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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton - CA 95202-3029 <br /> (209)468-3420 - Pax: (209)464-0139 - We w,\vw.cf,).,,-,an-,Ioaquin.ca.us/elid <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: �< <br /> PA#:j <br /> REPORT DATE: <br /> S '"it""'t San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> F 1 F] 1.1 Description of site, including zoning information, <br /> ❑ 1.2 Description of proposed development. <br /> 1.3 Parcel vicinity location map. <br /> 1.4 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 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 /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> 3.1 Description of exiting on-site septic tank usage(system types, age, functioning1repair rates). <br /> 3.2 Site septic permit history(numberltypes/dates of permits, age of system, permit numbers, copies in report). <br /> 2 <br /> P] F-1 3.3 Discussion of on-site septic tank repair history. <br /> F9 E] 3.4 Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, <br /> proximity to parcel). <br /> ❑ 3.5 General area septic permit(s) history(numberitypes/dates of permits, age of system, permit numbers, copies in <br /> report). <br /> 3.6 Discussion of general area septic tank repair history, <br /> ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ ❑ 41 Description of the depth and gradient of groundwater in the general area, <br /> 4,2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. <br /> [Tj H 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, <br /> 4.4 Description of constituents being tested for in the water sample. <br /> F-I 4.5 Description of how sample was 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 /> ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. <br /> r <br /> F-1 5.2 Description of soil profile pit including depth and dimensions. <br /> r] 5.3 Description of soil lith9logy 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 /> 1A ID 26-02-003 Page I of 3 Soil suitelhlltN("heckli'l <br /> . ........................................­11............... ............................................. <br /> .......................... ............................................ <br /> .................................. <br />