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ou <br /> l° °o SAN JOAQUIN COUNTY <br /> .. Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> J 304 E Weber Avenue 30°Floor Stockton•CA 95202-2708 <br /> (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.uslehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> FITEATION: gg p Sa �C/ PA#: n 6 _ e-/ ,z <br /> REPORT DATE: J <br /> s = Sufficient <br /> I = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ® ❑ 1.1 Description of site,including zoning information. <br /> 0 ❑ 1.2 Description of proposed development. /p 2- <br /> ® ❑ 1.3 Parcel vicinity location map. /r/Opwu "x <br /> F-11.4 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.) AAe"a ,K <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-6 y <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> D ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioning/repair rates).1 Z- <br /> 3.2 <br /> 3.2 Nv sept��Cs istQryum er/type c/dates gf,permits,age of system,permit numbers,copies in report)�ia Z <br /> ❑ ❑ 3.3 Discussion of on-site septic tank repair history.. p <br /> q 7- <br /> ® ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). pt 3 <br /> © ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system, permit numbers,copies in <br /> report). Po 3 <br /> ❑ 3.6 Discussion of general area septic tank repair history. P'J 3 p'4 y <br /> Ud ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ® ❑ 4.1 Description of the-depth and gradient of groundwater in the general area. �� <br /> El4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> of the site. f;� y <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. ,Ma Kjp,, q jot 4- f <br /> © ❑ 4.4 Description of constituents being tested for in the water sample. f <br /> © ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. fyy � <br /> RI ❑ N R <br /> 4.6 Complete Chain of Custodydocument,including 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 /? r <br /> report to include the above noted information. N/A <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> ® ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel.la"&. <br /> ❑ 5.2 Description of soil profile pit including depth and dimensions. 01® & <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 lithology as related to future onsite septic uses. < L <br /> �J <br /> Ellin 26-02-001 Pagel of3 <br /> L14aM <br />