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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> INA 304 E Weber Avenue 3d Floor Stockton•CA 95202-2708 <br /> a�g (209)468-3420•Fax:(209)464-0138• Web:wwvv.co.san-joaquin.ca.us/chd <br /> SOILSUITABILITY <br /> SITE LOCATION: /�/STUDY REQUIREMENTS CHECKLIST <br /> !X U�S 111—le ' PA#: <br /> S <br /> REPORT DATE: <br /> S = Sulfflmu icut San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2. <br /> I = InsutT¢icnt r <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ® ❑ 1.1 Description of site, including zoning information. <br /> ❑ 1.2 Description of proposed development <br /> 1.3 Parcel vicinity location map. <br /> 2" ❑ 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 /> ED ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 'G� <br /> 3.0 EXISTING AND PROT)OPf_D SEPTIC TANK GE7FTION A � <br /> ❑ �G f7Z�/z3 )UU Kr�i �j1JJ 'r cwn ,� / \/ <br /> EO3.1 Description df ext on-slt se Gc tank usage�5ystem)i pes,age,fundioning/rep�ir ates) ,��rY <br /> ❑ ® ree'� <br /> 3.2 Site septiq permit ' tory(n rttype�/da s t its, age of system,pgr�'it numbers,copies in report). <br /> ❑ 3.3 Disc�(sslon of on-siie septi ank rY-, til tory. <br /> ❑ ® 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). <br /> ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system, permit numbers,copies in <br /> report). <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> ❑ 3.7 Description of proposed 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 /> 4.2 Description/discussion of any existing and/or potential groundwater coniaimination issues in the general location <br /> of the site. <br /> �/� ❑ 4.3 Description of location(addresslAPN),type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained. <br /> d/d EZ ❑ 4.4 Description of constituents being tested for in the water sample. <br /> N/n [Z ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. <br /> MED4.6 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 /> ElM 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel.EX D <br /> 5.2 Description of soil profile pit including depth and dimensions. uSE� ?Pr 4 14 <br /> Eff ❑ 5.3 Description of soil lithology as noted from lest pit by appropriate professional using industry standard protocol. <br /> EfEl 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD 2602-003 Page 1 of <br /> 7/14f2003 <br />