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SAN JOAQUIN COUNTY <br /> .<l ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Avenue 3rd Floor Stockton • CA 95202-2708 <br /> s (209)468-3420 •Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> $ITE LOCATION: /� 5 / / Q tj�// PA#: 5) <br /> REPORT DATE: 11,11a <br /> S = Insufficent <br /> ient <br /> San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> I = Insufficient <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTIOW <br /> ❑ 1.1 Description of site, including zoning informatio(Or) <br /> ® ❑ 1.2 Description of proposed development. 7 <br /> ® ❑ 1.3 Parcel vicinity location map. kw---2(�l <br /> E ❑ 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.) 91/) 9) <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION/ l�D <br /> [� ❑ 2.1 Discussion of past and present uses at the site to assess potential prcblems(i�2, <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTIO{{Nuu <br /> ® ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates(/y 2) <br /> Q ❑ 3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report)/y�Q <br /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> [e� ❑ 3.4 Description of existing ptic tank usage in the general area (system types,ages,functioning/repair rat*.k) <br /> proximity to parcel). <br /> ® ❑ 3.5 General area septic mit(s)history(number/types/dates of permits, age of system, permit numbers, copies in <br /> report).(,V ;-) <br /> 3-) <br /> ® ❑ 3.6 Discussion of general area septic tank repair history.(�3) <br /> ®- ❑ 3.7 Description of proposed or expected maximum (including �j unit dwellings) septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> N ❑ 4.1 Description of the depth and gradient of groundwater in the general area(o y) Ue s i,-0 <br /> ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the sit - <br /> ❑ 4.3 Descript 0 4- location (address/APN),type and construction of well and location (well head/kitchen tap)where <br /> water sample(s)were obtained. v7 <br /> F14.4 Description of constituents bein ested for in the water sampl<'�9, <br /> ® ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab( iVAi ) <br /> �. ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler,condition of <br /> sample and date and time the sample was sub itted to the lab. For Laboratory samplers,complete laboratory <br /> report to include the above noted information.(/✓/f) <br /> 5.0 SOIL PROFILE INFORMATION SECTION/„ iO4r.5�(o4e I?-) <br /> ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parc(p iw� /)/ <br /> ® ❑ 5.2 Description of soil profile pit including depth and dimensior(o wv C <br /> ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protoc�G,__�) <br /> ❑ 5.4 Discussion of soil lithology as related to future onsite septic ust�,Y--) <br /> EHD 26-02-003 Page 1 of 3 Soil Suitability Checklist <br />