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SAN JOAQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 304 E Weber Avenue 3rd Floor Stockton- CA 95202-2708
<br /> x, (209)468-3420•Fac:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd
<br /> 4.
<br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST
<br /> Fs
<br /> LOCATION: _2 yea f r{ 14 - i WC4 PA#:
<br /> REPORT DATE: 3/1
<br /> S = Sufficient
<br /> Insufficient
<br /> 1 = Insufficient San Joaquin County p
<br /> Development Title Cha ter 9-1105,Section 9.1105.2
<br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION
<br /> ❑ 1.1 Description of site, including zoning information.
<br /> P El1�-va 1
<br /> 1.2 Description of proposed development. ,/{�,t,�4,,,ayr,., x,,;.11 I,,- s„y,.,,,;µ,,A
<br /> ❑ 1.3 Parcel vicinity location map.
<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 problems. 1
<br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION
<br /> ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioning/repair rates). /
<br /> ❑ 3.2 Site septic permit history(number/types/dales of permits,age of system,permit numbers,copies in report).
<br /> ❑ 3.3 Discussion of on-site septic lank repair history.
<br /> ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, /
<br /> proximity to parcel). (2� 1
<br /> ❑ 3.5 General area septic permit history(number/types/dales of permits,age of system, permit numbers,copies in
<br /> report).
<br /> r� ❑ 3.6 Discussion of general area septic lank repair history. �,I z
<br /> I/ I ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. )oc�, L
<br /> ✓1� 4.0 GROUNDWATER INFORMATION SECTION
<br /> til ❑ 4.1 Description of the depth and gradient of groundwater in the general area. G w =4 s_6� z
<br /> p ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location /-a
<br /> n of the site.
<br /> f`- ❑ 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. K.;j ;e-
<br /> E:1❑ 4.4 Description of constituents being tested for in the water sample. /',y e-
<br /> ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. ?i L
<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. AVp�{.,k
<br /> 5.0 SOIL PROFILE INFORMATION SECTION
<br /> ([,-J ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel.
<br /> ❑ 5.2 Description of soil profile pit including depth and dimensions.P ,3
<br /> ❑ y
<br /> 5.3 Description of soil lilhology as noted from test pit by appropriate professional using industry standard protocol.Pif 3
<br /> .❑ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses.�,t 3
<br /> EHD 2602-003 Page I of
<br /> ]/142003
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