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°°' `"\ SAID JOAQUIN COUNTY z �t1 ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton-CA 95202-3029 (209)468-3420 -Fax:(209)464-0138 - Web:www.co.san-joaquin.ca.us/ehd �Ct✓a N SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: aG� � I' PA#: a>- 3a 3 0;7 -av41 Fj* REPORT DATE: I? r7 S = Sufficient I = Insufficient San JoaquinCounty p Coun Development Title Chapter 9-1105, Section 9-1105.2 S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTIO ) N ❑ 1.1 Description of site, including zoning information. �] ❑ 1.2 Description of proposed deveiopm t.W2I ❑ 1.3 Parcel vicinity location m U " ❑ 1.4 Site map showing location -all items on parcels(i.e.,structures,drives,wells,septic systems, large trees, pastures, pools, natural drainage courses, ponds, waterways, et�l4G 2.0 PRESENT AND PAST USES OF THE SITE SECTION ❑ 2.1 Disc;�461 f past and present uses at the site to assess potential problems. 2 3.0 EXI AND PROPOSED SEPTIC TANK USAGE SECTION ® ❑ 3.1 Description.of ] Elf exiting on-site septic tank usage(system types, age,functioning/repair rates). E 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report). W'7 El 3.3 Discussion offoorsite septic tank repair history. ❑ 3.4 Description o�existing septic tank usage in the general area(system types,ages,functioning/repair rates, proximity to parcel). D-3 ❑ 3.5 General area septic permit(s)history(number/types/dates of permits,age of system, permit numbers,copies in report). W3 ❑ 3.6 Discussion of general area septic tank repair history. ❑ 3.7 Description of p osed or expected maximum(including second unit dwellings)septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION ® ❑ 4.1 Description of the depth and gradient of groundwater in the general area.P ❑ ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location of the site. y ® ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where water sample(s)were obtained. �A 0-' ❑ 4.4 Description of constituents being tes#ed for in the water sample. Ck 0- E] 4.5 Description of how sample wa's�ained, handled,stored, and transported to the lab. ❑ 4.6 Completk'Chain of Custody document,including printed and signed name of third party sampler,condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION --' ❑ 5.1 Site m s wingrr1ohle a loca'on,with dimensions, of the soil profile piton the parcel. � t�5.2 Desch on of ole pit including depth and dimensions. [D ❑ 5.3 Descriptioi caf soil lithology as noted from test pit by appropriate professional using industry standard protocol. ❑ 5.4 Discussion ofil(illithology as related to future onsite septic uses. EHD 26-02-003 4 " Page ] of 3 Soil Suitability Chccklist