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0-TI SAN JOAQUIN COUNTY � G ENV..cONMENTAL HEALTH DEPARTM-,4T k y; 304 E Weber Avenue Yd Floor Stockton- CA 95202-2708 Tz (209)468-3420 •Fax:(209)464-0138 - Web;www.co.san joaquin.ca.us/ehd ��IK(jiLN'. SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: Pro#: 03- REPORT DATE: 5 = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 F = Insuffcient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description of site, including zoning information. ® ❑ 1.2 Description of proposed development. Ot- -4-- o Fpe¢ ❑ 1.3 Parcel vicinity location map. ❑ 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.) AAA 2fa� &0 PRESENT AND PAST USES OF THE SITE SECTION y�L ® ❑ 2 Discussion of past and present uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION O� . ® ❑ 31 Description of exiting on-site septic tank usage (system types, age,functioning/repair rates). I ❑ 3.2 Site septic permit history(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 (syste types, ages,functioninglrepair rates, proximity to parcel). V� c�uf = y�` � ? ® ❑ 3.5 General area septic permit history(numberltypesl ates of permits, age of system, permit numbers, copies in report). ® F-13.6 Discussion of general area septic tank repair history. 1 JQ� O ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings)septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION ® ❑ 4.1 Description of the depth and gradient of groundwater in the general area.6"f— 4.2 Descriptionldisc ssion of any existing and/or potential roundwa(ex ontaimination issues in the general location �] ® 4.3 Description of location (addresslAPN),type and construction of II and location^(welll�h/e�ad/kitchen tap where water sample(s)were obtained.— G�Jb q- Uj �� U ® ❑ 4.4 Description of constituents being tested for in"the water sample. 07- 4- rte, �( } ❑ 4.5 Description of how sample was obtained, handled,stored, and transported to the lab. ® ❑ 4.6 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 samplers,complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION ® ❑ 5.1 Site map showing,the loc/attiion,with dimensions, of the soil profile pit on the parcel. ® 5.2 Description'of soil pro lle piVincluding depth and dimensions. ® 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. ® ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. EHD 26-02-003 Page 1 of 3 Soil Suitability Checklist •,1,A MI,l.1