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SAN JOAQUIN COUNTY zr ENMONMENTAL HEALTH DEPARTMTNT a 600 East Main Street, Stockton • CA 95202-3029 Ail (209)468-3420 •Fax: (209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: J� / j�d/_y /{/_/ �� .L PA#: T DATE: J REPORT DATE: S = Insufficient Sufficient 1 = San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 e S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description(of site, including zoning information. ❑ 1.2 Descripoyf proposed development. ❑ 1.3 Parcel niity��cati�n,m, ❑ 1.4 Site map swing locion of aff items on parcels(i.e., structures, drives, wells, septic systems, large trees, pastures, pools,patural drainage courses, ponds, waterways, etc.) F� 2— C 2.0 PRESENI-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 ® ❑ 3.1 Description 2of exiting on-site septic tank usage(system types, age,functioning/repair rates). (' ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers, copies in report). ❑ ❑ 3.3 Discul�eon of on-site septic tank repair history. [l] ❑ 3.4 Descripiioh of existing septic tank usage in the general area (system types, ages,functioning/repair rates, proximity to parcel). t ❑ 3.5 General arta septic permit(s)history(number/types/dates of permits, age of system, permit numbers, copies in report). Z �] ❑ 3.6 Discussion of general area septic tank repair history. F] 3.7 Description6 f prroposed or expected maximum(including second unit dwellings)septic tank usage on site. 4.0 GROUNAATER INFORMATION SECTION [g ❑ 4.1 Description of the depth and gradient of groundwater in the general area. Oki ❑ 4.2 Description/diswion of any existing and/or potential groundwater contamination issues in the general location of the site. 3 ❑ 4.3 Description of Imation(address/APN),type and construction of well and location(well head/kitchen tap)where water sample(s)were_s2btained. ® ❑ 4.4 Description of conituen s being tested for in the water sample. ® ❑ 4.5 Description of how d�nple�vas obtained, handled, stored, and transported to the lab. ❑ 4.6 Complete Chain of d&.to9y document, including printed and signed name of third party 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 D ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. ❑ 5.2 Descriplon�f soil profile pit including depth and dimensions. ❑ 5.3 DescriptD of1il lithology as noted from test pit by appropriate professional using industry standard protocol. ❑ 5.4 Discussior6soil lithology as related to future onsite septic uses. ERD 26-02-003 �� Paget o173 Soil Suitability Checklist