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SAN JOAQUIN COUNTY <br /> ` ENV ONMENTAL HEALTH DEPARTML. 4T <br /> 304 E Weber Avenue 3rd Floor Stockton - CA 95202-2708 <br /> (209)468-3420 •Fax: (209)464-0138 • We6:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> � PAM )PA- 7'-�v� <br /> SITE LOCATION: "-2,1 /f rj 7 � REPORT DATE: 3 r6 <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 /> �❑ 1.1 Description of site, including zoning informatioy+;� � ( 1 <br /> ❑ 1.2 Description of proposed development. ~— <br /> ❑ 1.3 Parcel vicinity location map. `/Tz) <br /> ❑ 1.4 Site map showing location of all items on parcels (Le., 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. 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,functioning/repair rates).0> <br /> Site septic permit histo number) es/dates of permits, age of system, permit numbers, copies in reppo _ 2 <br /> ❑ 3.2 Ste p p history( tYP <br /> 3.3 Discussion of on-site septic tank repair history. (f, 3 <br /> [� ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, <br /> proximity to parcel). r� <br /> [� ❑ 3.5 General area septic per it(s) hitory(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). 1116 3� <br />} [� ❑ 3.6 Discussion of general area septic tank repair history,/ 3'�y <br /> ❑ 3.7 Description of proposed or expected maximum (including secon'qunit 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 ' <br /> F-14.2 Description/discussion tion/discussion of any existing and/or potential groundwater conn ination issues in the general location <br /> of the site. p6 52 <br /> F] 4.3 Description of location (address/APN),ty�e and construction o ell and location (well head/kitchen tap)where <br /> water sample(s)were obtained. _7 <br /> 0� ❑ 4.4 Description of constituents being tested for in the water sample,�r� <br /> ❑ 4.5 Description of how sample was obtained, handled, stored, and Iransported to the lab. _AIA <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. i✓j�j <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> ❑ 5.1 Site map showing the location,with dimensio s, of soil profile pit on the parc 'S� �3J N <br /> ❑ 5.2 Description of soil profile pit including depth and dimension 6� <br /> [-� ❑ 5.3 Description of soil lithology as noted from test pit by appropriate profess' al using industry standard protocol. <br /> [� F15.4 Discussion of soil li ology as related to future onsite septic uses. l7. <br /> �L—f tr <br /> EHD?b^02-003 Page I of 3 Soil Suitability Checklist <br />