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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton•CA 95202-3029 <br /> yY (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> $ITE LOCATION: �rCV %l PA#: G 7 at�e�a�/49' J <br /> REPORT DATE: <br /> S - sufficient <br /> I <br /> I = nsuffiufcient <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 /> a El1.2 DescrJJkiption of proposed development. <br /> Tt 1 <br /> ® ❑ 1.3 Parceftnicinity_Igc�yiontrap. <br /> �' ❑ 1.4 Site map sho#A.nngg lococ�alidnLof all items on parcels(i.e., structures, drives,wells, septic systems, large trees, <br /> pastures, I , natural drainage courses,ponds,waterways,etc.) <br /> L ) See ten✓ -_UL r j a.C-Su <br /> 2.0 PRESENIT AND PAST USES OF THE SITE SECAON <br /> ® ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> {� 2 <br /> 3.0 EXISY`ING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ®` ❑ 3.1 Description of exiting on-site septic tank usage(system types, age, functioning/repair rates). <br /> 0 ❑ 3.2 Site sepb�@ p�rmit history(number/types/dates of permits, age of system, permit numbers, copies in report). <br /> il <br /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> �] ❑ 3.4 Description ot-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). 3 <br /> r[�] ❑ 3.6 Discussion ofgeneralarea septic tank repair history. <br /> r� [:1 3.7 Description ofJproposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 3 <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ ❑ 4.1 Description of tpF. depth and gradient of groundwater in the general area. <br /> ❑ 4.2 DescripboAdisZssion of any existing and/or potential groundwater contamination issues in the general location <br /> of the si <br /> r] 4.3 Descript� 5 <br /> of location(address/APN),type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained. <br /> a ❑ 4.4 Description of constituents being tested for in the water sample. <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 PROFILE INFORMATION SECTION <br /> �.. ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. <br /> -❑ ❑ 5.2 Dption 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 Discussion of soil lithology as related to future onsite septic uses. <br /> EM 26-02-003 Page ] ot3 soil suitability Checklist <br />