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L SAN JOAQUIN COUNTY r' x ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3rd Floor Stockton• CA 95202-2 (209)468-3420-Fax.(209)464-0138 - Web:www.co.san-joaquin. .0r1ehd 'ti.,r c O Rs i,_ SOIL SUITABILITY STUDY REQUIREMENTS CHECK�S PN ' SITE LocATiow PA#: O-1,— 1 7- REPORT DATE: /-9/0 (1 = Sufficient I _ Insufficient 9-1105,section Joaquin County Development Title Chapter 9-1105 Section 9-1105.2 ' e S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION EZ/ ❑ 1.1 Description of site,including zoning information. ❑ 1.2 Description of proposed development. ®9 t ��❑ 1.3 Parcel vicinity location map. �p I �:'c ED�'❑ 1.4 Site map showing location of all items on parcels(i.e.,structures,drives,wells,septic systems,targe trees, pastures,pools,natural drainage courses,ponds,waterways,etc.) A Pe�_ 2.0 PRESENT AND PAST USES OF THE SITE SECTION ❑�❑ 21 Discussion of past and present uses at the site to assess potential'problems.1�2p / 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION �� ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functidninglrepair rates). ❑ 3.2 Site septic permit histo number! P . P history( typesldates of permits,age of system,permit numbers,copies in re port).p5 �' ❑ 3.3 Discussion of on-site septic tank repair history. /9e� /. ✓ E2' 3.4 Description of existing septic tank usage in the general area(system types,ages,functioninglrepair rates, proximity to parcel). /V,, F-1Er3.5 General area septic permit history(numberftypesldates of permits,age of system, permit numbers,copies in W report). ❑ E�r 3.6 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 2 4.0 GROUNDWATER INFORMATION SECTION ��❑ 4.1 Description of the depth and gradient of groundwater in the general area. RZ ❑'%❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location of the site. [t'h� ❑ 4.3. Description of locati6n(adddresslAPN),type and construction of well and location(well head/kitchen tap)where water sampte(s)were obtained. L P- [[S ©� El 4.4 Description of constituents being t4sted for in the water sample. D ❑ 4.5 Description of how sample was obtained, handled,stored,and transported to the lab_ . E ❑ 4.6 Complete Chain of Custody document,including printed and,signed name of third party sampler,condition of r sample and date and time the sample was submitted to the lab. For Laboratory samplors,complete laboratory / ��e �b�r�e rt to include the above noted information. �� Z Qy `• 5.0 01L PROFILE INFORMATION SECTION (n-Lei i pp a i µ� �,i�� ❑ 5.l Site map showing the location,with dimensions,of the soil profile pit on the parcel. ryu! t } El 5.2 Description of soil profile pit including depth and dimensions. 120 2— ('V0 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol�� 3 /e� 5.4 Discussion of soil lithology as related to future onsite septic uses. j EUD 26.02-043 Page 1 of 3 7114/2003 t