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"a. .l" SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. Hazelton Ave, Stockton - CA 95202-3029 (209)468-3420 •Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST �J PA#: FSITELOCATION' � '7 �/�C� > /rA� REPORTDATE: S = Sufficient I = Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION �] ❑ 1.1 Description of site, including zoning information. 1 © ❑ 1.2 Description of proposed development. ® ❑ 1.3 Parcel vicinity location map. 4D ❑ 1.4 Site map showing location of i e all ms on parcels(i.e., structures, drives,wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.) 7 2.0 PRESENT AND PAST 6SES OF THE SITE SECTION ® ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 1 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION a[ ❑ 3.1 Description of exiting on-site septic tank usage(system types, age, functioning/repair rates). ® ❑ e se 3.2 Sitptic permit history(numberkypes/dates of permits,age of system, permit numbers,copies in report). Q ❑ 3.3 Discussion of on-site septic tank repair history. [� ❑ 3.4 Descriptlarl of existing septic tank usage in the general area(system types, ages,functioning/repair rates, proximity to parcel). R ❑ 3.5 Generalirea septic permit(s) history(number/types/dates of permits,age of system, permit numbers, copies in report). ❑ 3.6 Discussion of general area septic tank repair history. ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings)septic tank usage on site. L- 4.0 GROUNDWATER INFORMATION SECTION ® ❑ 4.1 Description of the depth a�d 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. 3 ❑ 4.3 Description of location (address/APN),type end construction of well and location (well head/kitchen tap)where water sample(s)were obtained. /,/0 ..its ❑ 4.4 Description of c stituents being tested for in the water sample. ❑ 4.5 Description of w sample was obtained, handled,stored,and transported to the lab. ❑ ❑ 4.6 Complete Zam o ustody document, including printed and signed name of third party sampler, condition of sample and dat and time the sample was submitted to the lab. For Laboratory samplers, complete laboratory report to incl a the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION ® ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. © ❑ 5.2 Description of soil profile pit including depth and dimensions. 1 ® ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. F9 5.4 Discussion of soil lithology as related to future onsite septic uses. Perna 1 nf]