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op0.�t"•.c SAN JOAQUIN COUNTY
<br /> 2' 'G ENVIRONMENTAL HEALTH DEPARTMENT
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<br /> 1868 E. Hazelton Ave, Stockton • CA 95202-3029
<br /> (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd
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<br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST
<br /> Nw� PAM )-6' c 1 LZ
<br /> SITE LOCATION: \i 67C) G 17-0 REPORT DATE: �f V f L o g
<br /> S = Sufficient 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 /> rZF-11.1 Description of site, including zoning information. i, 3
<br /> ❑ 1.2 Description of proposed development. P6 1
<br /> ® ❑ 1.3 Parcel vicinity location map. R PP,cM.,X !} 6x 6,'6't 2•
<br /> ® ❑ 1.4 Site map showing location of all items on parcels(i.e., structures, drives,wells, septic systems, large trees,
<br /> pastures, pools, natural drainage courses, ponds,waterways, etc.) AP P�sf� ��1i y,; Z)•
<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. t7D H
<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). S
<br /> ❑ 3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report).
<br /> ® ❑ 3.3 Discussion of on-site septic tank repair history.
<br /> F(] ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates,
<br /> proximity to parcel). ?5 iip
<br /> [g ❑ 3.5 General area septic permit(s) history(number/types/dates of permits, age of system, permit numbers, copies in
<br /> report).
<br /> ❑ 3.6 Discussion of general area septic tank repair history.
<br /> Z, ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. PO 7
<br /> 4.0 GROUNDWATER INFORMATION SECTION
<br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. Pb 7
<br /> N ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location
<br /> of the site.
<br /> ❑ 4.3 Description of location (address/APN), type and construction of well and location (well head/kitchen tap)where
<br /> water sample(s)were obtained. P5 �r ti,��ir +"'
<br /> NJ ❑ 4.4 Description of constituents being tested for in the water sample.,„'+",'4- .) U
<br /> Q ❑ 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. &Pr,e,.J t7A A, 6xl,,%,-t 2
<br /> ❑ 5.2 Description of soil profile pit including depth and dimensions.iljr j0) •-t-" e 4
<br /> 9 ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol.
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<br /> ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses.
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