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€ SAN JOAQUIN COUNTY <br /> w ;?. ENVIRONMENTAL HEALTH DEPARTMENT <br /> I"• K 304 E Weber Avenue Std Floor Stockton-CA 95202-2708 <br /> z;'• (209)468-3420-Fax:(209)464-0138 - Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> it �3 `7 � � �Oi4-.� - PA#: <br /> SITE LOCATION: <br /> REpoRT DATE: a <br /> S = Suffic1cnt San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> I = Insufficient <br /> S I 1.0 INTRODUCTION S PROPOSED DEVELOPMENT SECTION <br /> El <br /> k �f <br /> � i1.1 Description of site,including zoning information. 3 � a� <br /> h ❑ <br /> i 1.2 Description of proposed development. <br /> 11 ❑ 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 /> ®! natural drainage courses, ponds,waterways, etc.) <br /> pastures,peels, 5 <br /> f !� <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> I <br /> I ❑ 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 existing 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 /> I ❑ 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 /> i proximity to parcel). <br /> �( ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers,copies in <br /> report). <br /> I <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> i <br /> ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> I� <br /> i 4.0 GROUNDWATER INFORMATION SECTION <br /> ` 4.1 Description of the depth and gradient of groundwater in the general area. <br /> 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> of the site.`l . <br /> El4.3 Description of location(addresslAPN),type and construction of well and location(well head/kitchen tap)where <br /> j 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 laky. <br /> 1`771 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. E� r7f <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> J! <br /> ❑ 5.1 Site map showing the location,with dimensions,of the soil profile piton the parce <br /> 7 ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> r END 26-02-003 Page 1 of 3 <br /> 7114/2003 <br />