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nQ' l SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ;z °` 304 E Weber Avenue 3`a 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 SITE LOCATION: a Lt Soo � �L� `f- � , 1 f'rnC PA#: E: U X ( REPORT DATE: S = Sufficient San Joaquin County Development Title Chapter 9-1105 1 = Insufficient p , Section 9-1105.2 S I 1.0 INTRODUCTION $ PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description of site, including zoning informatio -90 ❑ 1.2 Description of proposed development 1) A fktxt r� E( ❑ 1.3 Parcel vicinity location map. C rl ❑ 1.4 Site map showing location of all items on parcels (i.e., structures,drives,wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.) C 2.0 PRESENT AND PAST USES OF THE SITE SECTION ❑ 7 ❑ 2.1 Discussion of past and reser► uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION [� ❑ 3.1 Description of exiting on-site septic tank usage (systemnty)pes, age,functioning/repair rates). Q ❑ 3.2 Site septic permit history(number/types/dates o4e m9�,age of system, permit numbers,copies in report). ❑ 3.3 Discussion of on-site septic tank repair history. 2 [� ❑ 3.4 Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, proximity to parcel). X6 2-) ['j ❑ 3.5 General area septic permit(s) history(number/types/dates of permits, age of system, permit numbers, copies in report). L [� ❑ 3.6 Discussion of general area septic tank repair history.` ❑ 3.7 Description of proposed or expected maximum(including second 1 dwellings)septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTIflN� E9 E] 4.1 Description of the depth and gradient of groundwater in the general arta. ❑ 4.2 Description) iscussign of any existing and/or potential groundwater contamination issues in the general location of the site. �v 1 [2-' ❑ 4.3 Description df location (addresslAPN),type and construction of well and location (well head/kitchen tap)where water sample(s)were obtained. ti } L9" F-14.4 Description of constituents being tested for in the water sample. J F-14.5 Description of how sample was obtained, handled, stored, and transported to the labs �1 [� ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION L3 ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. Cve— ay C) ❑ 5.2 Description of soil profile pit including depth and dimensions.f'63 ) ❑ 5.3 Description of soil lithology as noted from t t pit by appropriate professional using industry standard protocol. ❑ 5.4 Discussion of soil Gthology as relatd to� d l( fuyture onsite septic uses CIZ `7 EHD 26-02-003 Pagel of 3 Soil Suitability Checklist