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o.P°�'"'•.c SAN JOAQUIN COUNTY <br /> z '? ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: <br /> j 304 E Weber Avenue 3`d Floor Stockton - CA 95202-2708 <br /> c P (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> ���FORN <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: 34443 N. DRY CREEK ROAD,GALT PA#: 14-209(MS) <br /> REPORT DATE: 2/10/2015 <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> 1 = Insufficient <br /> S / 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ® ✓ ❑ 1.1 Description of site, including zoning information. <br /> ® ✓/ ❑ 1.2 Description of proposed development. <br /> ®✓ ❑ 1.3 Parcel vicinity location map. <br /> E vl ❑ 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 /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> E ✓ ❑ 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 /> ®y ❑ 3.1 Description of exiting on-site septic tank usage (system types, age,functioning/repair rates). <br /> E✓ ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). <br /> ®I/ ❑ 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 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 /> E ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> E V// ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> ® i/ ❑ 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 (address/APN), type and construction of well and location (well head/kitchen tap)where <br /> water sample(s)were obtained <br /> ®vl ❑ 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 /> E t/ ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel <br /> E,; ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> E ✓ ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> E v1 ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD 26-02-003 Page I of 3 Soil Suitability Checklist <br />