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SAN JOAQUIN COUNTY �..r ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3rd Floor Stockton• CA 95202-2708 (209)468-3420•Far:(209)464-0138• Web:www.cosan-joaquin.ca.u;'zhd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST �e` 3Sd �(GI,Lmiyt o p r,ei) PA#: O y� �7 io 3 SITE LOCATION: REPORT DATE: 5 = Sufflcient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 t = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION i✓ ❑ 1.1 Description of site,including zoning information. F2 ❑ 1.2 Description of proposed development. ❑ 1.3 Parcel vicinity location map. ❑ 1.4 Site map showing location of all items on parcels(i.e.,structures,drives,wells,septic systems,large trees, pastures,pools,natural drainage courses, ponds,waterways,etc.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION ❑� ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION d ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioningirepair rates). LSI ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system,permit numbers,copies in report). UZEl 3.3 Discussion of on-site septic tank repair history. 3.4 Description of existing septic tank usage in the general are�am typ s,ages,tuna_ ionin4hepa,�r rate,/ proximity to parcel). `/'r'_(��np„�,'•��'L'�p )GQ ❑" ❑ 3.5 General area septic permit history(number/types/dates of permits,a e of system, pernit numbers,copies in report). ❑ 3.6 Discussion of general area septic tank repair history. II& ❑�' 3.7 Description of proposed or expected maximum(including eco d unit dwellings)se tic tank usage on site. 0" /r 99q a 4.0 GROUNDWATER INFORMATION SECTIOL 77 ❑ 4.1 Description of the depth and gradient of groundwater in the general area. ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaiminalion issues in the general location gooof the site. 4.3 Description le location btainess/APN),type and construction of well and location(well tap)where water sample(s)were obtained. ❑ 4.4 Description of constituents being tested for in the water sample. < ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. Ea E__14.6 Complete Chain of Custody document,including printed and signed name of third parry sampler,condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION ❑ 5.1 Site map showing the location,with dimensions,of the soil profile piton the parcel. 'M*j 0 ❑ 5.2 Description of soil profile pit including depth and dimensions. ¢�S31 21 F-15.3 Description of soil lithology as noted from test pit by appropriate professional using indurstry standard protocol.; Z ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. U026-02-003 Page I of 7,1 a.2-003