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t <br /> �..r <br /> SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> c i?: 304 E Weber Avenue 3' Floor Stockton - CA 96202-2708 <br /> (209)468-3420-Far:(209)464-0138- Web:www.co.san joaquin.ca.u&'ehd "" <br /> ye <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> PA#: D �-- 3 <br /> ESITELoCA:TION: 30_37 J — 23_? y ;1Iyy <br /> REPORT DATE: d '-dlriv <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 <br /> ff_SECTION A G- u0- <br /> ® 1.1 Description of site,including zoning information. <br /> ❑ 1.2 Description of proposed development. <br /> EZ ❑ 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 /> �tvv �I 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 existing on-site septic tank usage(system types,age,functioningirepair rates). <br /> ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system,permit numbers,conies in report). <br /> c.- <br /> ❑ 3.3 Discussion of on-site septic tank repair history. S x PV -4 r v <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, ermit number , copies in <br /> report). _ Put <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> E2/ ❑ 3.7 Description of proposed or expected maximum(including second unit 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 Description/discussion 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 I on(wAl head/kitchen tap)where , , <br /> water sample(s)were obtained. SV - oZ� <br /> 4.1 <br /> ❑ 4.4 Description of constituents being tested for in the water sample. <br /> d � <br /> ❑✓ F—],,,4-.5 Description of how sample was obtained,handled,stored, and transported to the lab. <br /> ❑ 44.6 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. Fr <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> 0 ❑ 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 /> ❑ r •. <br /> 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocols; <br /> 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> END 26-02-003 Page 1 of 3 r t <br /> 7,14 2003 <br />