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eF I SAN JOAQUIN COUNTY G ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3'a Floor Stockton•CA 95202-2708 E (209)4b8-3420•'iax:(209)464-0138 • Web:www.co.san-Joaquin;ca.us/ehd P. SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST - i SITE LOCATION: 9 O PA IM REPORT DATE: I j— ` S — Sufficient �p I = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 . S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ ❑ 1.1 Description of site,inclu�ding zoning information. �_ 3 -4-c-Xe —7 �" f � ❑ 1.2 Description of proposed development. ❑ ❑ 1.3 Parcel vicinity location map. ,i ❑ ❑ 1.4 Site map showing location of all items on parcels(i.e.,structures,drives,wells,septic systems, large trees, pastures, pools, natural drainage courses,ponds,waterways, etc_) 1 2.0 PRESENT AND PAST USES OF THE SITE SECTION 2.1 Discussion of past and present uses at the site to assess potential problems. I 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ❑ 3.1 Description of existing Ion-site septic tank usage(system types,age,functidninglrepair rates). ❑ 3.2 Site septic permit histolry(numberltypesldates of permits,age of system,permit numbers,copies in report). ❑ 3.3 Discussion of on-site septic tank repair history. ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioninglrepair rates, proximity to parcel). Ip. © ❑ 3.5 General area septic permit history(number/types/dates of,permits,age of system, permit numbers,copies in report). �3 R 5 e^ V_' mt(r LTJ ❑ 3.6 Discussion of general area septic tank repair history. ❑ 3.7 Description of proposeld or expected maximum(including second unit dwellings)septic tank usage on site. 4.0 GROUNDWATER;INFORMATION SECTION ❑ ❑ 4.1 Description of the deptlh and gradient of groundwater in the general area. 12, ` ! 4.2 Description/discussionl�of any existing and/or potential groundwater contaimination issues in the general location ❑ of the site. ❑ 4.3 Description of location'(address/APN),type and construction of well and location(well head/kitchen tap)where water sample(s)were obtained. It ❑ 4-4 Description of constituents being tested for in the water sample. 4.5 Description of how samil pie was obtained, handled,stored,and transported to the lab. El4.6 Complete Chain of Custody document,including printed and signed name of third party sampler,condition of sample and date and time the sample was submitted to the lab. For Laboratory samplors,complete laboratory report to include the above noted information. I 5.0 SOIL PROFILE INFORMATION SECTION ❑ F75.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. ❑ ❑ I 5.2 Description of soll profile pit including depth and dimensions. ❑ ❑ 5.3 Description of soil lithFogy as noted from test pit by appropriate professional using industry standard protocol, 7`� ❑ 5.4 Discussion of sail lithology as related to future onsite septic uses, EHD 26-02-003 I� Pagel of 3 7114/2003 p I