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p4u/N ,So SAN JOAQUIN COUNTY ;s ENVIRONMENTAL HEALTH DEPARTMENT r 304 E Weber Avenue 3`'Floor Stockton • CA 95202-2708 ` (209)468-3420• Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/chd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: y / ��fG PA#: �- OD�'f'a' �.G(SJ I L 7 ale- ��;Xj REPORT DATE: S = Insufficient Sufficient 1 = InSan Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION v ❑ 1.1 Description of site, including zoning informatioi( ® ❑ 1.2 Description of proposed deveel (2 lopmen , l � ® ❑ 1.3 Parcel vicinity location map./pr 2.) �/ e.2' © ❑ 1.4 Site map showing location of all items on parcels(i.e., structures, drives,wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.��/( / 2.0 PRESENT AND PAST USES OF THE SITE SECTION / ❑ 2.1 Discussion of past and present uses at the site to assess potential problem(._�z) 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ® 7 ❑ 3.1 Description of exiting on-site septic tank usage(sYstem types, age, functioning/repair rates 2 [ ° ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit nomb ,gopieg i(r report �(ff ❑ 3.3 Discussion of on-site septic tank repair historv/�,S 37 �*»�J ® ❑ 3.4 Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, proximity to parcel).1 j' 3) ® ❑ 3.5 General area septic permit(s) history(number/types/dates of permits, age of system, permit numbers, copies in repo tys h) ®- ❑ 3.6 Discussion of general area septic tank repair history.(f k 3) ® ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings)septic tank usage on site 3 4.0 GROUNDWATER INFORMATION SECTION ❑ 4.1 Description of the depth and gradient of groundwater in the general area(,y) ® ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location of the sit /'5141 ❑ 4.3 Description of location (address/APN),type and construction of well and location (well head/kitchen tap)where water sample(s)were obtained. ® ❑ 4.4 Description of constituents being tested for in the water sample(l�1/) ® ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the la� ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler,condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION ,;3( / 07 a� 0® ❑ 5.1 Site magysf3. z tl1e location,with dimensions, of the soil profile pit on the parcel. ®. ❑ 5.2 Desc ptioq of soil profile pit including depth and dimensions. ® ❑ 5.3 D�s t5ptii of soil lithology as noted from test pit by appropriate professional using industry standard protocol. a ❑ 5.4 D(is/2pssioort/of sail lithology as related to future onsite septic uses. EHD 26-02-003 `-�� ) Pagel of`3 Soil Suitability Checklist