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u I"c SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2 600 East Main Street, Stockton - CA 95202-3029 <br /> (209)468-3420 • Fax:(209)464-0138 • Web: www.co.san-joaquin.ca.us/chd <br /> •9)'i_F_oRiN� <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: 1 PA#: <br /> �� Lt7 t'C--, REPORT DATE: <br /> I = suffiInsu ici San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> I = Insufticien[ <br /> S I 1.0 INTRODUCTION B PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information. <br /> I <br /> ® ❑ 1.2 Description of proposed development. <br /> l <br /> ® ❑ 1.3 Parcel vicinity location map. /A. P <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.) <br /> A iA <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. <br /> 15- <br /> 3.0 <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). <br /> A i <br /> F-13.2 Site septic p4rmit history(number/types/dates of permits,age of system, permit numbers,copies in report). <br /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> 2- <br /> ❑ 3.4 Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, <br /> proximity to parcel). Z <br /> ❑ 3.5 General area septp permit(s)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 /> Z <br /> ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br /> 4.0 GROUNDWAT49INFORMATION SECTION <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> �f ❑ 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. <br /> 3 <br /> ® ❑ 4.4 Description of constituents being tested for in the water sample. <br /> J <br /> ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br /> ❑ ❑ 4.6 Complete Chairrof 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 /> apf <br /> ® ❑ 5.2 Description bf soil profile pit including depth and dimensions. <br /> ❑ 5.3 Descripfion 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 /> E D 26-02-003 3 1 I Page I of 3 Soil Suitability Checklist <br />