NEFCO worked with the Stark County Health Department (SCHD) and the Stark County Metropolitan Sewer District (SCMSD) to produce an environmental priority ranking for extending sewers to eleven areas the Health Department had determined to have above average failure rates for home sewage treatment systems (HSTSs). These high failure rates are common in areas with dense housing stock, small lot sizes, and poor soils for a properly functioning HSTS. These areas are a concern due to the potential threat to public health and local water quality. The criteria included HSTS age weighted risks, housing density risks, soil suitability, surface water potential pollution, drinking water supply source, and E-coli qualifiers levels. Other qualifying indicators included percent E-coli, odor scores, estimated flow of sewage, and groundwater pollution potential. NEFCO suggested that the priority of extending sewers to these areas, based on environmental and health concerns, is in the following order (highest to lowest priority): Limaville, Harmon, States, Moreland, East Tuscarawas, Justus, East Greenville, North Lawrence, Nellabrook, Lynnette, and Uniontown.