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L i - _;c r SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> i 304 E Weber Avenue 3rd Floor Stockton- CA 95202-2708 <br /> (209)468-3420 Fax:(209)464-0138- Web:www.co.san-joaquin.ca.us/ehd <br /> c � <br /> SOIL <br /> ��SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LocAnow �ILJ S ] PA#: <br /> REPORT DATE: p <br /> I = SutInsu icnt <br /> ic San Joaquin County Development Title Chapter 9-1105,Section 9-1145.2 <br /> = Insufticicnt ' <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ ❑ 1.1 Description of site,including zoning information. rf,�j� n�/LP/J� 2-SFR- - /v <br /> p ❑ 1.2 Description of proposed development, <br /> ❑ 1.3 Parcel vicinity location map. P�tka. v <br /> `� ❑ ❑ 1.4 Site map showing location of all items on parcels(i.e.,structures,drives,wells, ens tic systems large trees,. <br /> pastures,pools, _ura rasna se , ponds,waterways, etc.) y� e"\ <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. C_ <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑� ❑� 3.1 Description of existing on-site septic tank usage(system types0ag, funstionin e arates . <br /> 0 ❑ 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 /> ❑ ❑ 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 lystory(numberltypesldates of permits,age of system,permit numbers,copies in <br /> report). <br /> ❑ ❑ 3.6 Discussion of general area septic tank repair history. <br /> ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> nj ❑ i vtJ / �ir)L <br /> 11 SS 11 4.1 Description of the depth and gradient of groundwater in the general area. tl O <br /> ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> © F7 of the site. C� ,.q z� �{ r✓1 C 104- -� S r�1L P 1) �S c o� <br /> 4.3 Description of location(addresslAPN),type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained. 9k TPP q s rr"P <br /> ❑ 4.4 Description of constituents being tested for in the water sample. (7 / p be <br /> ❑ ❑ 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. <br /> ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> ❑ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> El-1D 26-02-003 Page I of 3 <br /> 7714!2003 <br />