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OPQ�IN�� <br /> i 7 � SAN JOAQUIN COUNTY <br /> r x ENVIRONMENTAL HEALTH DEPART <br /> r <br /> y .a <br /> i' 304 E Weber Avenue 3`d Floor Stockton •DEPARTMENT <br /> :. (209)468-3420 ■Fax.-(209)464-0138 . CA 95202-2708 <br /> We6: <br /> www.co.san joaquin.ca.uslehd - <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> ' <br /> SITE LOCATION: ] / �7 <br /> S = Sufficient REPORT DATE: <br /> I = Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9.1103,2 <br /> i SI r � <br /> 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> � t , <br /> ® ❑ 1.1 Description of site, including zoning informatio <br /> k ❑ 1.2 Description of proposed development U <br /> ❑ 1.3 Parcel vicinity location map.� � <br /> ❑ 1.4 Site map showing location of�l+items on parcels (i.e.,'stractures, drives,wells, septic systems, large trees, <br /> Pastures, pools, natural drainage courses, ponds, waterways, etc.) } � <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br />� TION <br /> f ❑ 2.1 Discussion of past and present uses at the Site to assess potential <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE Problem SECTION N 3� <br /> SECTION I <br /> ❑ 3.1 Descript�n3�exiting on-site septic tank usage(system types, age, function in <br /> � �rr E <br /> ❑ 3.2 Site septic permit histo g/repair rates). <br /> history(number/types/dates Of permits, age of system, permit numbers, copies in report). <br /> EE ❑ 3.3 Discus`sio of <br /> © p o -1 -site septic tank repair history. <br /> ❑ 3.4 Descri ti f existing septic tank usage in the general area (system types, ages, <br /> CF,--/) g functioning/repair rates, <br /> Proximity to parcel).C <br /> ❑ 3.5 General area septic permit(s) histo <br /> report). �r ry(number/types/dates of permits, age of system, permit numbers, copies in <br /> l� . <br /> ❑ 3.6 Discu ion of eneeral area septic tank repair history. <br /> y� <br /> ❑ 3.7 Des p n ofproposed or expected maximum <br /> y� ximum (including second unit dwellings)septic tank usage on site. k <br /> 4.0 GR"U�jD1 ATER INFORMATION SECTION <br /> 1 <br /> 4.1 Description of the depth and gradient of groundwater in the general areEl . <br /> 4.2 Description/discuss, of any existing and/or potential groundwater co Q k <br /> Ej of the site � 67 ntamination issues in the general location <br /> 4.3 Descriptio f loca_tio'n (address/AP <br /> water sample(s)were obtained type and construction of well and location (well head/kitchen tap)where <br /> 6 <br /> ❑ 4.4 Description of constituents beimtested for in the water sampiI <br /> 4.5 Description of how sample was obtained, handled, store (fr— o <br /> .1 <br /> d, and transported to the la �-,Z� <br /> ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, condition of <br /> sample and date and time the sample was submtted to the lab. For Laboratory samplers, complete laboratory <br /> report to include the above noted informatio i <br /> AjXA <br /> 5.0 SOIL PROFILE INFORMATION SECT O ) <br /> Q ❑® 5.1 Site a wing the location,ocation with <br /> dimensions, of the soil profile pit on the parcel.❑ 5.2 DesFit <br /> ' tip f soil profile pit including depth and dim <br /> ® ensions. <br /> 5.3 Deslona f soil lithology as noted from test pit by appropriate rof xx )) �� p essional using industry standard protocol. <br /> ❑' 5,4 DiscCoon of foil lithology as related to future onsite septic uses. <br /> EHD 26-02-003 Pagel of3 <br /> Soil Suitability Checklist <br />