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Pq�l" •�o SAN JOAQUIN COUNTY <br /> ..� ENIrm,0NMENTAL HEALTH DEPARTM� TM <br /> N < <br /> OT <br /> 304 E Weber Avenue 3`d Floor Stockton • CA 95202-2708 <br /> (209)468-3420 • Fax: (209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> OCATION: /�F�L <br /> ` �a"7C <br /> �Q SS11�b PA#: <br /> ��� � REPORT DATE: <br /> I = SufInsufficient <br /> San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> 1 = Insufficient <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information( <br /> ❑ 1.2 Description of proposed developmenQ��) <br /> M ❑ 1.3 Parcel vicinity location ma aero. <br /> ❑ 1.4 Site map showing location 11 items on parcels (i.e., structures,5�rives, wells, septic systems, large trees, <br /> pastures, pools, natural drainage courses, ponds,waterways, etp� <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> ® ❑ 2.1 Discussion of past and present uses at the site to assess potential problems J ' <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 /> FQ ❑ 3.2 Site septic permit history (number/types/dates of permits, age of syst m, permit umbers, copies in repoM.f: <br /> �] ❑ 3.3 Discussion of on-site septic tank repair history. <br /> P, <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 area septic permit(s) history (number/types/dates of permits, a/ge of systemst permit numbers, copies in <br /> report). <br /> ❑ ❑ 3.6 Discussion of general area septic tank repair histor���� <br /> ❑ 3.7 Description of proposed or expected maximum (including second it 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 Descriptio discuSion of any existing and/or potential groundwater contamination issues in the general location <br /> of the sit � 7) <br /> F-] 4.3 Descripti _of location (addres /APN), type and construction of well and location (well head/kitchen tap)where <br /> water sample(s)were obtaine (l o <br /> ❑ 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 lib.6o <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 subrpitted o the b. For Laboratory samplers, complete laboratory <br /> report to include the above noted information.'/' A,r"V( J <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> ® ❑ 5.1 Site map showing he o tion,Yvith dimensions, of the soil profile pit on the parcel. <br /> (( l�Lsss��G )) <br /> ❑ 5.2 Description of soil profile pit including depth and dimension 66 <br /> ;5) <br /> ® ❑ 5.3 Description of soil lithology Tl cloted)from test pit by appropriate professional using industry standard protocol. <br /> LI <br /> ® ❑ 5.4 Discussion of soil lithology related to future onsite septic uses. <br /> El ID 26-02-003 Page ] of 3 Soil Suitability Checklist <br />