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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3`d Floor Stockton • CA 95202-2708 j� (209)468,3420 • Fac:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST FFLOCATION: {(„/ /lRG't /mss' RE O �JAT -/��i REPORT DATE: S = Sufficient I = Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION a ❑ 1.1 Description of site, including zoning informatio( r3) [r�} ❑ 1.2 Description of proposed developrill I)(rib, ❑ 1.3 Parcel vicinity location winmap.C � �} ❑ 1.4 Site map shog location of ll items on parcels (i.e., structures,drives,wells, septic systems, large trees, pastures, pools, natural drainage"c((oo�urrsi s, ponds,waterways, etc.) 2.0 PRESENT AND PAST 11.1 OF THE SITE SECTION ❑ 2.1 Discussion of past and present uses at the site to assess potential problemS(M 79 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). 6g j ® ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). ® ❑ 3.3 Discussion of on-site septic tank repair history. 6'y3 ® ❑ 3.4 Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, rd proximity to parcel). ® ❑ 3.5 General area septic permit(s) history(number/types/dates of permits, age of system, permit numbers, copies in report). 6,l) 12 ❑ 3.6 Discussion of general area septic tank repair history. 6; M ❑ 3.7 Description of proposed or expected ma ' um Including second unit dwellings) septic tank usage on site. 15 4.0 GROUNDWATER INFORMATIO SECTION [g ❑ 4.1 Description of the depth and gradient of groundwater in the general are s 6/ 0 ❑ 4.2 Description/discuotin of any existing and/or potential groundwater contamination issues in the general location of the site{ '7 Eq ❑ 4.3 Description of location (address/APN), type and construction of well and location (well head/kitchen tap)where water sample(s)were obtained.(V, ❑ 4.4 Description of constituents be' g\tested for in the water sample. X41 ® ❑ 4.5 Description of h ttcsa�pJe w s obtained, handled, stored, and transported to the lab. [3 ❑ 4.6 Complete Chair bT Custody document, including printed and signed name of third parry sampler, condition of sample and date and time the sample was subtpitted to the lab. For Laboratory samplers, complete laboratory report to include the above noted information. &r 5.0 SOIL PROFILE INFORMATION SECTION ['.�} ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. C� ®— ❑ 5.2 Description of soil profile pit including depth and dimensionsR53) [✓�— ❑ 5.3 Descriptio of�oil lithology as noted from test pit by appropriate professional using industry standard protocol. ❑ 5.4 Discussiof soil lithology as related to future onsite septic uses. EHD 26-02-003 I y) Pagel of 3 Soil Suitability Checklist