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SAN JOAQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 304 E Weber Avenue 3nd Floor Stockton•CA 95202-2708
<br /> (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquin,ca.us/ehd
<br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST
<br /> FSITELoCATION: —2-:7 yn j y PA#: oe)Aeez
<br /> REPORT DATE:
<br /> I = SufTicicic San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2
<br /> I = Insufficient q ly P
<br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION
<br /> ® ❑ 1.1 Description of site,including zoning information. O, /,IV
<br /> ® ❑ 1.2 Description of proposed development.
<br /> E@ ❑ 1.3 Parcel vicinity location map. /}p ,,!>,
<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. a=.,n,.o+- 1011r-0',py /
<br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION
<br /> © ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioningfrepair rates).p, /
<br /> ® ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system,permit numbers,copies in report)./a.1 /
<br /> ® ❑ 3.3 Discussion of on-site septic tank repair history. k /
<br /> ® ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates,FV1 -
<br /> proximity to parcel). /
<br /> ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers,copies in
<br /> report). x
<br /> ® ❑ �� �,
<br /> 3.6 Discussion of general area septic tank repair history.
<br /> ® ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site.
<br /> 4.0 GROUNDWATER INFORMATION SECTION
<br /> EA ❑ 4.1 Description of thedepthand gradient of groundwater in the general area.9 L✓-"ilo /ny z
<br /> ® ❑ 4.2 Desrription/discussion of any existing and/or potential groundwater contaiminatlon issues in the general location
<br /> of the site. P� L
<br /> ® ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where
<br /> water sample(s)were obtained. /9�y
<br /> ® ❑ 4.4 Description of constituents being tested for in the water sample.D 3- PP 12-) 2-
<br /> El❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. .49 Z-
<br /> EN® ❑ 4.6 Complete Chain of Custody document,including printed and signed name of third party sampler,condition of
<br /> sample and dale and time the sample was submitted to the lab. For Laboratory samplors,complete laboratory
<br /> report to include the above noted information. /J-.,..,,t"k,
<br /> 5.0 SOIL PROFILE INFORMATION SECTION
<br /> EXI ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel.
<br /> ® ❑ P�3
<br /> 5.2 Description of soil profile pit including depth and dimensions.,,'q� g
<br /> ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. �y 3
<br /> ® ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses.
<br /> END 2602-003
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