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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3`d Floor Stockton • CA 95202-2708 =. sµ (209)468-3420 • Fax:(209)464-0138 - Web:www.cosan joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST //�� !f PA 4. OG —pDa 09 SITE LOCATION: 3 �3/3 - , /3/"'//4"` " /� �:: / REPORT DATE: B�.rZ9 i s = Sufficient San Joaquin County Development Title Chapter 9-1105,section 9-1105.2 I = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION M -// ❑ 1.1 Description of site, including zoning information I}(IP-�-) [p� ❑ 1.2 Description of proposed development.(5r�) ❑ 1.3 Parcel vicinity location map. ck-A-a-) ® � ❑ 1.4 Site map showing 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 ( IS// ❑ 2.1 Discussion of past and present uses at the site to assess potential problem �) 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ❑ ❑ 3.1 Description of exiting on-site septic tank usage (system types, age,functioning/repair rate';S'�? ❑ 3.2 Site septic permit history(numberltypesldates of permit"� 5f 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). rwP f �� ❑ 3.5 General area septic ermit(s) history (numberlrypesldates of permits, age of system, permit numbers, copies in report). Cu ❑ 3.6 .Discussion of general area septic tank repair histo r 3 L0 [ � ❑ 3.7 Description of proposed or expected maximum (including sec o d unidwellings) septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION �t] ❑ 4.1 Description of the depth and gradient of groundwater in the general are p 14 �J ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location of the site. L�`h k F [] 4.3 Description of location (address/APN , pe a d onstruction of well and location (well head/kitchen tap)where water sample(s)were obtained. 1•\-.— t) ©/ ❑ 4.4 Description of constituents being tested for in the water sample 4.5 Description of how sample was obtained, handled, stored, and transported to the la I( /' ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third parry 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. CrT S ) 4 5.0 SOIL PROFILE INFORMATION SECTION t 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parch i ❑ 5.2 Description of soil profile pit including depth and dimensio4ur -6J �.� ❑ P f ® / ❑ 5.3 Description of sail lithology as noted from test pit by appropriate prof�s�io�l q�sing industry standard protocol. E] 5.4 Discussion of soil lithology as related to future onsite septic uses/- EHt7 26^ Soil Suitability Checklist 42-443 Pagel of 3