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°°' `"\ SAID JOAQUIN COUNTY <br /> z �t1 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 /> �Ct✓a N <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: aG� � I' PA#: a>- 3a 3 0;7 -av41 Fj* <br /> REPORT DATE: I? r7 <br /> S = Sufficient <br /> I = Insufficient San JoaquinCounty p Coun Development Title Chapter 9-1105, Section 9-1105.2 <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTIO ) <br /> N ❑ 1.1 Description of site, including zoning information. <br /> �] ❑ 1.2 Description of proposed deveiopm t.W2I <br /> ❑ 1.3 Parcel vicinity location m <br /> U " <br /> ❑ 1.4 Site map showing location -all items on parcels(i.e.,structures,drives,wells,septic systems, large trees, <br /> pastures, pools, natural drainage courses, ponds, waterways, et�l4G <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> ❑ 2.1 Disc;�461 <br /> f past and present uses at the site to assess potential problems. <br /> 2 <br /> 3.0 EXI AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ® ❑ 3.1 Description.of <br /> ] Elf exiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> E 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report). <br /> W'7 <br /> El 3.3 Discussion offoorsite septic tank repair history. <br /> ❑ 3.4 Description o�existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). D-3 <br /> ❑ 3.5 General area septic permit(s)history(number/types/dates of permits,age of system, permit numbers,copies in <br /> report). W3 <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> ❑ 3.7 Description of p osed 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.P <br /> ❑ ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. y <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. �A <br /> 0-' ❑ 4.4 Description of constituents being tes#ed for in the water sample. <br /> Ck <br /> 0- E] 4.5 Description of how sample wa's�ained, handled,stored, and transported to the lab. <br /> ❑ 4.6 Completk'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 /> --' ❑ 5.1 Site m s wingrr1ohle <br /> a loca'on,with dimensions, of the soil profile piton the parcel. <br /> � t�5.2 Desch on of ole pit including depth and dimensions. <br /> [D ❑ 5.3 Descriptioi caf soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> ❑ 5.4 Discussion ofil(illithology as related to future onsite septic uses. <br /> EHD 26-02-003 4 " Page ] of 3 Soil Suitability Chccklist <br />