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SAN JOAQUIN COUNTY <br /> z" ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0- i <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 /> Gi�pZtN <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: � C7 �(7 �rdr��Gfi PU,, PA#. <br /> REPORT DATE: �cce�v,n�c✓ lc� <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> 1 = Insufficient <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information., <br /> 91 ❑ 1.2 Description of proposed development. <br /> ❑ 1.3 Parcel vicinity location map. Ar4ArA- <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 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 /> "'c' ❑ 3.1 Descriptionofexiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> ❑ 3.2 Site septic permit histofy(numberttypesldates of permits,age of system, permit numbers,copies in report). <br /> ® E] 3.3 Discussion of`OA-site/ epi tic tank repair history. <br /> E] 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). ) <br /> [L] ❑ 3.5 General area septic permit(s)history(number/types/dates of permits, age of system, permit numbers,copies in <br /> report). ' 1 A <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> ®. ❑ 3.7 Description of propos4d or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ® ❑ 4.1 Description of the dept 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. z <br /> ® ❑ 4.3 Description of location(address/APhi),.type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained. <br /> I- <br /> ❑ 4.4 Description of constituents being tested for in the water sample. <br /> ® ❑ 4.5 Description of how sample was dbtained,handled, stored,and transported to the lab. <br /> ® ❑ 4.6 Complete Chain of Custo y aoc/v�'r gntt,, iuncluding 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. <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> 1] ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. <br /> © ❑ 5.2 Description of soifprofile pit including depth and dimensions. <br /> © ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> [] ❑ 5.4 Discussion of soil iifhology as related to future onsite septic uses. <br /> f <br /> EHD 26-02-003 / Pagel of`3 Soil Suitability Checklist <br />