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•R l� j�' ` f ' SAN JOAQUIN COUNTY <br /> r ` ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Avenue 3'd Floor Stockton- CA 95202-2708 <br /> (209}468-3420•Fax:(209)464-013$• web:www.co.san-joaquimca.us/chd <br /> SOIL SUITABILITY STUDY REQUIREME S CHECKLIST <br /> SITE LOCATION: 70 PA <br /> REPORT DATE: <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105,section 9-1105.2 <br /> i <br /> I = insufficient <br /> h S �I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> r ❑ 1.1 Description of site,including zoning information. <br /> sr � 1 <br /> 1.2 Description of proposed development. >� ,5/ <br /> ��/ ❑ 1.3 Parcel vicinity location map. <br /> I J{ ❑ 1.4 Site map showing location of all items on parcels(i.e.,structures,drives,wells,septic systems, large trees, <br /> f 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. <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ( [J' El 3.1 Description of existing on-site septic tank s usage stem <br /> g ( y types,age,functioning/repair rates). <br /> ❑ ❑ 3.2 Site septic permit 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 /> ❑ ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, <br /> proximity to parcel). <br /> /E ❑ 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 /> r n ❑ 3.7 Description of proposed or expected maximum(including second unit 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. / S z1J C <br /> 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> of the site. <br /> ❑ 4.3 Description of location(addresslAPN),type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained. <br /> ❑ 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 /> t ❑ 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 samplo was submitted to the lab. For Laboratory samplors, comploto 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. <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 Paget of 3 <br /> t <br /> 7/14/2003 <br /> r <br />