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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 /> Ct•., �P <br /> �IFORN <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> PA#: <br /> E <br /> E LOCATION: G2� REPORT DATE: <br /> S = Sufficient <br /> I = Insufficient San 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 /> F4 ❑ 1.2 Description of proposed development. . <br /> ❑ ❑ 1.3 Parcel vicinity location map. <br /> [/} w. <br /> F] 1.4 Site map showing location of a'Ir items on parcels(i.e., structures,drives,wells, septic systems, large trees, <br /> pastures, pools, natural drainage courses, ponds,waterways,etc.) <br /> I / 4- <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 /> l <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> EJ] ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> ❑ 3.2 Site septic permit Ids ory(number/types/dates of permits, age of system, permit numbers, copies in report). <br /> /. Ate, . <br /> ® ❑ 3.3 Discussion of on-site septic tank repair history. <br /> i <br /> Q ❑ 3.4 Description of existing"sept tank usage in the general area(system types,ages,functioning/repair rates, <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 <br /> report). /i Au- <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> ❑r ❑ 3.7 Description of proposed 6f expected maximum (including second unit dwellings) septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> © ❑ 4.1 Description of the dept and gradient of groundwater in the general area. <br /> [j] ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. 1 <br /> [� ❑ 4.3 Description of location(address/APN),type and construction of well and location (well head/kitchen tap)where <br /> water sample(s)weybtained. <br /> ❑ 4.4 Description of constituents being tested for in the water sample. <br /> [�] ❑ 4.5 Description of how sa Zle vas obtained, handled,stored,and transported to the lab. <br /> 0 ❑ 4.6 Complete Chain of Custoby 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. <br /> 5.0 SOIL PROFILE ORMATION SECTION <br /> ® ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. <br /> 2 <br /> ❑ ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> Z <br /> ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> 3 <br /> ® ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> 3 <br /> Parts 1 nf2 <br />