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". SAN JOA <br /> QUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, 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: D �� �, 7. PAM ) 5 - O9_7 <br /> REPORT DATE: <br /> = SufBcirnt <br /> I Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> = <br /> S 1 1.0 INTRODUCTION 8 PROPOSED DEVELOPMENT SECTION <br /> ® ❑ 1.1 Description of site, including zoning information. <br /> p1 <br /> 0 ❑ 1.2 Descriptio proposed development. <br /> I , /if CA <br /> 0 ❑ 1.3 Parcel vicinity location ,maa�p. <br /> ® ❑ 1.4 Site map showmg!'Ititab n 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 problems. <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> El ❑ 3.1 Description of exiting on-site septic tank usage(system types, age, functioning/repair rates). <br /> ® ❑ 3.2 Site s"pc permit history(number/types/dates of permits, age of system, permit numbers, copies in report). <br /> © ❑ 3.3 Discussion of on-site septic tank repair history. <br /> I <br /> �] ❑ 3.4 Descripi6n of existing septic tank usage in the general area (system types, ages,functioning/repair rates, <br /> proximity to plareal). <br /> Q ❑ 3.5 General area septic permit(s)history(numberttypes/dates of permits, age of system, permit numbers, copies in <br /> report). <br /> ® ❑ 3.6 Discussion ofgeneral area septic tank repair history. <br /> ® ❑ 3.7 Description o�posed 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. <br /> z <br /> ® ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. z <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 /> 2. <br /> [p� ❑ 4.4 Description of constituents being tested for in the water sample. <br /> 2- <br /> 4.5 <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 /> 1 /i d <br /> 5.0 SOIL PROFILE INFORIj'ICATION SECTION <br /> ® ❑ 5.1 Site map shoving the location, with dimensions, of the soil profile pit on the parcel. <br /> r <br /> ❑ 5.2 Descrip oti n dF it p file pit including depth and dimensions. <br /> 2-- <br /> 5.3 Description of soil lithology as noted from lest pit by appropriate professional using industry standard protocol. <br /> ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD 26-02-007 Pagel of 3 soli Suitability Checklist <br />