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`- SAN JOAQUIN COUNTY " <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Avenue 3'd Floor Stockton•CA 95202-2708 <br /> 209 468-3420•Fax:(209)464-0139 • Web:www.co.san-joaqu'Lmca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> PA#: <br /> SITE LOCATION: <br /> REPORT DATE: Q <br /> s = sufficicnt San Joaquin County Development Title Chapter 94105,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. P <br /> d ❑ 1.2 Description of proposed development. >) 2^ <br /> ❑ 1.3 Parcel vicinity location map. �I# Q 2 <br /> F71.4 Site map showing location of all items on parcels(i.e.,structures,drive ,w Ils,septic systems,large trees, <br /> pastures,pools,natural drainage courses,ponds,waterways, etc.) . 1 <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 existing on-site septic tank usage(system types,age,functioning/repair rates). 3 <br /> d ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system,permit numbers,copies in report). <br /> P/ ❑ 3.3 Discussion of on-site septic tank repair history. <br /> E7 ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). 00 3 <br /> fd ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers,copies in <br /> report). In�- `j . <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> Ii ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. 2;> <br /> t 4.0 GROUNDWATER INFORMATION SECTION (f <br /> Er ❑ 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 contaimination issues in the general location iP,;�e <br /> of the site. t <br /> ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where f y <br /> water sample(s)were obtained. <br /> F"'r 4.4 4.4 Description of constituents being tested for in the water sample. <br /> ❑ 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 f <br /> i El 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. <br /> 5.0 SOIL PROFILE INFORMATION SECTION r <br /> E(❑ 5.1 Site map showing the location,with dimensions,of the soil profile piton the parcel. V 4 <br /> ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> 1 <br /> �❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> 2 ❑ <br /> 5.4 Discussion of soil lithology as related to future onsite septic uses. �.� <br /> EHD 26-0�-003 Pagel of 3 <br /> 7/34/2003 <br />