. -l,CX.xr/BaEed on krformatiur.reclved' l!:11i-*,y"

ff"*

ilffi", (oae {tre) thealtenrate "lTlI' *'fu'*"u"uintv--Dgq :o ohgresbictonE'Wilt betimibdh;

Landowner:

rit+rHrtl(l.Lll.,lr l\J' u r Lr l'rrL L{J

Store Water e&'

Alternate Review Process (ORS 537'409)use thle fgm f+r ai'E/ rffir'i*ir **itt'6lej: 'ji;rr 9'2 acrefeet

rrwih e llem !n55 rhan lf! fe*-rhigh

Use a separate form for each reservoir

please type or print in dark inlc lf your application is found to be incomplete or inaccurate, we will return il. to you. tf any requested informatian does nolappiy, insert*n[a'

HECEIVEDI

Nov 2 7 71fr2

'iverE?mo##E%8f Ee;Authorizing Agent:

Mailing Addrels:

1. A PPI ICA h'LI NEORMATI.Q}{

"Fax:'Optior:al I nbrmatiott

A- Reservoir Name:

+E-MaiI Address:

?"-tf, cATlolj-A N.n*s o t IRCF

B. Source provide the name of the water body or o*ter source from which \'vater will be diverted,

and tlre narne of the stream or lake if ftows into" lndicate if source is run-off, seepaEe, or an

unnamed stream or sPring-

h,ir S€

,'I

source: Rt nr-E€F -

Tributaryto, Cesu'.$el- #: ':::;-

C" Reservair Location

D. County of

E- Dam: Maxirnurn height of dam; I L feeL lf excrvated, write 'oceavated' or'o feet"'

E. euantfty: Amount of water to be stored in the reservoir at rnaximum capacity- List quantity in

Township (N or5) Range (E onr- W) Secticn guartertrqnarter tax tct *urnheE

3qs l!r1 tt\i Stt"tl t^rt { -10(J

AcrpFeet:

Deparirnent Use

lndicate the proposed use(s) o[ tre stored water. NOTE You may wish to consider filing for "MultipurFogeuse" for your reseryoir. Muftipurpose use does not [irnit the typu of fufure uses for the stcred water.Multipurpose coverE all sses including stoch'#eter, Ss* ead'*it*,::. :.'-:i;:l;, i;;;:-i;;, ;.";;;-l;;,a6rirulti:re, fire protrriior: ard pollution abaternent. if any use will be out of reservoirusg regardless olu rL rr l,$ e!

.*-jB TIPFBJY QwN FRsHle-

Do you own all rhe land where you propose to divert, transport, a.nd use water?Gt' Yes {S/<rp to section 5)tr No Please chect the appropriate bex below.

,qrtElvtnN0Y 27 L0l2

fri&Trll ?!f\rtt t I tLgl

sAtE&{.

,:i:e nEr)LbIJtro I have a recorded easemen( or writtefi aijihoiization permiiiing access.

acic:s lc h:rd: n+f uxder my o$rnership.List the narnes and rn*iling ,eJ'u-;:iiii *f ;!i =#ectsd

lendourners*:Fft .*l--.

+J_-.!

rhan 25landownErs are." 1E-. X?54"q . . - _ _ ..t[moreinvolved, a list is not reqrrr€d- .{*-er,ii*eits* r.l,rtke ffi*r $€' ftiede.

5. FNVIRf}NMFNITAI JtrdPACT

A. CHhene[: [s tlre reservoir iir slreanri -]t :r lf *:i,r:t-:-B. Wetland: ls lhg proiE{l i- :.';rll::::{' - '"!--

"1 ?'!'- = l,l='i lri}rirar

,L. Lxiriirrg:, ir ihis.afi B;isring resenroir? Pves "E No lf yes. how' long has if been in- .l.rrl-?",_:.- F;;1 7't . t/eal.s.

D. Fish H"bitatr ts rhere fish habirat upsfrearfi sf the p{c'P3r€d str-u,cture? I Yes Hr.+*EI Don'I know. If yes, how muchl *_*s rnill,q

[.Parirerships;iia.ueycubcen*di*Gffia8encies?E}YesHr.ioitiiiiciie 6Eency, Sidii ;riii. p..** .,*.,,1-,- *; i.--- 1.,..:lved- Alsu indicate any agencies thal are

cost sharing in this proiect.

> Fa-+Lt sfr ldrb- ftt ltEiaj-lj-El-

I swear that all stetements made and i*forrna:': n -' ' '- ' ' . ,,,1i' aii*n ar6 true irnd cgrrect to

?-3o *o?-the best of my knowledge.

2-4-.:= you subrrrit your ap$lication be sure you have:

. Answered eaeh, qii#'ii; :;=Pl=l:!':II I L: L : -1.-J^- T-..,^.L:- 6-^-^ E^,-.{^^ .^.{ :s-. ln(f,uoeo a lgEtute r!1arl lxrrt(_i! rril_rr_rrrn ru*rsrru_- r\6rEes rcLuurr.- quatrsrltuorrsr d'.u ru^

l:i r::;Ll:- Th I =rp :: g:: ::::i : : :;p r s,;*!'.'r :i' r'; iv lrr ..-cpired-

' ir-rcir.iAi a iani! ii:e iom-: i;,;' ,i.:iuli;i =i-!. sig*='J ty a lc'c=l planning OffiCiaf.

. luqtuueu c (Jlet*t frofdurE rrr \"rr cfvr-, *.-.i- i*--,** ]-r-."i,nent for thg apprqariatg

amounL

rrr -EEt i.i i i ,arL3 7 *^ rijfrrbff ryi er#-fe*i ;ifOpCSd to be stored.

i ii€ rLC u iP. u t.r: : ;-:: I _*-.ll; I - ,r i-:2:,; ?O-OAF-$IOO

Maximum fee is $;c* i-.r ;-v iirsr.i-r.ili:- Etcri:tg mo:-e ii=rt iO Acre-Feet'-t

a rL-..i.- n-.---- . i+ .J lA Sltt ."d fi'a.n tr OExhibll t

?rxa +&

Basedon hformafitrr recefie4 treurE of hrcfioviorfillhg (oaa@rheahenabrffiryl: ||ff$: ff::. *' -

--- 1"-i1 ::r'4sgi* .,+=+-=?.Eii*iri? L:<i?- i:r-ij{ali -== -ir= i---.ili>- z,i-: --:i; :ixEir'oirstoring lgss than 92 acr+fggt

,1Fulllg,Lllrlr rrJr q r Lr arrtL LU

Stcre Water

uf* Uetimihdto:--Ie0*Use a separ-ate fCIrr'n fer eaclr reserroir

Please type orprint In darft ink, lf your applicarion is fcunC,s be incomple€ +r inaccui-ate, i',,c.;rill return 11

to you. lf any requestedinformatian &es riatagl:ty.;heri 'nie-

'i. A Ltstll* ;j.-{'. lNffi RMATION

Landowner: Gqr.l h\rrr-,;r-,u*.-|==,{ -

IIECEIVED:!nt, 4 n ,thfiiru;trY c I 4UU4

d+ iEtr .jttl]{JncEs DEF.T:ir:r{, Anfgflnt - "

Authorizing Agenf:

I BlMailing Addr-ess: , -t ,.. , _

,,\\f\ f,-] LJ

Fi-n^^., -l -i i

I lunrg

s_l./ t I - ,, +, /\i-!/-r\-iA lt I I i j _s;"q-?cfnt -5*LGaLrTA?

VYUTla

"E-MailAddress:-OptrbnaI In{armetion

A. Reservoir Name;

B. Source: Provide the name of tlre -',yitcil'b-cdg cr t&el :ci;;te f;"am '*vhi;l: ',vaia;- -r;lll La ilavait*i-l,and fhe name olthe stream or lake i; f!+-*.,= i,-,i,:- i;'l,ji,:-.,i= if .icLr'=;i i:, r:r- -,fi 5trsoF.;:, r=i ni-r

unnamed $€am or spring. i ---'--{-' '' '"

, o r r...QrsE *A Qlr,o.\- 4 T :i L :, = 1,,". C SPgl&q k f ReeK

* Fax:

{;) sI UVrrl5llrp gr* ur

D- County of r rlt

(:.!- | ( C-lr

r. *a*i: i';iaximu* heighl or *=*, ? t, !.]i- Ieer- lr eHC€laled, *r* lo*r*' o, { *.*.F. Quantity: : I ,,, ii-re ieSAru0ir Ai r-i-rA*imufir rEuai-.ii-* - Liii rrr r.ii iiii v irr

Acr+Feeu

irrdEte *e prupased -.rset5) af hestored Water, NOJE_Y1u may wish to consider fifing for,Multipurpose

&tnltipnrpm covers =!1.',:;,-

*si-tdi.p ".-=;k"=,;i;;, fi:h ;;* u.:lrfi;f., a*iiieii.s, ,i..-=*r. !;rig;-;i

agriculturer$reprcf. -:1. -.-.' , " ts.r 4Li lL6qrutHf U,

:-,iB:]lSXEiHNEB,iLltL

s- ENVTRONMFT'+TA! tMFAfT

A. Clhnnel: ls tlre reseF,,ci:'in strEar,-, X nr aff ch;n*e! ?

B. Wetland: ls the projeci ir-r a weiiaii,]fE +I-.J;;u - fr','filiTs jr ." -.. . --"':ting rsservciri V res u ttto rf yes. ncw tong hal il been in

-t---! IIrialEr ___t2___ years.D. rish Habitat ls there r'i;h l,-'-..:*= *-i-.,.--. , .,:.:,* ;,..p.-.,--: -., -.-.-,-, yes ?{i*otr Don't know. [f yes. how murh? nn!l=:- r

i rt r .-r: 1- - , i";"'t:"'rr -n: "''l -11.-. -;l:.-r!esi DY€s Hruolr,r{1arr*aga*I, t*$*;;*h.;; -,,,*,'hj,=ur.*f ,h,-<r.;-'.lt'-.-4- AIsoindicai"rnyigenciesrhatarecost sharin5 ift thii F;'r.i=:l-

&s!fi-ilAalr,B!

il;= ier ls S ll; F i,1$E:l-*ct -:-::r.:pl= " r.3 *l *r-J.l*; : 'l ;l-:,:i5"Ifi, :0-O AF-$1O0

I-If*r-': :t !.f1trtrtrlVtrUilNV ? ? ?RR?

L I Pi*-

'#*itastl$r.08E60[t--

It

I

NlaXifnuut i'e,e t$ $ i*q-, 'rur' .:i,-; .'::-!=+ir' :i-'"'iz;=a ;-:;),'-':]=:----. i X --'";'- l.-:lI

ff-*f ?r- iSiefrdt

Pase Ln

E-2-

I sr,vear hat al].staternci1ts tneCc arid ii":forp:-ti-;, ,,-,; ;i-l-i l;. 'j;!; *ppi;'-.-;i;=- a;; i,-';e anii cuirai bfheJaaqr af mrr L^^r..t^-.1,.i, , I

%

5:'grpr:pahxfJ'!er;:n:r E"riir!:ii,^-l =:::v-z ?-=il::=z: F-evired IO ?0Ol 'wgd

,e,ffP.*F

l(trr rbbL. \}[h-Q/ lvrr'--

$"- +cEgtr= ffi ,f ;. it cF*tr =

*E="1;'*ir

N0v ? 7 u$Bi

'"L*T#gugP=o'

Prarr af fl*ana

']i :l:':' ?-*!-* ?rtr OtPartrnent::: :-* i:.,:-- lgSalemOR *t;:;i-+;T:(503)37&&*s5t* w\fl-lirr{i-SIE.dl.Us

Applieant:c t

Cffie11^toral<tr<

fu;lication for a Permit to

..'I=rir 11.i: .,. :.:iy: lz i:*fui ii':--: -;:.'-'ii::'.j.i:: i: !:::,.:] l'- l:!-*mplgteorlnsccurdt4ll

it wiII be returned-

RTCEIVED HECEtvrnDEI I I leije

"-=;:#_t;i#,fE:l

I

*Eax:

,ns= QTr tLi:Ea:i '1 -"'a - -ziP---1-15-r"i-

*E*Mtil a$d:;.::

* o ptia n aI info r tnatio n

I(We) make apqilicd+a ,s,. ri iiirlT:t t1', +-*tr-'f ,i :-s€*,'il -.r:i *-: *: '-.1'll'*.=.L= j..==*a: j ,--Iri 'iftheStiltcof$r5 . -'--'-:''- -:-.----i-i: I-:'-i.'j

ar(*)::i"3,

- tt rs Prs.eyl*r"ln

Is the proposedusg an enlargm'cai- Af ;- o:,r:S:i;,g Ja:**="r--"+l? :'43---iii+---

r r I I lE a t:hBt Yaltl L5 I.LU! D Vflll.& vi u sr;q

,r 1.=--."oxol - Rt*"nk"4€ )J'

Paee 1 of 3 r,niui, 4r*ge L_;f3_

'ir,r,/.,i-./2. DAIII IIEIGtrI AND COMFCSH{.}}{ ;

#' Tha maxirnusr height of the strrretm ":o!u'1=-j-1-*'-/' o==*r==iis.e cfthe crest ofthe dain.

ft*t eb*vc stre-mr be-t1 or ffotud sr:r$-ee at6e

Note: Ifyour da*; .';irJ:: -l:;;.-;:-- :I:-;; ;;' '-;,..;,' ,";- *'.X.-1' .:.1--:-;-' ,L -;..j ';*l*.-.;,11'T F*:"-:"i;*-:-j;;';' ...3

StOfe eqUAl fC Ol. gi.o-'.rro* rI--.-. a " .---=-l**i *.;--"--. .r -!.*.- o-.) *.ri$.-!ii::z.r ,,t::lt *l ,ff:;-:'i-1d ,-----r-:-

to storage ofwater.

The dam witl be (chetk One) Eart}fill-X* {:.:1::r:-i-- Ei,',,-,ii l,''',',1 *--.- f,&t" -

il "--ilsr" gi.rc description:

{ t'

couc,refo<.ricoseA P,'o** ;i,#- Co!!=.r_: a.;;i; € t," i3 *.;-r, ;?-;..1

t

.'-'.'l':':: l.-i.=..,'.,..,-:-.irj*{ +;;i,:*;-;i;'ir;atttht;:ixeiwliint:*i^ttrzoitilgicanduithavingaminimum-t-7ara- ^{E i*thzt ny o-rantpf

'J r 6r'r'--

m.rtElrff.su rt .f*l

lor - , tl,rtrl< \d CoN crect e.r ttt I 1__.- ni:ffifia,ir a'= TiF c-''i:ili,=_., aieE-Fi-

'i;r:r;'

fr TEI A]lf{}ltryT OP aiI='L=3:=';=:::;';f :.:;

: .-.s ;. -, - :--:- -- ----i -. -::- -----.--- --.iFn i;;=n

acrc-ftetacres.

n

IiECEIVTDNov 2 7 ZUSI

?age2of 3 rr\iF Exhbit .4r"p 4 "rT-

7 rrcs X ,-NA --If .bf,r,. piea== ii=i ,,.,^- . , ,, ,,11,.= *-.: *.-. .*. . . : ':,* :-r-: * . . .--.; ,f all iri.p*ties involved in the propoSed

developmeut

;-;;; ,'=;tii*;i*i -.rtr*-ifs/ if necassary

g, Ifyou answere* Tl:-"' .- ;.--*:..*,- i* ;1;-:;, :.:-;;;L*-."-;=I:; -:.=r;i;:::il,: i:-:: ^T 3:l1=rfleliI

permiuirrg acces= t; il; I;;* i-c;;l; ;c:;';;;? 't'E3-1":C-.-

VED11". SIGI{ATTTRE

-1-=. : ;:-,: - i.. .;:-i-;- l-';.1; :*' I ;---i:iiTlifE ihai- t lEU. tq' i[nni-..J; i; niii.@- ---rii ^ -;*-*

Applieant

1".-

:i ,,ir-{ firn?- . ':!...

.-. !: : '

r r!.r-r:ut9

?fis2

i

.-;;iicarioa pac.lmt-. --it to rsB

k

IlEf 't- tl,iJi :i l-'+-*:'+t E :_L-

HCIY 2 7 t[02':- I r ia,! rEnFF hFF*Wfittrn fir*! *,.-*

SAIE::"- -:::ii;:,.

t]aI