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¢7t" SAN JOAQUIN COUNTY <br /> • f2 J rCom.rR <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> f 304 E Weber Avenue Yd Floor Stockton• CA 95202-2708 <br /> �o r (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquin.cams/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> F <br /> TE LOCATION: ® PA#: 47_6- rho it <br /> REPORT DATE: -Z <br /> SSuf= Insu icm <br /> I InsufO<ient <br /> San Joaquin County Development Title Chapter 9.1105, Section 9.1105.2 <br /> I Ste! I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION by Z <br /> I �t ❑ 1.1 Description of site,including zoning information. <br /> ❑' ❑ 1.2 Description of proposed development. <br /> Ea- ❑ 1.3 Parcel vicinity location map. (7(wYy 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.) <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION p 2 <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 P� z <br /> ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioning/repair rates). <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. P? 3 <br /> ❑'i ❑ 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 /> L� ❑ 3.6 Discussion of general area septic tank repair history. <br /> ✓r- ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION Ppv q <br /> 12:� ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> -- _ �i ❑ 4.2 Description/discussion of any existing and/or potential groundwater wntaimination issues in the general location oE2- f the site. 1404 ;,.r,2,j a/ t"p. y <br /> ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where h9 S <br /> ED` El <br /> water sample(s)were obtained. <br /> t� ❑ 4.4 Description of constituents being tested for in the water sample. <br /> I ,x ❑ 4.5 Description of how sample was obtained,handled,stored, and transported to the lab. t JIA PJ„ ,.,,,.,P U <br /> Ea- ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler,condition of <br /> sample and dale and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory <br /> report to include the above noted information. Ole No <br /> -/' 5.0 SOIL PROFILE INFORMATION SECTION _ <br /> D ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. r t"X I (7 g s <br /> E2�- ❑ 5.2 Description of soil profile pit including depth and dimensions. P� i, U <br /> E2"'❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> ED--❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD 2402-003 Page I of 3 <br /> 7/14/2003 <br />