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iPq 1" SAN JOAQUIN COUNTY <br /> EPMRONMENTAL HEALTH DEPARTNTtNT <br /> 304 E Weber Avenue P Floor Stockton• CA 95202-2708 <br /> (209)468-3420•Fan:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST / <br /> FITELOCATION: JL(�-lPj y y6 `,qtr i 5e- 14 /e PA#' 6 7— <br /> J REPORT DATE: <br /> S = ImuSufficient <br /> GsuOici <br /> 1 = mn <br /> 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 informatior�� <br /> EB-- ❑ 1.2 Description of proposed development. ) ) <br /> ❑ 1.3 Parcel vicinity location ma� �'� <br /> ❑ 1.4 Site map showing location`of all items on parcels(i.e., structures, drives, wells, septic systems, large trees, <br /> pastures, natural drainage courses, ponds,waterways, etc.) <br /> 2.0 PRESENAND PAST USES OF THE SITE SECTION <br /> 64 ❑ 2.1 Discussion of past and present uses at the site to assess potential problem (V 1) (P;9 <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ® ❑ 3.1 D9scription of exiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> i <br /> ® ❑ 3.2 Sse j permit history(number/types/dates of permits, age of system, permit numbers, copies in report). <br /> ® El 3.3 DI cu Ion of on-site septic tank repair history. <br /> H E] 3.4 b z n of existing septic tank usage in the general area(system types, ages,functioning/repair rates, <br /> proximity to parce ,,g Z <br /> ® ❑ 3.5 General area septic permits)history(number/types/dates of permits, age of system, permit numbers, copies in <br /> repo 1'6 � (ja i) <br /> ® ❑ 3.6 Disculs�'aIl'oyrof general area septic tank repair history. <br /> ® ❑ 3.7 Descript ll f proposed or expected maximum (including second unit dwellings)septic tank usage on site. <br /> 4.0 GROU }WATER INFORMATION SECTION <br /> ❑ 4.1 Descrio�nn ghe depth and gradient of groundwater in the general area. <br /> ® ❑ 4.2 DescriCtion/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site.f41) (ry'> <br /> ® E] 4.3 Descriptio loca il(address/APN),type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained./ L1 <br /> ® ❑ 4.4 Descri do of constituents beim tested for in the water sample. <br /> W�) <br /> i®-- ❑ 4.5 Desert tion of kss�ym,pile was obtained, handled, stored, and transported to the lab. <br /> ❑ 4.6 Complete Chain aft C dy document, including printed and signed name of third party sampler, condition of <br /> sample and date and time the sample was su mitted to the lab. For Laboratory samplers, complete laboratory <br /> report to include the above noted information%-t.O <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> ❑ 5.1 sitema )ho( g the tion, with dimensions,of the soil profile pit on the parcel. <br /> ❑ 5.2 De%Yiption <br /> ONSol <br /> pit including depth and dimensions. <br /> 2 <br /> �g � <br /> ®. El 5.3 ' Fon of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> ` �) <br /> a El 5.4 DiscWion of soil lithology as related to future onsite septic uses. <br /> a7 CPy3� <br /> erroze ozm3 Pagel of 3 soil suirabacrycheddisr <br />