number Date Submitted Final Stabilization Date Initial: Keep this permit posted on-site and updated to reflect current site conditions. Initial: Inspect and maintain all control measures at the end of EACH workday. Initial: 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, asphalt sealant, paint, and all other pollutants hazardous to the environment). Initial: Maintain a spill kit on-site, which includes, at a minimum, absorbent material, cleanup tools, and covered waste container. 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. Signature of Legally Responsible Person (Submission must include original signature) Name (printed) Date Title **For Official Use Only** LESS than one acre Received City By Date SMP Checklist Yes No Field Visit SMP Plan Yes No Approval SMP Map Yes No Comments: Payment-$10.00 Yes No No Issued Delineated Staked Perimeter BMPs installed SWM Permit Application Page 5 of 5