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SANJOA UIN COUNTY <br /> c Q <br /> ' <br /> 1W.-ENVIRONMENTAL HEALTH DEPARTMENT <br /> r 304 E Weber Avenue 3`d Floor Stockton• CA 95202-2708 <br /> + (209)468-3420•Fax:(209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> SIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITELOCATION: 31-7)-1 <br /> PA <br /> REPORT DATE: <br /> S = Suffcicnt <br /> 1 = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> SI�-1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> i Description of site,including zoning information. <br /> ❑ 1.2 Description of proposed development. <br /> ❑ 1.3 Parcel vicinity location map. P� ""l <br /> � YLo � <br /> 4 Site map showing location of all items on parcels(i.e.,structures,drives,wells,septic systems, large trees, t <br /> pastures,pools, natural drainage courses,ponds,waterways,etc.) <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION O� h�` -7ell Jj � ! <br /> ❑ ❑ 2.1 Discussion of past and present uses at the site to assess �t p � <br /> potentia!probles6'" <br /> �ro <br /> 3.0 EXISTING AND <br /> PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ ( <br /> 7D3.1 Description of existing on-site septic tank usage(system types,age, functioning/repair rates). <br /> © ❑ 3.2 Site septic permit history(numberltypes/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 septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). <br /> 0 ❑ 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 /> ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER !INFORMATION SECTION <br /> �.� 1, <br /> 4.1 Description of the deo h and gradient of groundwater in the general area. <br /> ❑ .2 Description/discussion of any existing and/or <br /> of the site. potential groundwater contaiminati n issues in the general location <br /> ❑ 4,3 Description of locationddresslAP �) type and construction of well and location(well head/kitchen lap)where _ <br /> water sampleo <br /> s)were <br /> ® ❑ 4.4 Description of constituents being tested for in the water sample. 3 1 1 vs <br /> p S � ` <br /> 4.5 Description of how sample was obtained,handled,stared,and trans o ed 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 dale 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 "C' vt pj <br /> ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> FT <br /> ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> Erin 26-02.003 Page t of 3 <br /> 711412003 _ <br />