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Pp4 Iy••� SAN JOAQUIN COUNTY <br /> = 2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> G i <br /> 1868 E. Hazelton Ave, Stockton • CA 95202-3029 <br /> cP . (209)468-3420 • Fax:(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd <br /> qG l c o'RN� <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> FSITELOCATION: 7( G ,S 1 6/x"} R� PA#: 1 `G7-o 70—/5' <br /> REPORT DATE: Ip13 iil <br /> = Sufficient <br /> I Insufficient <br /> San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> = <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> 9 ❑ 1.1 Description of site, including zoning information. Pq l <br /> F11.2 Description of proposed development. P� 1 V <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 <br /> ® ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. P1 7- <br /> 3.0 <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). ��2 <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. PO2� Ate e«a x 4 U <br /> ® ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, <br /> proximity to parcel). P02 <br /> ®, ❑ 3.5 General area septic permit(s) history(number/types/dates of permits,age of system, permit numbers, copies in <br /> report). py Z <br /> ® ❑ 3.6 Discussion of general area septic tank repair history. eb 3 <br /> ® ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings)septic tank usage on site.Pe <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ® ❑ 4.1 Description of the depth and gradient of groundwater in the general area. Py 3 <br /> ® ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. 9131 Pg 4 <br /> ® ❑ 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. 95 y 1 A}PDe4l'AH <br /> �t ❑ 4.4 Description of constituents being tested for in the water sample.fj I <br /> .oaw, n.•tia4.rj <br /> 5d ❑ 4.5 Description of how sample was obtained, handled,stored, and transported to the lab. P5 4 <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 /> 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 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. is <br /> Pana 1 nf¢ <br />