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SAN JOAQuIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ..w ,,. 600 East Main Street, Stockton-CA 95202-3029 <br /> (209}468-3420 -Fax:(209)464-0138 - Web:www.co.san-joaquin.ca.uslehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: C �� yv2� S . �sca�arr� , PA#: <br /> j REPORT DATE: teyh�,r-�j yrb <br /> I = Insufficint <br /> ent <br /> San Joaquin Count Development Title Chapter 9-1105,Section 9-1105.2 <br /> � = Insufficient 4 Y p <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information. <br /> ❑ 1.2 Description of proposed development. I <br /> ❑ 1.3 Parcel vicinity location map.,J�ftA <br /> �' ❑ 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 cos, 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 /> 5 <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ 3.1 Description`exiting on-site septic tank usage(system 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 DiscussiFn oo�f on-site septic tank repair history. <br /> ❑ 3.4 Descriptionki existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). j <br /> �] ❑ 3.5 General area septic permit(s)history(number/types/dates of permits, age of system, permit numbers,copies in <br /> report). 2- <br /> 3.6 <br /> 3.6 Discussion of general area septic tank repair history. <br /> J> A.— <br /> ❑El <br /> 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> R ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> � ❑ 4.2 Descriptionldiscussion of any existing and/or potential groundwater contamination 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. X <br /> ® ❑ 4.4 Description of constituents being estd for in the water sample. <br /> I <br /> ❑ 4.5 Description of how sample was obtainA, handled,stored, and transported to the lab. <br /> ❑ 4.6 Complete Chain of Custody Vinlebht, 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. 0- <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 Descriptiooil profile pit including depth and dimensions.t63 <br /> ® ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> EL ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHn <br /> .r^2�6�-�02-003 Pagel of 3 <br /> Soil Suitability Checklist <br />