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SAN JOAQUIN COUNTY r � ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3 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: S ,3M PA* Li S C1 G REPORT DATE: p S = Sufficient I ici = Insufcicnt San Joaquin County Developnent Title Chapter 9-1105,Section 9-1105.2 - S I 1.0 INTRODUCTION 84 PROPOSED DEVELOPMENT SECTION W ❑ 1.1 Description of site, including zoning information. ANO El �- 2 1.2 Description of proposed development. Pe x ® ❑ 1.3 Parcel vicinity location map. Pt"c.l , &1p r'i`d Lx Al ❑ 1.4 LSite 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.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION © ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. M 7_ 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION © ❑ 3.1 Description of existing on-site septic tank usage(system.types,age,functioning/repair rates). rep- IF UN 11 3.2 - 3.2 Site septic permit history(numberltypesldates of permits,age of system,permit numbers,copies,in report). PcJ 2- 3.3 3.3 Discussion of on-site septic tank repair history. f3 ❑ 3.4 Description of existing septic Tank usage in the general area(System 9 m proximity to parcel). ( Ys types,ages,functioning/repair rales, I r% ❑ 3.5 General area septic permit history(nurriberltypesldates of permits,age of system, permit numbers, copies in report). el 37 5i ❑ 3.6 Discussion of general area septic tank repair history. L& ❑ 3.7 Description of proposed or expected maximum(including Jsecond unit dwellings)septic tank usage on site. g Py � 4.0 GROUNDWATER INFORMATION SECTION ❑ 4.1 Description of the depth and gradient of groundwater in the general area. `'w t a-Zo r Pla `f n ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location ` of the site. Nj Lt ❑ 4.3 Description of location(addresslAPN ,type ype acid construction of well and location(well head/kitchen tap)where wafer sample(s)were obtained. ❑ 4.4 Description of constituents being tested for in the water sample.PfS&P ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the I.ab.s}q fe4" I'K ❑ 4.6 Complete Chain of Custody document,including printed and'signed name of third party sampler,condition of sample and dato,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 Pxil ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. ❑ 5.2 Description of soil profile pit including depth and dimensions. P J� �� ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. a ❑ 5.4 Discussion of soil tithology as related to future onsite septic uses. Gyy E]to 2(j-02.003 711412903 Page 1 of 3