Application for Onsite
Wastewater Treatment System
MARION COUNTY PUBLIC WORKS
BUILDING INSPECTION DIVISION
5155 Silverton Rd NE
Salem OR 97305
(503) 588-5147 Fax (503) 588-7948
www.co.marion.or.us/PW/BuildingInspection
Date Stamp:
For City Use Only:
City of __________________
Date Received ____________
Received by ______________
Zoning by ________________
Fee ______________________
Receipt # _________________
Activity # ______________
A. Property Owner Information
___________________________
Name
________________________
___________________________
__________________
Mailing Address
City, State, and Zip
(Area Code) Phone #
B. Legal Property Description
__________________________________________
_________________________
_____________________________
Legal Description
Tax Lot
Acreage or Lot Size
___________________________________________
Subdivision Name
____________________________
Lot
_____________________________
Block
__________________________________________
___________________________
_______
_________________
Property Address
City
State
Zip Code
Directions to Property: _____________________________________________________________________________________
_________________________________________________________________________________________________________
C. Existing Facility / Proposed Facility / Water Information
Existing Facility:
Proposed Facility:
Single Family Residence
Single Family Residence
___________________
Number of Bedrooms
____________________
Number of Bedrooms
Other _______________
Water Supply:
Public ____________________
Name
Private ____________________
Well, Spring, Shared
Other _______________
D. Type of Application
Site Evaluation
Construction Permit
Repair Permit
Major
Minor
Alteration Permit
Major
Minor
Renewal Permit
Permit Reinstatement
Permit Transfer
Existing System Evaluation
Record Review
Other _______________
Authorization Notice for:
Replacing a Dwelling
The Addition of One or More Bedrooms
Personal Hardship
Temporary Housing
Connecting to an Existing System Never in Use
(over 5-yrs old)
Other – Please Specify
If the required fee and attachments are not included with this application, it will be returned to you as incomplete.
Post the orange card at the entrance to the property. Flag the test holes.
By my signature, I certify that the information I have furnished is correct, and hereby grant Marion County, authorized agent of the
Department of Environmental Quality, permission to enter onto the above described property for the sole purpose of this application.
__________________________________
Applicant’s Name – Please Print Legibly
__________________________________
Applicant’s Phone Number
_________________________________
DEQ Lic. # (if applicable)
____________________________________________________________________________________________________________
Applicant’s Mailing Address
__________________________________
Signature
Applicant is the
Owner
__________________________________
Date:
Authorized Representative
__________________________________
CCB # (if applicable)
Authorization to Apply form Attached
Marion County Onsite Disposal System Fee Schedule
Effective September 1, 2015
Total Fee
w/DEQ
Surcharge
$725
$675
$725
$120
New Site Evaluations
Marion
County Fee
DEQ
Surcharge
Single Family Dwelling - First Lot
- each add’l lot evaluated during initial visit
Commercial Facility System – First 1,000 Gallons
-Each Additional 500 Gallons
$625
$575
$625
$120
$100
$100
$100
-
Construction Installation Permits
Fee
DEQ
Surcharge
Total Fee
w/DEQ
Surcharge
$750
$100
$850
$990
$100
$1090
$1200
$290
$559
$600
$100
$675
$175
$100
$100
$100
$100
$100
$100
$100
$1300
$390
$659
$700
$200
$775
$275
$75
-
$75
$50
$336
$26
$100
$100
Fee
DEQ
Surcharge
Gallon/day = 601 - 1000 Gallons
$250
-
$50
$436
$126
Total Fee
w/DEQ
Surcharge
$250
Each 500 Gallons per day above 1000
$50
-
$50
Fee
DEQ
Surcharge
$450
$150
$98
$50
$435
$264
$50
$341
$67.25
$52
$100
$100
$100
$100
-
Total Fee
w/DEQ
Surcharge
$550
$250
$98
$50
$535
$364
$50
$341
$67.25
$52
-
$47
Standard System, Redundant System, Saprolite, Seepage Pit, Steep
Slope
Alternate Treatment Technologies, Capping Fill, Pressure Distribution,
Tile Dewatering
Sand Filter, Recirculation Gravel Filters
Gray Water Disposal Sump
Holding Tank
Major Repair
* Commercial P/R Requires add’l fees over 1000 gals.
Minor Repair
Major Alteration Permit
Minor Alteration Permit
Permit w/sewage flow > 1000 gallons per day in addition to above, per
500 gallons per day
Pump System - in addition to permit fee
Permit Renewal - Field Visit
Permit Renewal - No Field Visit
Commercial Plan Review
Other Onsite Activities
Authorization Notice with Field Visit
Authorization Notice without Field Visit
Pumper Truck Inspection - First Truck
Pumper Truck Inspection - Additional Truck
Existing System Report
Mobile Hardship Renewal Inspection
Annual Report Evaluation Fee Holding Tanks/ Alternate Systems
Alternate System Inspection Fee
Hourly Inspection Rate
Reinspection Fee
Compliance Recovery Fee (For work done without permits) when
authorized by OAR 340-071-0140 is equal to the application fee.
Record Review
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G:\Forms\Septic\Application Packets\S-01 Onsite Appl Sept 2015.doc
Varies
$47