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i <br /> s _ <br /> r42r . <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL TAL HEALTH DEPARTMENT <br /> 304 E Weber Avenue 3`4 Floor Stockton• CA 95202-2708 . <br /> 209 4 <br /> ( } 6$-3420•Fax: 209 <br /> 464- <br /> \ ( ) 013$ Web:� www -couin:J Q ca.us/ehd <br /> _._ SOIL SUITA131LITY STUDY.REQUIREMENTS CHECKLIST <br /> i <br /> SITE LOCATION: eZvJa, PA <br /> REPORT DATE: <br /> = sufficient <br /> I = Insuficicnt San Joaquin County Developrnent Title Chapter 9-15,section 9-1105.2 <br /> Al 1.1 <br /> I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> I Al ❑ 1.1 Description of site,including zoning information. <br /> ® <br /> ❑ � �' <br /> 1.2 Description of proposed development. <br /> r,� L <br /> ❑ 1.3 Parcel vicinity location map. ,'.q�rX <br /> ❑ 1.4 Site map showing location of all items on parcels(i.e.,structures,drives,wells,septic systems,large trees, <br /> natural d <br /> pastures,pools, drainage courses,ponds,waterways,etc.) <br /> . �pkat i.+c , <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 /> ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioning/repair rates). f Y' <br /> ® ❑ 3.2 Site septic permit history(numberltypes/dates of permits,age of system, permit numbers,copies:in report). <br /> 0 ❑ 3.3 Discussion of on-site septic tank repair history. / <br /> lil F-1r� <br /> 3.4 Description of existing septic tank usage in the general area(system types,ages,functioninglrepairrales, <br /> proximity to parcel). p� j <br /> ® ❑ 3.5 General area septic/permit history(numberltypesldates of permits,age of system, permit numbers,copies in <br /> report). r� +�� �5 / <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 /> 4.4 GROUNDWATER INFORMATION SECTION <br /> ® ❑ <br /> 4.1 Description of the depth and gradient of groundwater in the general area 1,29 2— <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 lap)where <br /> water sample(s)were obtained. <br /> 5�1' ❑ a. <br /> 4.4 Description of constituents being tested for in the water sample. D g G A7 4f., N,,hra-Ea <br /> Lai <br /> ❑ <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 laborato <br /> report to include the above noted information. Ityp"'aL ry <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> ❑ 5.1 Site map showing the location,with dimensions,of the soil profile piton the parcel_ p�,t.�yL►w 1 <br /> L-CO ❑ 5.2 Description of soil profile pit including depth and dimensions. ' d <br /> 5.3 Description Of soil lithology as noted from test pit by appropriate professional using industry standard protocol. 3 <br /> LMAJ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD 202-003 Pv <br /> 7/14/2003 Pagel of 3 <br /> �t <br />