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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E Weber Avenue 3`d Floor Stockton - CA 95202-2708 <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: �yPA: <br />- WFQftT DATE: � /C <br />S = SuffInsufficient <br />I = InsufFicient <br />San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br />S <br />I <br />1.0 INTRODUCTION A PROPOSED DEVELOPMENT SECTION <br />/ ET <br />❑ <br />1.1 <br />Description of site, including zoning information. <br />-�—i <br />❑ <br />1.2 <br />Description of proposed development. <br />Ef <br />❑ <br />1.3 <br />Parcel vicinity location map. <br />❑ <br />1.4 <br />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 <br />PRESENT AND PAST USES OF THE SITE SECTION <br />/cEr <br />❑ <br />2.1 <br />Discussion of past and resent us th <br />es at a site t otentia! problems. <br />R R e o assess p <br />3.0 <br />EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br />a <br />❑ <br />3.1 <br />Description of exiting on-site septic tank usage (system types, age, functioninglrepairvates). <br />'gam <br />a <br />❑ <br />3.2 <br />Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report). <br />[� <br />❑ <br />3.3 <br />Discussion of on-site septic tank repair history. <br />"� <br />❑ <br />3.4 <br />i <br />Description of existing septic tank usage in the general area (system types, ages, functioning/repair rates, <br />proximity to parcel). <br />x <br />❑ <br />3.5 <br />General area septic permit history (number/types/dates of permits, age of ,system, permit numbers, copies in <br />report). <br />3 <br />[- <br />❑ <br />3.6 <br />Discussion of general area septic tank repair history. <br />'� <br />❑ <br />3.7 <br />Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br />4.0 <br />GROUNDWATER INFORMATION SECTION <br />�' <br />[� <br />❑ <br />4.1 <br />i <br />Description of the depth and gradient of groundwater in the general area. <br />f <br />0 <br />❑ <br />4.2 <br />Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br />of the site. <br />®- <br />❑ <br />4.3 <br />Description of location (address/APN), type and construction of well and location (well head/kitchen tap) where <br />water sample(s) were obtained. <br />�j % <br />[� <br />❑ <br />4.4 <br />Description of constituents being tested for in the water sample. <br />B' <br />❑ <br />4.5 <br />Description of how sample was obtained, handled, stored, and transported to the lab. <br />�.� <br />®' <br />❑ <br />4.6 <br />Complete Chain of Custody document, including printed and signed nam6of 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 <br />SOIL PROFILE INFORMATION SECTION <br />0� <br />❑ <br />5.1 <br />Site map showing the location, with dimensions, of the soil profile pit on the parcel. <br />[ff <br />❑ <br />5.2 <br />Description of soil profile pit including depth and dimensions. <br />[ <br />❑ <br />5.3 <br />Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br />Z <br />❑ <br />5.4 <br />Discussion of soil lithology as related to future onsite septic uses. <br />EHD 26-02-003 <br />r,��� <br />Pagel of 3 <br />ge Soil Suitability Checklist <br />