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SAN JOAQUIN COUNTY <br /> ENvMoNMENTAL HEALTH DEPARTMt�NT <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 /> _i'ii <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: ab� � rya[_ [) ,�. 5�3 PAM Ob—G�/O/ <br /> I[ REPORT DATE: <br /> S = Sufficient <br /> t = Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ®,/ ❑ 1.1 Description of site, including zoning informatiDfi� / <br /> ®� ❑ 1.2 Description of proposed development.0-1) <br /> SCC <br /> R-� ❑ 1.3 Parcel vicinity location map. <O,z�CP1,AA)r <br /> ✓ 1.4 Site ma showing location of all items on parcels (i.e., structures, drives,wells, septic stems, large trees, <br /> 0 ,/ <br /> ❑ P 9 P (• P Y 9 <br /> pastures, pools, natural drainage courses, ponds,waterways,etc.) P,/.k <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( �) <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(j�3,2 <br /> ® ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in re or1' � ) <br /> ©� ❑ 3.3 Discussion of on-site septic tank repair history, 5) <br /> �� ❑ 3.4 Description of existing-septic tank usage in the general area (system types, ages,functioning/repair rates, <br /> proximity to parcel). '>J <br /> ®� ❑ 3.5 General area septic permit(s) history(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). �j�_y ) 6-(Ag dlu <br /> ® � ❑ 3.6 Discussion of general area septic tank repair histor(�y 1) <br /> �� ❑ 3.7 Description of proposed or expected maximum(including second_ur+jt dwellings) septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION WI-) <br /> ®✓ ❑ 4.1 Description of the depth and gradient of groundwater in the general areg�py �� ✓'�`s -6 <br /> ®� ❑ 4.2 Description/ iscussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. J5- 5) <br /> ®� ❑ 4.3 Description o location (address/APN),type and construction of well nd location head/kitchen tap)where <br /> water sample(s)were obtained. /� r7) li✓a 5 'JA w&a Xstk' <br /> p ei g to P h �r��(e 6/ 7 7F/L, M3 <br /> ❑ 4.4 Description of constituents n t� d for in the water sample. ✓ � �++ <br /> ® � ❑ 4.5 Description of how sample was obtained, handled,stored, and transported to the lab. 0�6 <br /> �/ ❑ 4.6 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 th lab. For Labor tory samplers,complete laboratory <br /> �report to include the above noted information. v &I (elm• ,.6. 7 <br /> 5.0 SOIL PROFILE INFORMATION SECTION I� <br /> ® � ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel./- 7��aw,�� <br /> [}'� ❑ 5.2 Description of soil profile pit including depth and dimensions.(G&--7) <br /> 4�j ❑ 5.3 Description of soil lithology as noted from test pit by approgryte professional using industry standard protocol. <br /> g/ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses( <br /> 6HD 26-02-003 Pagel of 3 Sod Suitability Checklist <br />