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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3rd Floor Stockton- CA 95202-2708 (209)468-3420•Fax:(209)464-0138 - Web:www.co.san-joaquin;ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: Gi/ +�Cc�O / � PA#: p REPORT DATE: lo fa = Sufficient I = Insuflcic nt San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION Ea/ ❑ 1.1 Description of site,including zoning information. Q;�'_ ❑ 1.2 Description of proposed development. 1.3 Parcel vicinity location map. —ppr x �i ❑ 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.) wr .�c 2.0 PRESENT AND PAST USES OF THE SITE SECTION �❑ 2.1 Discussion of past and present uses at the site to assess potential problems./'�'p / 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioning/repair rates)./°!J' / �� ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report)-/P5 / �� ❑ 3.3 Discussion of on-site septic tank repair history. l9dj. I ✓ 3.4 Description of existing septic lank usage in the general area(system types,ages,functioning/repair rates, proximity to parcel). Na s—yo '� 0- 1.5 0- ❑ ❑/3.5 General area septic permit history(numberltypes/dates of permits,age of system, permit numbers,copies in r report). ElE3`�3.5' Discussion of general area septic tank repair history. ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. o c� 4.0 GROUNDWATER INFORMATION SECTION d PEI ❑ 4.1 Description of the depth and gradient of groundwater in the general area. RL ❑�/❑ 4.2 Description/discussion of any existing and/or potential groundwater contaiminalion issues in the general location of the site. flcr�- Gt4 r Jam,0 : AUYI ,14 ❑ 4.3 Description of locati6n(add✓resslAPN),type and construction of well and location(well head/kitchen tap)where water sample(s)were obtained. � y Nq FT ❑ 4.4 Description of constituents being td"Sted for in the water sample. �5) ❑ 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 s sample and date and time the sample was submitted to the lab, For Laboratory samplers,complelo laboratory GA fl„rime rt to include the above noted information. 01L PROFILE INFORMATION SECTION Gfr -i4� � ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. At�7ca tai ED-` ❑ 5.2 Description of soil profile pit including depth and dimensions. { { �' ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocolK 3 PJ”j. ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. j EHa 26-02-003 Page i of 3 7/1412003