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p� SAN JOAQUIN <br />.. `� COUNTY <br />CSP, <br />gt�Fod Greatness grows here. <br />Environmental Health Department <br />PERCOLATION TEST/SOIL PROFILE INSPECTION CHECKLIST <br />SJC Ordinance Code, Title 9, Section 9-1105.2 <br />EHD Policy for Percolation Test Procedure 98-01 <br />Site Location: 2 C 1q -j& 1"1Cir1 kn a <br />Date: <br />B Iq 120 r! <br />Test Performed by: I TAttM 42A'Cn C VI Permit#: JSFOpj <br />PA#: <br />SITE MAP <br />Includes perc test and soil profile locations with accurate measurements from a fixed reference point (must be able to locate <br />the test hole areas in the future). Perc/soil profile holes must meet distance setbacks as noted in the sewage standards for <br />septic system locations. Percolation test holes and soil profile pits must be conducted in the are proposed for future septic <br />systems. <br />Notes any changes in elevation on the subject property. <br />Notes all water wells. <br />Notes all man-made features (septic sstems, drives, barns, outbuildings, animal pens, etc. <br />Notes all natural features (ephemeral drainage courses, large stands of trees, ponds, rivers, etc. <br />PERC TEST PREPARATION PROTOCOL <br />Date and time of test hole preparation. 8 11V i STahed 15 alm <br />Diameter and depth of test hole 4"-12" diameter and 36"-42" depth). M <br />WF <br />Dimensions and depth of deep test hole 4"-12" diameter and 42"-25' or minimum 10' above seasonal high water table). <br />N <br />Test hole preparation(scoring of sidewalls, removal of loose material). <br />Weather conditions at time of testing (raining, wind , etc. %OF <br />Soil type and condition encountered in test hol a� 120 5 <br />W' san w Gl <br />Addition of 2" of course sand or fine gravel to tesf hole. <br />Pre-soak by addition of minimum 12" of water over gravel 24 -hours before test). <br />PERC TEST CONDITIONS, MEASUREMENTS, AND REPORTING <br />Condition of test hole after the 24-hour re -soak amount of water remaining in the hole, any soil sloughing noted). <br />Correct amount of water used to refill hole 6" over gravel). Documented on the recordation sheet. <br />Description of type of perc test procedure used based on conditions Procedure #1, #2, or#3 . <br />Accurate recordings of drop and refill of water in same measurements. <br />Same fixed reference point used for each reading. Description of reference point used to be included in the final report. <br />Math calculations checked for accuracy. <br />Beginning and end measurements of the last reading verified by REHS. All above reviewed and verified by REHS. <br />SOIL PROFILE <br />N <br />Descri tion of the date, time, and protocol used to prepare soil profile pit. <br />140 <br />Description of soil profile pit including depth and dimensions. <br />(� <br />Soil lithology described by appropriate professional using industry standard protocol. <br />COMMENTS <br />i2:qgE5 readyn @ a•Q>-1-4 reA led G 2 (�qj}- 30 m in <br />IS read i @ 3.04 -ft, `7 5 m I h <br />waie ? drop 60 v,6- n <br />REHS Name: <br />Calculations Examples: <br />Last drop reading = .07' over 30 minutes time. <br />.07' x 12" = .84" (convert from feet to inches) <br />30 minutes _ .84" = 35.7 minutes/inch <br />Last drop reading = 1.2' over 10 minutes time. <br />1.2' x 12" = 14.4" (convert from feet to inches) <br />10 minutes = 14.4" = .69 minutes/inch <br />E H D 4200-xx 8-1-2018 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />