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c�o SAWN JOAQUIN COUNTY <br /> G\ ENVIRONMENTAL HEALTH DEPARTMENT <br /> �i 600 East Main <br /> � _ �, = Street, Stockton• CA 95202-3029 <br /> (209)468-3420-Fax:(209)464-0138 - Web:vwvw.co.san-joaquin.ca.us/ehd <br /> r' <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATIOtV: V1, <br /> C�v� 1 PA#: D6 - o6A <br /> REPORT DATE: <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> I = Insufficient <br /> S I 1.0 INTRODUCTION $ PROPOSED DEVELOPMENT SECTION <br /> 53 ❑ 1.1 Description of site, including zoning information. 1 <br /> ❑ 1.2 Description of proposed development. <br /> C� ❑ 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.) Np-`�"�-J,� <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. Z <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ® ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioningtrepair rates).Gr-3 <br /> j ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report). <br /> 94 ❑ 3.3 Discussion of onsite septic tank repair history. <br /> to ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> Proxim' . <br /> �Y to parcel). 61 <br /> [ ❑ 3.5 General area septic permits)history(numberAypesldates of permits,age of system, permit numbers,copies in <br /> report). cf3 <br /> ® ❑ 3.6 Discussion of general area septic tank repair history. 3 <br /> EB ❑ 3.7 Description of proposed or expected maximum(includingjsecond unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. M 3 <br /> ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. <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. A <br /> ❑ 4.4 Description of wristituents being tested for in the water sample. <br /> ❑ 4.5 Description of how sample was obtained, handled,stored,and transported to the lab. <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. `r-5 <br /> 0— ❑ 5.3 Description of soil lithology as noted fir <br /> test,�sieseptic&es. <br /> priate professional using industry standard protocol. <br /> a ❑ 5.4 Discussion of soil lithology aEiret�tec�too future <br /> J <br /> t mm 26-02-003 age 1 of 3 Sail Suitability Checklist <br />