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SAN .TOA UIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> E °; ,i 304 E Weber Avenue 3rd Floor Stockton• CA 95202-2708 <br /> AKIO- (209)468-3420•Fax.•(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION:4330 W. PELTIER RD., LODI PA#: 11-125(MS) <br /> REPORT DATE:8/2011 <br /> = sufficierit <br /> I = Insufficirnt <br /> San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> E ✓ ❑ 1.1 Description of site, including zoning information. <br /> E V ❑ 1.2 Description of proposed development. <br /> E V ❑ 1.3 Parcel vicinity location map. <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.) <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. <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 /> E ❑ 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 history(number/types/dates of permits,age of system, permit numbers, copies in <br /> report). <br /> E I/ ❑ 3.6 Discussion of general area septic tank repair history. <br /> ® t/ ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> E I/ ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> ® ✓ ❑ 4.2 Descriptionidiscussion of any existing and/or potential groundwater contaimination 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. <br /> E V ❑ 4.4 Description of constituents being tested for in the water sample. <br /> E ✓ ❑ 4.5 Description of how sample was obtained, handled, stored,and transported to the lab. <br /> E t/ ❑ 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 /> E V/ ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. <br /> E t/ ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> E ✓ ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> E ✓ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> ERD 2s-02.003 Pagel of 3 Soil Suitability Checklist <br />