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ot`;1'Ili•.c SAN JOAQUIN COUNTY <br /> 2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Avenue 3`d 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 /> SITE LOCATION: 22260 E. HARNEY LANE, LODI PA#: 12-230(MS) <br /> REPORT DATE:4/22/2013 <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 /> ® � ❑ 1.2 Description of proposed development. <br /> N t/ ❑ 1.3 Parcel vicinity location map. <br /> ® / F-11.4 Site map showing location of all items on parcels(i.e.,structures, drives,wells, septic systems, large trees, <br /> V pastures, pools, natural drainage courses, ponds,waterways, etc.) <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> N✓ ❑ 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 /> ® ✓ ❑ 3.1 Description of exiting on-site septic tank usage(system types,age,functioning/repair rates). <br /> Ni,// ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report). <br /> N,/ ❑ 3.3 Discussion of on-site septic tank repair history. <br /> N t/ ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, <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). <br /> ® � ❑ 3.6 Discussion of general area septic tank repair history. <br /> N>/ ❑ 3.7 Description of proposed or expected maximum (including second 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. <br /> Z/ ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> of the site. <br /> ®V/ ❑ 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. <br /> N/ ❑ 4.4 Description of constituents being tested for in the water sample. <br /> ® 1/ ❑ 4.5 Description of how sample was obtained, handled,stored,and transported to the lab. <br /> N i/ ❑ 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 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 /> N/ ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. <br /> N✓ ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> ®/ ❑ 5.3 Description of soil Iithology as noted from test pit by appropriate professional using industry standard protocol. <br /> N>/ ❑ 5.4 Discussion of soil Iithology as related to future onsite septic uses. <br /> EHD 26.02.003 Page 1 of 3 Soil Suitability Checklist <br />