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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3rd Floor Stockton• CA 95202-2708 c� }F% (209)468-3420•Fax:(209)464-0138• Web:www,co.san-joaquin.cams/chd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST ( t� 3 �'• A i P o!L7- c.0 A-- PA#: Q 4— 2 SITE LOCATION: F .� • I REPORT DATE: y �l = s fficienE�m I = InsusuffSan Joaquin County Chapter Development Title Ch9 Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION d ❑ 1.1 Description of site, including zoning information. ❑ 1.2 Description of proposed development. Q/ ❑ 1.3 Parcel vicinity location map. 0 ❑ 1.4 Site map showing location of all items on parcels(i.e.,structures,drives,wells,septic systems,large trees, pastures, pools,natural drainage.courses, ponds,waterways,etc.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION Q� ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION f ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioningtrepair rates). f E ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system,permit numbers,copies in report). k �! ❑ ►4`�wlvper3'n,.�c-v rSaF..�72c S r�'7'2�a'It rnV S r7`F ��o+k' �cd �o.�Src.F r,(6�.f.��/��r!i f` 3.3 Discussion of on-site septic tank repair history. i t ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, proximity to parcel). ❑✓�/ ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers,copies in report). ❑ 3.6 Discussion of general area septic tank repair history. �� ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic lank usage on site. 4 4.0 GROUNDWATER INFORMATION SECTION 4I 0�❑ 4.1 Description of the depth and gradient of groundwater in the general area. t © ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location of the site. ❑ ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where water sample(s)were obtained. F-1/ ❑ 4.4 Description of constituents being tested for in the water sample. AJ Af`6W 'QT DI ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. ❑ ❑ 4.6 Complete Chain of Custody document,including printed and.signed name of third party sampler,condition of sample and dale.and time the sample was submitted to the lab. For Laboratory samplers,complolo laboratory 1 report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION i F 0� ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. ❑✓ ❑ 5.2 Description of soil profile pit including depth and dimensions. ❑ 5.3 Description of soil litholo as noted from test It b appropriate rofessional using Indust standard protocol. ' P gY P� YP . g�industry ©' ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. EHD 26-02-003 Page 1 of 3 7/1412003 ' l f