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H ElC�LOMI�OCT 082021 <br /> 0 <br /> S>TEFI.AiNFORPROPOS 3RE�EPd'I,!3L DE O i�Af�iON (;®UBUILDNita Address: Ili 9 3 //1.:7((,"AAA) R. R.- • - <br /> NG INSPECT/ON <br /> taLwIoc000soso Totai Acres t%>+"'(A - <br /> vwT <br /> EI Drawn to Scale: la Not Drawn to Scale -OR- 1 share= feet <br /> 1100 .L <br /> lid i/5 <br /> ft i ( <br /> k ' •(�A Q1. - <br /> K <br /> • - 6o - 1.1l'y <br /> h/g -5 - - is- l - . - od - • w • Ott <br /> fig tk'eirtrwl • <br /> 700 '1 _,,�}. rD4i Oa?a2 6 , <br /> - • tt - lit,' %.*--.%- ..‘.• --- -4- .1 ,• - . El.etLvtai . - - - - - • <br /> � --;-%� kze 6i1�T -,,,, ex c Pai mit'ap <br /> :e. r, <br /> c ..�1!p 1_-�Z N. <br /> i <br /> - - - - - SIAT <br /> E CEkTIFIE® <br /> - - 2nvironmenfal health Specialist - <br /> - `.,7,. <br /> '^ EH-hS 102�•540 <br /> . . . 2 <br /> Il <br /> r <br /> � �. Robert Goodwin <br /> . . . . . . . - . . - - - -5-tah-a--. . . . <br /> Iearth',that- tit:ahoy;inforinutionLSsccuratetothe6cstaftnyimInvl2Igef10. al;.[ IOwn- ator _rat8artzedagent. - <br /> NAMEtpieaseptint) 77e 5 K.ji' lgelklya Te1eplbnner3' 73z-z'Of <br /> Applicant's Signature:. Date: <br /> Applicanntt's/qui 2Address: 31 WI- 4i is 6tha 7 /f <br /> an: 5 4v2i Zip: TPA/7 Applicant's mall <br /> Septic Site Plan <br /> S-31-5-202e GAFnmaESepiiei ORMSIS-3IaSepdcSystemSicel <br /> 555-21-010192-PRMT <br /> WISE, HEIDI L&WISE,MICHAEL D <br /> 3495 BERGMAN PL SE, SALEM <br /> 082W30 00500;2.65 acres <br />