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- c ` SAN JOAQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> r� P1.
<br /> j 304 E Weber Avenue 3'a Floor Stockton• CA 95202-2708 .
<br /> (209)468-3420•Fax:(209)464-0138• web:www.co-san-joaquin.ca.us/chd
<br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST
<br /> SITE LOCATION: $ -A PA#: G
<br /> REPORT DATE:
<br /> S = SufficInsufficient icqtY
<br /> 1 = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2
<br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION
<br /> ❑ 1A Description of site, including zoning information.
<br /> 0 ❑ 1.2 Description of proposed development. 2,
<br /> ❑ ❑ 1.3 Parcel vicinity location map. e Lztk,-
<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.)
<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 problemsrc),. y �+
<br /> f Y
<br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION
<br /> ❑ 3.1 Description of existing on-site sepfic tank usage(system types,age,functioninglrepair rates). �� 2 15
<br /> ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system,permit numbers,copies,in report). z
<br /> D❑ p�
<br /> 3.3 Discussion of on-site septic tank repair history, 19`r �
<br /> ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates,
<br /> proximity to parcel), (91,3 qij
<br /> ❑� ❑ 3.5 General area septic permit history(nuniberllypesldates of permits,age of system,permit numbers, copies in
<br /> report). ?� 3-1f
<br /> ❑� ❑ 3.6 Discussion of general area septic tank repair history,
<br /> ED` ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usago on site. j
<br /> y 5l.,op� y�;-rl'c�C.(n� �' L./t+((�"r+-c171. S�'r'7-iJGf<'n�y�P`a
<br /> 4.0 GROUNDWATER INFORMATION SECTION L
<br /> ❑- ❑ 4.1 Description of the-depth and gradient of groundwater in the general area,i-Eg- El
<br /> 4.2 Descriptionldiscussion of any existing and/or potential groundwater contaimination issues in the general location
<br /> of the Site. /,j% �y s
<br /> ❑�' ❑� 4.3 Description of location(addresslAPN),type and construction of well and location(well head/kitchen tap)where
<br /> water sample(s)were obtained. (,b a �,5
<br /> ❑ 4.4 Description of constituents being tested for in the water sample. „ ck«
<br /> ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab, _ AIM
<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 the lab. For Laboratory samplers,complete laboratory
<br /> report to include the above noted information._
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<br /> 5.0 SOIL PROFILE INFORMATION SECTION
<br /> ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel.)ot wt 7 I A-p P"'-)c r P
<br /> Er ❑ 5.2 Description of soil profile pit including depth and dimensions_ C&,r to �p
<br /> ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. 6
<br /> ❑�❑ r'� �
<br /> 5.4 Discussion of soil lithology as related to future onsite septic uses.
<br /> FHL)26-02-003 Pae 1 of 3
<br /> 7/14/2003
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