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..........� �./ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT -but it 304 E Weber Avenue 3d Floor Stockton•CA 95202-2708 a (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: ! Z� CPA#: X35— REPORT DATE: S = Imufficient icic I = insuc San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description of site,including zoning information. y - ❑ ❑ 1.2 Description of proposed development. — Gvf (..-,tet ,•.� tel" ❑ ❑ 1.3 Parcel vicinity location map. ❑ 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 problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION Q ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioning/repair rates). ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report). El ❑ 3.3 Discussion of on-site septic tank repair history. n ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, 7`--' proximity to parcel). ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers, copies in report). ,��0; 3.6 Discussion of general area septic lank repair history. �3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank u 0 sited oYS`x6 L7 -�e�3�j c �/ 4.0 GROUNDWATER INFORMATION SECTION LLl ❑ SS 4.1 Description of the depth and gradient of groundwater in the general area. ❑ ❑ 4.2 Oescription/discussion of any existing and/or potential groundwater contaimination issues in the general location / ED 4.3 the site. �;�'r. @I e 3 * 5-e - 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap where water sample(s)were obtained. 11� —/34� F-14.4 Description of constituents being tested for in the water sample. ��QQQ ��D,,, ��,,, ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. 5—p / �. ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler,condition o sample and dale and time the sample was submitted to the lab. For Laboratory samplers,comploto laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. ❑ 5.2 Description of soil profile pit including depth and dimensions. ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. ❑ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. EnD 26-02-007 Page 1 of 7/142003