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a1 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton •CA 95202-3029 <br /> �R. }mow, lP (209)468-3420.Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/chd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> $ITE LOCATION: , ���3 5, S}� <br /> REPORT DATE: <br /> Sufficient <br /> I Insufficient <br /> nsficie nt San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> C3 ❑ 1.1 Description of site,including zoning information. p5, .1 ) <br /> ® ❑ 1.2 Description of proposed development. 9 11 <br /> R ❑ 1.3 Parcel vicinity location ma , ,Q�) <br /> ❑ 1.4 Site map showing location o -all items on parcels(i.e.,structures, drives,wells, septic systems, large trees, <br /> pastures, pools, natural draina q courses, ponds, waterways, etc.) <br /> �ro 1 <br /> f 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. 'L s <br /> 3«0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ 3.1 Descriptio oof ex ti g on-site septic tank usage(system types,age,functioning/repair rates).~ <br /> �] ❑ 3.2 Site sep4�err Istory(number/types/dates of permits,age of system, permit numbers,copies in report). <br /> 0 ❑ 3.3 Discussio of on�si septic tank repair history. <br /> ML ❑ 3.4 Description exist) g septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to M <br /> arca . <br /> 3.5 General are t ermi s <br /> ❑ p' p t( )history(number/types/dates of permits, age of system,permit numbers,copies in <br /> report). C1 -1 <br /> } ❑ 3.6 Discussionj9f general area septic tank repair history. <br /> Y <br /> ❑ 3.7 Descrip' Qposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 ORO WATER INFORMATION SECTION <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. o) <br /> ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. y ((� 5) <br /> ❑— ❑ 4.3 Description ovation(address/APN),type and construction of well and location(well headikitchen tap)where <br /> water {am nlefis)were obtained. <br /> ❑ 4.4 Des ri tion of constituents being tested for in the water sample. <br /> �` P 9 P <br /> Q CSS) <br /> ❑ 4.5 Descriptio hrrm pie was obtained, handled,stored, and transported to the lab. <br /> ® ❑ 4.6 Complet"in 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 i ude the above noted information. <br /> 5.0 SOIL PALE INFORMATION SECTION <br /> E- ❑ 5.1 sitz n4apshowing the location,with dimensions,of the soil profile pit on the parcel. <br /> ❑ 5.2 Des�1c`rrlptioo of2)11 <br /> rofile pit including depth and dimensions: <br /> 5.3 Descripupn oofhology as noted from test pit by appropriate professional using industry standard protocol. <br /> �� ❑ 5.4 Discussi n of soil lithology as related to future onsite septic uses. <br /> EHA 26-02-003 �� Paget of 3 Soil Suitability Checklist <br />