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SAN.JOAQUIN COUNTY <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> N:. 1868 E. Hazelton Ave, Stockton • CA 95202-3029 <br /> (209)468-3420• Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: 1Cls -5, vim.Aike..,P4, I E_15C4jZ PA#: /3 00a2Cl <br /> REPORT DATE: qC � <br /> 7n <br /> S = sufficient <br /> I = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> [4 ❑ 1.1 Description of site, including zoning information. <br /> ® ❑ 1.2 Description of proposed development. <br /> 2 <br /> ® ❑ 1.3 Parcel vicinity location map. <br /> ] ❑ 1.4 Site map showing location of Iron parcels(i.e., structures, drives,wells, septic systems, large trees, <br /> pastures, pools, natural drainage courses,ponds,waterways,etc.) <br /> 04 lzz� <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 /> 2 <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). <br /> 3 <br /> ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers, copies in report). <br /> O ❑ 3.3 Discussion of on-site septic tank repair history. <br /> 3 <br /> [� ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to pard). <br /> ❑ 3.5 General area septic permit(s) history(number/types/dates of permits,age of system, permit numbers, copies in <br /> report). 3 <br /> ❑ 3.6 Discussion of general a}rea septic tank repair history. <br /> © ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br /> -2- <br /> 4.0 <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> ® ❑ 4.2 Description/discussi no any existing and/or potential groundwater contamination issues in the general location <br /> of the site. Z 17 <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 /> ,© ❑ 4.4 DescriptJ of constituents being tested for in the water sample. <br /> ® ❑ 4.5 Descriptionofhow sample was obtained, handled,stored, and transported to the lab. <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. Act <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. <br /> ® ❑ 5.2 Descriptioh of f so p file pit including depth and dimensions. <br /> ® ❑ 5.3 Descriptio3of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> ® ❑ 5.4 Discussionofsoil lithology as related to future onsite septic uses. <br /> EHD 26-02-003 Page 1 of 3 Sail Suitability Checklist <br />