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PQM I" SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. Hazelton Ave, Stockton - CA 95202-3029 r. (209)468-3420• Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd --_ SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: 6 6 S �� PA#: � � REPORT DATE: S = Sufficient S I = Insufficient an Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ® ❑ 1.1 Description of site, including zoning information. ti �] ❑ 1.2 Description of prop-6sed development. ❑ 1.3 Parcel vicinity locaioA map. ❑ 1.4 Site map showing lldcation of all items on parcels (i.e., structures, drives,wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.) �W 2.0 PRESENT AND PAST USES OF THE SITE SECTION ® ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ® ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). ® ❑ 3.2 Site septic pe mit history(number/types/dates of permits, age of system, permit numbers,copies in report). ❑ 3.3 Discussion of oonnn--site septic tank repair history. ] ❑ 3.4 Description of ekisting septic tank usage in the general area(system types, ages,functioning/repair rates, proximity to parcel).; [/g ❑ 3.5 General area septic permit(s)history(number/types/dates of permits, age of system, permit numbers, copies in report). `„ ❑ 3.6 Discussion of eneral area septic tank repair history. ® F-13.7 Description o) roposed or expected maximum (including second unit dwellings)septic tank usage on site. 4.0 GROUNDt�ATER INFORMATION SECTION ❑ ❑ 4.1 Description of the depth and gradient of groundwater in the general area. ❑ ❑ 4.2 Description/discussion df any existing and/or potential groundwater contamination issues in the general location of the site. '7 : o ❑ ❑ 4.3 Description of location (address/APPN),type and construction of well and location (well head/kitchen tap)where water sample(s)were obtained. 1 ❑ ❑ 4.4 Description of constituents being tested for in the water sample. E] ❑ 4.5 Description of how sample`�vRRas oebtained, handled, stored, and transported to the lab. ❑ ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION ❑ ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. ❑ ❑ 5.2 Description of soil profile pit including depth and dimensions. ❑ ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. ❑ ❑ 5.4 Discussion ofoil lithology as related to future onsite septic uses.