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SAN JOAQUIN COUNTY '? ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton• CA 95202-3029 (209)468-3420 -Fisc: (209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST PAM $ITE LOCATION: �7 -5 , f P-! J 3l- 7 -5 , REPORT DATE: S = Sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 1 = Insufficient S I 1,0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION E [Z ❑ 1.1 Description)site,including zoning information. ® ❑ 1.2 Description of proposed development. [� ❑ 1.3 Parcel vicinity location map. K][ E] 1.4 Site map shoe ig location of all items on parcels(i.e.,structures, drives,wells, septic systems, large trees, pastures, pools, natural drainage courses,ponds,waterways, etc.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION �j ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION Ef ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). 4 ❑ 3.2 Site septic permit ist�umberttypes/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 existing septic tank usage in the general area(system types,ages,functioning/repair rates, proximity to parcel). ® ❑ 3.5 General area septic permit(s)history(number/types/dates of permits, age of system, permit numbers,copies in report). © ❑ 3.6 Discussion of general area septic tank repair history. 0 ❑ 3.7 Description of proposed or exp xia mum(including second unit dwellings)septic tank usage on site. "3 4.Q GROUNDWATER INFORMATION SECTION ❑ 4.1 Description of the depth and gradient of groundwater in the general area: [ ❑ 4.2 Description/disccuussion of any existing and/or potential groundwater contamination issues in the general location of the site. 3 ✓[� ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where _ water sample(s)were obtained. -_-� `f ❑ .4 Description of constit s bein ested for in the water sample. [� ❑ 4.5 Description of how L m ple was obtained, handled,stored, and transported to theab. ❑ ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler,condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION 9- ❑ 5.1 Site map shwithe location,with dimensions,of the soil profile pit on the parcel. ❑ 5.2 Description:fsoli �ofilepit depth and dimensions. ® ❑ 5.3 Description f oil lithology as noted from test pit by appropriate professional using industry standard protocol. 5 ®_ ❑ 5.4 Discussion 6 f/sol I lithology as related to future onsite septic uses. EHD 26-02-003 Pagel of 3 Soil Suitability Checklist