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SAN JOAQUIN COUNTY
<br /> 2
<br /> EN�VMONMENTAL HEALTH DEPARTNI!tNT
<br /> 304 East Weber Avenue, 3`'Floor, Stockton,CA 95202-2708
<br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd
<br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST
<br /> FLOCATION: ��5F�i7 �. ,K,q•I�,E,G,S �� 1 q.c.1••H,.>ov PAM e&L" 07000 V�Ct
<br /> REPORT DATE: S /P O
<br /> S = Inti dent
<br /> I San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2
<br /> = Insufficient ��
<br /> S I 1144 INTRODUCTION & PROPOSED DEVELOPMENT SECTION
<br /> IV
<br /> ❑ [a'ISI Description of site,including zoning information. AJo Zan• -S
<br /> P•f [] ❑ 1.2 Description of proposed development.
<br /> F,S'f ❑ ❑ 1.3 Parcel vicinity location map. c: ci ✓e• • , •^ ''�_c. �/a wr
<br /> f S t ❑ a 0l&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.) ,moo , ���s/,,, 1��,A��J"•<�
<br /> FS? e- r , ..
<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 /> F f u..••e r��+tc
<br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION
<br /> 1 d,)lA❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). `s
<br /> �. f [,r,IA ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers,copies in report).
<br /> .1
<br /> [,J44 ❑ 3.3 Discussion of on-site septic tank repair history.
<br /> EK ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates,
<br /> tf<.. proximity to " -tyR ' •,.-Fs
<br /> �✓J r C 5 G neral ea septic permit history(number/types/dates of permits,age of system,permit numbe ',copies in
<br /> P9' report). Ti.A . ;a j"t"4 try 4� jr .' .)rf Z ,Qc( 2-60r � �v-u, f woS
<br /> ❑ [] 013.6 Discussion of general area septic tank repair history.
<br /> Pq-
<br /> Z E3" ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site.
<br /> 4.0 GROUNDWATER INFORMATION SECTION
<br /> �� L [� ❑ 4.1 Description of the depth and gradient of groundwater in the general area.
<br /> ❑ [�r&C4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location
<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 /> rJ 1 A -1 ❑ ❑ 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 /> ❑ ❑ 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.
<br /> 5.0 SOIL PROFILE INFORMATION SECTION
<br /> ❑ [316�-5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel.
<br /> QO [2 ❑ 5.2 Description of soil profile pit including depth and dimensions.
<br /> X5.3 a ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol.
<br /> ❑ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses.
<br /> EHD 2&03 Page 1 of 3 Soil Suitability Checklist
<br /> 7/14/2003
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