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SAN JOAQUIN COUNTY <br /> ;x E `; ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Avenue P Floor Stockton• CA 95202-2708 <br /> (209)468-3420•Fax:(209)464-0138• Web:www.co.sanjoaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> PAM p04— oy 300 <br /> SITE t_ocATfoN: 3�O (.tJ . �c�J�>� Qt) �.G . // <br /> -- -- — REPORT DATE: '313010 <br /> S = <br /> sufficient <br /> sufcic <br /> I tnsufficicnt <br /> San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> = <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ®/ ❑ 1.1 Description of site,including zoning information. <br /> ®� ❑ 1.2 Description of proposed development. <br /> f ❑ 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 /> k 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> I <br /> ❑� ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> F / ❑ 3.1 Description of existing on-site septic tank usage s m t nes,age,functioninglrepair rates). <br /> 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report). <br /> fr <br /> 3f'7t-°= j 2e�n�r x7�nrrs . o ,S*,ort.c �A ,R. ot-s dN or-/ate FOAL 4're A&tv &407,CS-P <br /> f ^+r s ❑ 3.3 Discussion of on-site septic tank repair history. onJ <br /> ��' ❑"w ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> G <br /> S er 7 proximity to parcel). <br /> l PW F-` ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers,copies in <br /> report). <br /> ❑ ❑ 3.6 Discussion of general area septic tank repair history. <br /> d ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ ❑ the <br /> 4.1 Description of th -depth and gradient of groundwater in the general area. <br /> ©r ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> ❑may❑ <br /> 4.3 of the site. <br /> Description of location(addreWAPN),type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained. rC ,� r N Q o 7✓<( a a^2S T�c ^/�J <br /> ❑ 4.4 Description of constituents being tested for in the water sample. A-6-- 13 2- 60�^ <br /> ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the tab. ? <br /> 0' ❑ 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 samplors,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 /> k �� ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> i <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. <br /> EHD 26-02-003 Page I of 3 _ <br /> 7134!2003 <br />