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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave, Stockton - CA 95202-3029 <br /> (209)468-3420 • Fax:(209)464-0138- Web:www.co.san-joaquin.ca.us/ehd <br /> �`�/FORt�• � <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: l�% 1. �,r_�.j� PAM 16 Oo 1-76 Q'N S) <br /> REPORT DATE: <br /> = Sufficient <br /> I = Insufficient <br /> San Joaquin County Development Title Chapter 9-1105,Section 9.1105.2 <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> IR ❑ 1.1 Description of site, including zoning information. <br /> r <br /> W ❑ 1.2 Description of proposed development. <br /> y <br /> ® ❑ 1.3 Parcel vicinity location map. .4 /� <br /> ® F-11.4 Site map showing location of alritems on parcels (i.e., structures, drives,wells, septic systems, large trees, <br /> pastures, pools, natural drainage courses, ponds,waterways,etc.) <br /> .Aj-r <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> Q9 ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. , ,5 �r <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). <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. <br /> ® ❑ 3.4 Description of existing sepDank usage in the general area(system types, ages,functioning/repair rates, <br /> proximity to parcel). 5- <br /> 15 <br /> 3.5 General area septic permit(s)history(numberttypes/dates of permits,age of system, permit numbers, copies in <br /> ,}, report). <br /> u ❑ 3.6 Discussion of general area s�ptic tank repair history. <br /> ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> VIM <br /> tn.j ❑ 4.1 Description of the depth anLd gradient of groundwater in the general area. <br /> ® F-14.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. 9 <br /> © ❑ 4.3 Description of location (address/APP),type and construction of well and location (well head/kitchen tap)where <br /> water sample(s)were obtained. A <br /> 4 ❑ 4.4 Description of constituents ring Tested for in the water sample. <br /> © ❑ 4.5 Description of how sample was obtained, handled, stored,and transported to the lab. <br /> E] F] 4.6 Complete Chain of Custody docurhent, 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 /> 9 <br /> A] ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> ❑ 5.3 Description of soil liWology as noted from test pit by appropriate professional using industry standard protocol. <br /> 91 ❑ 5.4 Discussion of soil lit�ology as related to future onsite septic uses. <br /> Pm 1 of Z <br />