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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton • CA 95202-3029 <br /> c . <br /> (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> C,F ORN/ <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: s �t / PA#: 1-.t. <br /> 0 o S y <br /> 6 5 3 otry /791 3a� l ��Y REPORT DATE: iI t 6 1 3 <br /> S = SuffiInsufficent <br /> ient <br /> I = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> M ❑ 1.1 Description ot site, including zoning information. <br /> ® ❑ 1.2 DescriAn of proposed development. <br /> 1 <br /> ❑ 1.3 Parcel��cinitylocation <br /> �map. <br /> ❑ 1.4 Site map showi�glol cation of all items on parcels (i.e., structures, drives,wells, septic systems, large trees, <br /> pastures, pools, natural drainage courses, ponds, waterways, etc.) <br /> A1f�.1•r <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> ® ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> 3.0 EXISTI G AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ® ❑ 3.1 Description of exiting on-site septic tank usage(system types, age, functioning/repair rates). <br /> tr <br /> ❑ 3.2 Site septic permitZ history (number/types/dates of permits, age of system, permit numbers, copies in report). <br /> a � <br /> ® ❑ 3.3 Discussion of(on-site septic tank repair history. <br /> t <br /> ❑ 3.4 Description of eisting 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). Ilb y <br /> [.d ❑ 3.6 Discussion of general area septic tank repair history. <br /> L <br /> ® ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br /> CS3 <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ 4.1 Description o�the depth and gradient of groundwater in the general area. <br /> 4 F-14.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. R 3 <br /> 0 ❑ 4.3 Description of location (address/APN), type and construction of well and location (well head/kitchen tap)where <br /> water sample(s)were obtained 'S ,..( <br /> [� ❑ 4.4 Description of constituents being tested for in the water sample. <br /> ® F-14.5 Description of hdwvsa nple was obtained, handled, stored, and transported to the lab. <br /> ® ❑ 4.6 Complete Chain of dt:istody 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. A cl<-- <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> © ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. <br /> �] ❑ 5.2 Description df soil profile pit including depth and dimensions. <br /> C 5 <br /> ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> S <br /> ® ❑ 5.4 Discussion ofIsoilglith66logy as related to future onsite septic uses. <br /> EI-m26-02-003 �b , )1 Pagel of3 Soil Suitability Checklist <br />