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t SAN JOAQUIN COUNTY <br /> /s ;. c. <br /> Y` zs ENVIRONMENTAL HEALTH DEPARTMENT <br /> F._+ 304 E Weber Avenue 3rd Floor Stockton • CA 95202-2708 <br /> +� (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquinxa.us/ehd <br /> q.L,lFri•H Vii• <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> ESITE7LOCATION: 1 Z 1"g 7. S l,.1 1 r PA#; 07- - 31,5 <br /> REPORT DATE: I2/ 10104 <br /> 5 = ImufSufficientle San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> 1 = Insumcic0r 9 tY P <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> 0 ❑ 1.1 Description of site, including zoning information. Z=wll? 2 <br /> ® ❑ 1.2 Description of proposed development. pi <br /> ® ❑ 1.3 Parcel vicinity location map. Pkep",Xt <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.) ^Y/w�, <br /> qCydi C <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. eb y <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ ❑ 3.1 Description of existing on-site septic tank usage(system types,age, functioning/repair rates). <br /> ® ❑ 3.2 Site septic permit history(number/types/dales of permits,age of system, permit numbers,copies in report). 2- <br /> ® ❑ 3.3 Discussion of on-site septic tank repair history. F1 '2- <br /> ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, �cJ 2- <br /> proximity to parcel). <br /> ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers, copies in <br /> report). 2- <br /> ® ❑ 3.6 Discussion of general area septic lank repair history. p", 2- <br /> ❑X ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ® ❑ 4.1 Description of the depth and gradient of groundwater In the general area. Pg y 6 W 7C t0 i <br /> ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location P5 Y <br /> of the site. <br /> ❑ ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained. <br /> Q ❑ 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 /> N1 ❑ 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 the lab. For Laboratory samplers,complete laboratory <br /> report to include the above noted information. Apl)"-ct.X F- <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> ® ❑ 5.1 Site map showing the location,with dimensions,of the soil profile piton the parcel. Iirfc-v.L,,4 <br /> EY ❑ 5.2 Description of soil profile pit including depth and dimensions. r� 3 <br /> © ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. 5 3 <br /> i <br /> 0 ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD26-02-001 Page 1 of <br /> 7/142001 <br />