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ultv <br /> ?��Pp c��i. SANsd0A0UIN a <br /> Environmental Health Department <br /> " 71 � COUNTY <br /> cw4 P Greatness grows here. <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: Dec <br /> Test Performed by' Permit#: S 0 0-Mj PAM <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 area proposed for future septic <br /> systems. <br /> Notes any changes in elevation on the subject property. <br /> Notes all water wells. f/v2 S � <br /> Notes all man-made features(septic sstems, drives, bams,outbuildings, animal pens,etc. t s <br /> Notes all natural features(ephemeral drainage courses, large stands of trees, ponds, rivers, etc.)Welo� �n Ge�rA a f <br /> PERC TEST PREPARATION PROTOCOL <br /> Date and time of test hole preparation. <br /> Diameter and depth of test hole 4"-12"diameter and 36"42"depth). 11 •3 S <br /> Dimensions and depth of deep test hole 4"-12"diameter and 42"-25'or minimum 10' above seasonal high water table . <br /> Test hole preparation(scoring of sidewalls, removal of loose material). <br /> Weather conditions at time of testing (raining,windy, etc. "SU vrvl <br /> Soil type and condition encountered in test hole. <br /> Addition of 2"of course sand or fine gravel to test 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 /> orrect amount of water used to refill hole 6"over gravel), Documented on the recor tion sheet. <br /> Descri tion of a of erc test rocedure used based on conditions Procedure#1, 2 or#3 . <br /> t/ 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 /> V Be inning and end measurements of the last reading verified by REHS.All above reviewed and verified by REHS. <br /> SOIL PROFILE <br /> Description of the date,time, and protocol used to prepare soil profile pit. <br /> Description of soil profile pit including depth and dimensions. <br /> Soil lith logy described by appropriate professional using industry standard protocol. <br /> COMMENTS S �I %1A �" `---L1 1 <br /> ��rC plo-GOn �o UL w�vi inl�j . ! —15 f—I <br /> ice <br /> -72°� x <br /> X <br /> REHS Name: w/k A 6 41 a- <br /> Calculations Examples: <br /> Last drop reading=.07'over 30 minutes time. Last drop reading=1.2'over 10 minutes time. <br /> .07'x 12"=.84"(convert from feet to inches) 1.2'x 12"=14.4"(convert from feet to inches) — <br /> 30 minutes_.84"=35.7 minutes/inch 10 minutes-14.4"=.69 minutes/inch <br /> EH 4200-roc 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 />