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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Avenue 3`a Floor Stockton • CA 95202-2708 <br /> (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: PA <br /> REPORT DATE: gZXa �166 <br /> 1 <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 /> O <br /> [ ' ❑ 1.1 Description of site, including zoning information. <br /> s <br /> ,� ��' ❑ 1.2 Descri�(ion of proposed development. <br />` ❑ ❑ 1.3 Parcel vicinity location map. <br /> ❑ 1.4 Site map showing location of all iters on parcels (i.e., structures,drives,wells, septic systems, large trees, <br /> r pastures, pools, natural drainage courses, ponds,waterways, etc.) <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> d� ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> i 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> �3 ❑ 3.1 Description of exitindlon-site septic tank usage (system types, age, functioning/repair rates). <br /> l <br /> ��/ ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers,copies in report). <br /> /y3[` ❑ 3.3 Discussion of on-site septic tank repair history. <br /> y LJ, ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> y proximity to parcel). <br /> 1 ❑ 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 /> i <br /> / �, ❑ 4,1 Description of the depth and gradient of groundwater in the general area. <br /> ❑�� ❑ 4.2 Descriptionldiscussion 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. <br /> 0 ❑ 4.4 Description of constituents 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 /> .�7 [r-' ❑ 5.1 Site map showing the location,with dimensions,of the soil profile it on the parcel. <br /> J P <br /> �] ❑ 5.2 Description of soil profile pit including depth and dimensions. <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 1 of 3 Soil Suitability Checklist <br />