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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT o 600 East Main Street, Stockton• CA 95202-3029 - ! (209)468-3420 -Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd JJJ SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST k��LOCATION: / ��6 �E,f,�tU �'�• .X.r�, - PA#:O 7—D O / ((V// ((��All REPORT DATE: 5 = uf iem insffi I = Insucient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 [� S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION �i ❑ 1.1 Description of site, including zoning informafion'l © ❑ 1.2 Description of proposed development.q o I) ❑ 1.3 Parcel vicinity location map`s I',_kc 2-1 tZ ❑ 1.4 Site map showing location of all items on parcels(i.e., structures, drives, wells, septic systems, large trees, pastures, pools, natural drai aae courses, ponds, waterways, etc.) -" r P \,J 1 2.0 PRESENT AND AST 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 Descripfion of exiting on-site septic tank usage(system types, age, functioning/repair rates). qt z ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers, copies in report). M i ® ❑ 3.3 Discussion of on-site septic tank repair history.-5 ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, proximity to parcel). ❑ 3.5 General area septic permit(s)history(numberttypes/dates of permits, age of system, permit numbers, copies in report). d z t ❑ 3.6 Discussion of general area septic tank repair history. (q i ❑ 3.7 Description of propos or expected maximum(including second unit dwellings) septic tank usage on site. 4.0 GROUNDWATER NFORMATION SECTION ® ❑ 4.1 Description of the depth and gradient of groundwater in the general area. d' [� ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location of the site. q� b ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where water sample(s)were obtained. j E] 4.4 Description of constituents being tested for in the water sample. ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. P y ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, condition of j sample and date and time the sample was submitted to the lab. For Laboratory samplers, complete laboratory report to include the above noted information. P�, .A 5.0 SOIL PROFILE INFORMATION SECTION ® F15.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. \6 1r� 1 [� ❑ 5.2 Description of soil profile pit including depth and dimensions.C6 LJ ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. h ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. EID 26-02-003 Pagel 43 C� Soil Suitability Checklist