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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Avenue 3`d Floor Stockton • CA 95202-2708 <br /> .J:_. 07 (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: D — �q / S , PA#: O b — D 5 <br /> REPORT DATE: �j ,Z-3 � <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 SECTION <br /> © ❑ 1.1 Description of site, including zoning informatioq,: <br /> ® ❑ 1.2 Description of proposed development(: ,1-2" <br /> � Q e. <br /> [a ❑ 1.3 Parcel vicinity location map. /�G ? <br /> �C] ❑ 1.4 Site map showing location of al items on parcels (i.e., structures, drives, wells, septic systems, large trees, <br /> pastures, pools, natural drainage courses, ponds, waterways, etc.) / 0 <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./,+�1?0 <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> // <br /> [d� ❑ 3.1 Description of exiting on-site septic tank usage (system types, age, functioning/repair rate. p�3� <br /> ❑ 3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in repor{ <br /> [� ❑ 3.3 Discussion of on-site septic tank repair histo�y.G� <br /> 0 F–] 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 permits) history (number/types/dates of permits, age of system, permit numbers, copies in <br /> report) <br /> [g ❑ 3.6 Discussion of general area septic tank repair history <br /> 0 ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION gyp _3J 6 6),L/ <br /> ® ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> ❑ 4.2 Descriptioq/discus�Tn of any existing and/or potential groundwater contamination issues in the general location <br /> of the site! Ct <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 /> ® ❑ 4.4 Description of cor}stituenls being tested for in the water sample. <br /> (rr T, <br /> ®� ❑ 4.5 Description of how-sample was obtained, handled, stored, and transported to the lab.(VGD <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 lap. For Laboratory samplers, complete laboratory <br /> report to include the above noted information. <br /> 5.0 SOIL PROFILE INFORMATION SECTION ` <br /> F-1 F-15.1 Site map showing the location, with dimensions, of the soil profile pit on the parcel! f <br /> ❑ ❑ 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 protocor <br /> ❑ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD 26-02-003 Page I of 3 Soil Suitability Checklist <br />