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°O'"4. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockto>i -CA 95202-3029 <br /> (209)468-3420 -Fax:(209)464-0138 - Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: 3Avi, , / "te1Nt �� PAM 041 ( v <br /> T DATE: t] <br /> s = sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> s 1 Insufficient <br /> i� S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> j <br /> ❑ ❑ 1.1 Description of site,including zoning information. <br /> ❑ 1.2 Description of proposed development..'�j Z�C7.`( 6 sb <br /> ❑ 1.3 Parcel vicinity location map. <br /> ❑ 1.4 Site map showing location of all items on parcels(i.e., structures, 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�c� -f, � 0 41,'-yr Sc� <br /> 31 El 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> ] ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report). <br /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). <br /> ❑ 3.5 General area septic permit(s)history(number/types/dates of permits, age of system,permit numbers, copies in <br /> report). <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> ❑j, ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTI <br /> see_ <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the'+ga}1'il r <br /> ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. <br /> l ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where <br /> f water sample(s)were obtained. <br /> ® ❑ 4.4 Description of constituents being tested for in the water sample. <br /> ❑ 4.5 Description of how sample was obtained, handled,stored, and transported to the lab. <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 submitted to the lab. For Laboratory samplers,complete laboratory <br /> report to include the above noted information. <br /> ?WS.0 SOIL PROFILE INFORMATION SECTION <br /> Eg_ ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. l/ <br /> k,r (1A_Ak-- <br /> ® ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> ` �— l <br /> ® ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> I 2 <br /> El ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EUD 26-02-003 Pagel of 3 Soil Suitability Checklist <br />