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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 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 /> PA#: ^G/_ <br /> SITE LOCATION: � / I� )_� _o �, f cc f`1�e� T 5r�.��"1 ' <br /> REPORT DATE: �� G <br /> = InsuSufficm <br /> I Insuffi <br /> = cient <br /> San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ® ❑ 1.1 Description of site, including zoning information. <br /> 1 PL3__ <br /> El ❑ 1.2 Description of proposed development. <br /> Z <br /> ® ❑ 1.3 Parcel vicinity locption map. <br /> a ❑ 1.4 Site ma�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 /> P ❑ 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 /> ® F-13.3 Discussion of on-site septic tank repair history. <br /> z <br /> ® ❑ 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 areaseptic permit(s)history(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). <br /> i <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 /> ❑ ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> ® ❑ 4.2 Description/discission 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)were obtained. <br /> ❑ ❑ 4.4 Description of constituents being tested for in the water sample. <br /> z/ <br /> © ❑ 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 PROFI�#NVORMATION SECTION <br /> Er ❑ 5.1 Site map showing the location, with dimensions, of the soil profile pit on the parcel. <br /> Q ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> i <br /> u ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> .❑ ❑ 5.4 Discussion(koil lithology as related to future onsite septic uses. <br /> 6 <br /> EHD 26-02-003 Pagel of 3 Soil Suitability Chccklisl <br />