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SAN JOAQUIN COUNTY <br /> a' ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> [ <br /> 1868 E. Hazelton Ave, Stockton • CA 95202-3029 <br /> c' P• (209)468-3420 • Fax:(209)464-0138 • Web:www.co.sanjoaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: D PA#: 16 0 0 2.6 S�S) <br /> REPORT DATE: 11/1 & V- <br /> S = Sufficient <br /> [ = 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 /> ® ❑ 1.2 Description of proposed development. <br /> [�] ❑ 1.3 Parcel vicinity locat4 map. 11 <br /> c <br /> [� F-11.4 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 /> A-r <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> ❑ 2.1 Discussion past and p sent uses at the site to assess potential problems. <br /> 2- <br /> 3.0 <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> F1 ❑ 3.1 Description of exiting on-site septic tank usage (system types, age, functioning/repair rates). <br /> z <br /> ® ❑ 3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report). <br /> ❑ 1713.3 Discussion of on-site segc tank repair history. <br /> 0 ❑ 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(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). y <br /> Q ❑ 3.6 Discussion of general area septic tank repair history. <br /> r <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 /> �J ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> WZJ 3 <br /> ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. 3 <br /> ® ❑ 4.3 Description of location (address/APN),type and construction of well and location (well head/kitchen tap)where <br /> water sample(s)Ire obtained. <br /> ® ❑ 4.4 Description constituents being tested for in the water sample. <br /> ❑ ❑ 4.5 Descripti�of how sample was obtained, handled,stored,and transported to the lab. <br /> ❑ 4.6 Complete C fnof Custody document, including printed and signed name of third party sampler, condition of <br /> sample a date and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory <br /> report 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 /> H <br /> Q ❑ 5.2 Description of 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 Discu si f soil lithology as related to future onsite septic uses. <br /> P� 1 ..az <br />