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SAN JOAQUIN COUNTY y;� 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 ) SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST PA#: -oOl 7 9 SITE LOCATION. 3?� `�D� ��W2-)337 cJc.> S- Yes 1V �• 71 REPORT DATE: �, aI 2.�00 S = SuffiInsufficent ient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 I = Irtsufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION (9 ❑ 1.1 Description of site, including zoning information. ® ❑ 1.2 Description of propos development. I ❑ 1.3 Parcel vicinity location map. �Iw- ! ® ❑ 1.4 Site map showing location of all items on parcels(i.e.,structures, drives,wells,septic systems,large trees, pastures, pools, natural drainage courses,ponds,waterways,etc.) '4PG . k 2.0 PRESENT AND PAST USES OF THE SITE SECTION '� ® ❑ 2.1 Discussion f past and present uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). Gs 1 ❑ 3.2 Site septic�permit history(number/types/dates of permits, age of system, permit numbers,.copies in report). ❑ 3.3 Discussion 4if ori sit §eptiicc tank repair history. [+� ❑ 3.4 Description of existing sjptic aRrusage in the general area(system types,ages,functioning/repair rates, ` proximity to parcel). �, � 3.5 �General area septic r e mi+s history❑ p' p 4} ry(numberltypesldates of permits, age of system, permit numbers,copies in report). 2— Ll -- ❑ 3.6 Discussion f general area septic tank repair history. ® ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. 02.- 4.0 a'4.0 GROUNDWATER INFORMATION SECTION ® ❑ 4.1 Description of the depth and gradient of groundwater in the general area. [,�] ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location of the site. a. ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where water sample(s)were obtained. ❑ 4.4 Description of constituents being tested for in the water sample. 4 ❑ 4.5 Description of how samples waLs obtained, handled, stored, and transported to the lab. ® ❑ 4.6 Complete Chain of Cu 4 y 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 notpd information. 5.0 SOIL PROFILEINRMATION SECTION © ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. © ❑ 5.2 Description of s it profile pit including depth and dimensions. E ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. 44fc � [� ❑ 5.4 Discusjn of soil lithology as related to future onsite septic uses. EHD 26-02-003 Pagel of 3 Soil Suitability Checklist Yll A I'IIIM1]