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NNW d SAN JOAQUIN COUNTY j, ENVIRONMENTAL HEALTH DEPARTMENT Faa'. 304 E Weber Avenue 3'd Floor Stockton•CA 95202-2708 (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST PA#: 03-217 SITE LocATION: 9791 South Henry Road REPORT DATE: S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 1 = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑✓ ❑ 1.1 Description of site,including zoning information. ❑✓ ❑ 1.2 Description of proposed development ❑✓ ❑ 1.3 Parcel vicinity location map. 1.4 Site map showing location of all items on parcels(i.e.,structures,drives,wells,se ❑ ❑ ptic systems,large trees, m pastures,pools,natural drainage courses, ponds,waterways,etc.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION ❑r/ ❑ 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 existing on-site septic tank usage(system types,age,functioning/repair rates). ❑ ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). ❑✓ ❑ 3.3 Discussion of on-site septic tank repair history. ❑ 21 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 history(number/types/dates of permits,age of system,permit numbers,copies in r_1 ❑✓ report). ❑ ❑✓ 3.6 Discussion of general area septic tank repair history. 521 ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION ❑ ❑✓ 4.1 Description of the depth and gradient of groundwater in the general area. 0 ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location of the site. OF14.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where water sample(s)were obtained. ❑✓ ❑ 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. d party sampler, ❑ ❑ 4.6 Complete Chain of Custody a sample was submittedcluding ted to thedsigned name of lab. For Laboratoryrsamplers,complete laboratory tion of sample and date and time the sample 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. ❑ Fse-1 5.2 Description of soil profile pit including depth and dimensions. ❑ 0 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. ❑ 0 5.4 Discussion of soil lithology as related to future onsite septic uses. Page I of 3 EHD 2602-00J T 14/2003 I,IY/LVV)