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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave, Stockton • CA 95202-3029 <br /> (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> /pQ � <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> F[SITE LOCATION: 303 �� PA#: I > t>C>? 'T <br /> REPORT DATE: 1 l <br /> = sufficient <br /> I = InsufficientSan Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information. <br /> P- 1 <br /> ET ❑ 1.2 Description of proposed development. P 7-- <br /> Q ❑ 1.3 Parcel vicinity location map. /1,V C <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.) *PC <br /> ,�{ 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> -(J ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. y' Z <br /> rY 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION P Z <br /> ��I ❑ 3.1 Description of exiting on-site septic tank usage(system types, age, functioning/repair rates). 'z- <br /> E t ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). z <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, 7- <br /> proximity <br /> proximity to parcel). <br /> ,� ❑ 3.5 General area septic permit(s)history(number/types/dates of permits,age of system, permit numbers, copies in Z <br /> ,.,{ report). <br /> l.� ❑ 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 /> L 4.0 GROUNDWATER INFORMATION SECTION Q Zj <br /> "L_J ❑ 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 contamination 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 <br /> herewater sample(s)were obtained. <br /> ❑ 4.4 Description of constituents being tested for in the water sample. <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. ATV <br /> 5.0 SOIL PROFILE INFORMATION SECTION P <br /> Lo, ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. <br /> .L'f ❑ 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 /> PA / nFZ C..:I <br />