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SAN JOAQUIN COUNTY <br /> EivvIRONMENTAL HEALTH DEPARTWCNT <br /> x 600 East Main Street, Stockton • CA 95202-3029 <br /> (209)468-3420 •Fax: (209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> i PA#: /O— Oo/O5 i'fS� <br /> ELOC:ATION: /J/ / J �/ �J <br /> —/ 6 �C�NNf¢✓7 !i4«_ REPORT DATE: "Il.� �b �01() <br /> 5 = Suffcicin <br /> 1 = 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 /> Z) ❑ 1.2 Description of proposed development. <br /> ® ❑ 1.3 Parcel vicinity location map. <br /> ® ❑ 1.4 Site map showin//g{�dcation 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 AW <br /> 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,functioning/repair rates). <br /> 2 <br /> ® ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). <br /> e- <br /> ® ❑ 3.3 Discussion of on-site septic tank repair history. <br /> 2 <br /> Q ❑ 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). 1 <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 /> Q- ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> [}] ❑ 4.2 Description/discuss) of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. 3 <br /> Q ❑ 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 59Rdituents being tested for in the water sample. <br /> ❑ 4.5 Description of hed <br /> le was obtained, handled, stored, and transported to the lab. <br /> ® ❑ 4.6 Complete Chaidy document, including printed and signed name of third party sampler, condition of <br /> sample and dae the sample was submitted tot a lab. For Laboratory samplers, complete laboratory <br /> report to includve noted information. IVA <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 /> .2 <br /> ® ❑ 5.2 Description o?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 /> N <br /> ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> ERD 26m-003 Pagel of 3 Soil Suitability Checklist <br />