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SAN JOAQUIN COUNTY <br /> 2c 2' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton- CA 95202-3029 <br /> h �• (209)468-3420 -Fax:(209)464-0138 - Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: �o 7 5 i) , PA#: 10 -0D 7 6 v (e`%) <br /> REPORT DATE: JCC �j t7 <br /> S = Sufficient <br /> I = Insufficient <br /> 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 /> I <br /> ® ❑ 1.2 Description of proposed development. <br /> t 4 ❑ 1.3 Parcel vicinity location map� ,� <br /> ® ❑ 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.) I <br /> 2.0 PRESENT A`1D PAST USES OF THE SITE SECTION <br /> ® ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> Q�2 <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ® ❑ 3.1 Description of exitig on-site septic tank usage(system types, age,functioninglrepair rates). <br /> 2— <br /> D ❑ 3.2 Site septic permit history(numberltypes/dates of permits, age of system, permit numbers,copies in report). <br /> Z. <br /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> ® ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). Z <br /> [ ❑ 3.5 General area septic permit(s)history(numberltypesldates of permits, age of system, permit numbers,copies in <br /> report). —Z ( y\ <br /> ❑ 3.6 Discussion of general area septic tank repair history. 1 <br /> M ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 3 <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> ❑ ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. 3 <br /> ❑ 4.3 Description of location'(addresslAPN),type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained. <br /> ❑ 4.4 Description of constituents being tested for in the water sample. <br />{ [ ❑ 4.5 Description of how sample was obtained, handled, stored,and transported to the lab. <br /> ❑ ❑ 4.6 Complete Chain of Custody documlht, 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 L.aborato rnplers,complete laboratory <br /> report to include the above noted information. � ���,(�/l <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. <br /> [� ❑ 5.2 Description of s'a profile pit including depth and dimensions. <br /> Ed ❑ 5.3 Description of soillithology as noted from test pit by appropriate professional using industry standard protocol. <br /> E] 5.4 Discussion of soil(llithology as related to future onsite septic uses. <br /> EHD 26-02-003 Pagel of 3 Soil Suitability Checklist <br /> ?!4 A 1'11111'] <br /> k <br />