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o? SAN JOAQUIN COUNTY <br /> ? ENNNKONMENTAL HEALTH DEPARTMC�T <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 /> /� 1�'n°(en.. 55 -36 <br /> PA#: I$Y <br /> [SITEOCATION: 60Q S• /CWS / I �� REPORT DATE:, �DD6 <br /> AeLy: DSO <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> i = Insufficient <br /> ) <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION C <br /> [� ❑ 1.1 Description of site, including zoning information. ( ` <br /> [J� ❑ 1.2 Description of proposed development. Qy�l �1 <br /> dF-11.3 Parcel vicinity location map. o,up.c/J` \ <br /> [� ❑ 1.4 Site map showing location of all items on parcels(i.e., structures, drives,wells, s ptic systems, lar trees, <br /> pastures, pools, natural drainage courses, ponds,waterways,etc.) 'A <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> ❑ 2.1 Discussion of past and present uses at the site to assess potential problems.r��5 <br /> / 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION \ <br /> ©/ ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> [� d 3.2 Site septic permit history (number/types/dates of permits, age of system, per r t nur4bers,oo i�sn r port <br /> [� ❑ 3.3 Discussion of on-site septic tank repair history. <br /> l$l, ) w <br /> [� ❑ 3.4 Description of existing septic tank usage in the g peral area (system types, ages,functioning/repair rates, <br /> proximity to parcel). <br /> ❑ 3.5 General area septic permit(s) history(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). <G \ (aWWQV'`') . <br /> 1[7J�K d 3.6 Discussion of general area septic tank repair history] 1 2 fir` `^^M Z 4'A' 11 01W 6 r J <br /> [✓f ❑ 3.7 Description of proposed or expected maximum (including second ugt dwellings)septic tank usage on site. <br /> / 4.0 GROUNDWATER INFORMATION SECTION <br /> L3 ❑ 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. (/r Z� <br /> ❑ 4.3 Description of loc8 on (address/APN),tyne�and construction of well and location (well head/kitchen tap)where <br /> water sample(s)were obtained. ll 16 <br /> [� ❑ 4.4 Description of constituents being to Z for in the water sample $2 <br /> E�/ ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. 2- �gntdp_, <br /> F14.6 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. ForLaboratorysamplers, complete laboratory <br /> report to include the above noted information. ( ly 1'] <br /> 5.0 SOIL PROFILE INFORMATION SECVON W \ <br /> ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. Cser- <br /> [� ❑ 5.2 Description of soil profile pit including depth and dimensions. -J'5r <br /> [� ❑ 5.3 Description of soil lithology as noted from test pit by appropriate profes ional.jing industry standard protocol. <br /> d ❑ 5.4 Discussion of soil lithology as related to future onsite sep 'c uses. jb 3 <br /> EHD 2&02-003 Pagel of 3 �� � � Soil Suitability Checklist <br />