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SAN JOAQUIN COUNTY <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> " <br /> INA ,* <br /> 600 East Main Street, Stockton • CA 95202-3029 <br /> \c P (209)468-3420 •Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> 1/ \ <br /> PA#: <br /> SITE N:LOCATIO ? S Z -,-!> S. 1 -' � j r_P �u Z`tL <br /> REPORT DATE: <br /> S = Sufficient <br /> I = Insufficient San Joaquin County Development Title Chapter 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 /> I <br /> Q ❑ 1.2 Description of proposed development. <br /> Q ❑ 1.3 Parcel vicinity location map, <br /> ❑ 1.4 Site map showing to tign bf 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. <br /> 1 2_ <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ 3.1 Description of exiting on-site septic tank usage (system types,age,functioning/repair rates). <br /> .2- <br /> 12 <br /> 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers, copies in report). <br /> 2— <br /> El ❑ 3.3 Discussion of on-site septic tank 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). 5 <br /> ® ❑ 3.5 General area septic perm t(s)history(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). N <br /> ® ❑ 3.6 Discussion of general area <br /> septic tank repair history. <br /> ® ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 3 <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ 4.1 Description of the <br /> depth and gradient of groundwater in the general area. <br /> F-14.2 Description/discussi6n�of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. L( <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. e_ <br /> �] ❑ 4.4 Description of constituentsbeingtested for in the water sample. <br /> ❑ 4.5 Description of how sample) as obtained, handled,stored, and transported to the lab. <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. <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> t91 ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. <br /> ® F-15.2 DescriptioS5 f soil profile pit including depth and dimensions. <br /> ® ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> ❑ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD 26-02-003 Page I of 3 Sou suitability checklist <br />