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o "; SAWN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton•CA 95202-3029 <br /> _ (209)468-3420 -Fax:(209)464-0138 - Web;www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> t � <br /> PAM <br /> SITE r�13 <br /> $tTE LQCATION: f �'ur� /Z <br /> Z REPORT DATE: <br /> I <br /> S = sufficient San Joaquin County Development Title Chapter 9-1105, Section 9.1105.2 <br /> I = Insufficient <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ® ❑ 1.1 Description of site,including zoning information. <br /> ❑ 1.2 DescXboln of proposed development. <br /> ❑ 1.3 Parcel vicinity location map. <br /> [p� ❑ 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 /> ❑ 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 exiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> ❑ ❑ 3.2 Site sept/permit history(number/types/dates of permits,age of system, permit numbers,copies in report). <br /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> F13.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). <br /> ® ❑ 3.5 Geral area septic permits)history(number/types/dates of permits,age of system, permit numbers,copies in <br /> efort). <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> ��jy, <br /> EL E] 3.7 Dhsclription of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> El ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> ® ❑ 4.2 Description/discussion 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)1rre obtained. <br /> ® ❑ 4.4 Description of constituents being tested for in the water sample. <br /> �f ❑ 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 abovT oted i ormation. <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> Er�, ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. <br /> UN <br /> ❑ 5.2 (&escriti of sol profile pit including depth and dimensions. <br /> Ej ❑ 5.3 D f tion of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD 26-02-003 i3� Pagel of 3 Soil Suitability Cbecklist <br />