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_ 1 ,aa�,tN co SAN JOAQUIN COUNTY ENV LAONMENTAL HEALTH DEPARTME-NT { 304 E Weber Avenue 3`d Floor Stockton - CA 95202-2708 (209)468-3420 - Fax:(209)464-0138 - Web:www,co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: A, PA#: 4 5-19D SA •A REPORT DATE: S = Sufficient I = Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description of site, including zoning information ❑ 1.2 Description of proposed development. [/ F-11.3 Parcel vicinity location map. C P � � ❑ 1.4 Site map showing location of all items on parcels (i.e., structures, drives,wells, septic_systems r a iatrees, pastures, pools, natural drainage courses, ponds,waterways, etc.) 1' ? �z7 2.0 PRESENT AND PAST USES OF THE SITE SECTION ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies_in report). ❑ 3.3 Discussion of on-site septic tank repair history. [� [] 3.4 Description of existinu eptic tank usage in the general area (system types, ages,functioning/repair rates, proximity to parcel).( A�3� [� F-13.5 General area septic p�ermit(s) history(number/types/dates of permits, age of system, permit numbers, copies in report). 3�y� [d ❑ 3.6 Discussion of general area septic tank repair history. (mf) [� ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. ^� *y� �;L �tior�lt�e�dlla 5) Lei c ctS�wvwri�51 4.0 GROUNDWATER INFORMATION SECTIO N7 1'� ❑ 4.1 Description of the depth and gradient of groundwater in the general area. ❑ 4.2 Descriptionldis ussio5 of any existing and/or potential groundwater contariination issues in the general location of the site. kzk [-� ❑ 4.3 Description of location (addresslAPN),type and consI`uction of well and location (well head/kitchen tap)where water sample(s)were obtained.(?'c -t)) [.� G\ Q/ ❑ 4.4 Description of constituents being-tested for in the water sample. 6� NZI [� ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. lQ&&� ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third part sampler,condition of sample and date and time the sample was submit d to the lab. For Laboratory samplers, complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTI b) I/ ❑ 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. (-W�-)(�") Cr6 ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. 3 EHD 26-02-003 Pagel of 3 Soil Suitability Checklist