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SU0010861 SSNL
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SU0010861 SSNL
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Last modified
5/7/2020 11:34:48 AM
Creation date
9/9/2019 9:10:32 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SU0010861
PE
2631
FACILITY_NAME
PA-1600046
STREET_NUMBER
865
Direction
E
STREET_NAME
ROTH
STREET_TYPE
RD
City
FRENCH CAMP
Zip
95231-
APN
19332016
ENTERED_DATE
4/19/2016 12:00:00 AM
SITE_LOCATION
865 E ROTH RD
RECEIVED_DATE
4/18/2016 12:00:00 AM
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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SJGOV\rtan
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FilePath
\MIGRATIONS\R\ROTH\865\PA-1600046\SU0010861\SS NL STDY.PDF
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EHD - Public
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oPaO1�• c SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N? 1868 E. Hazelton Ave, Stockton • CA 95202-3029 <br /> � P (209)468-3420 •Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> �j/SSOOIL SUITABILITY /STUDY REQUIREMENTS CHECKLIST <br /> REPO <br /> [SITELOCATION: I3 vDl�o� <br /> �. <br /> - > 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 /> 2 ❑ 1.1 Description of site, i7luding zoning information. <br /> 0 ❑ 1.2 Description of proposed development. <br /> Z <br /> [/� ❑ 1.3 Parcel vicinity location map. <br /> 0 ❑ 1.4 Site map showing location of allii ms on parcels(i.e., structures, drives,wells, septic systems, large trees, <br /> pastures, pools, natural drainage courses, ponds,waterways, etc.) <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> R ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> z3 <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ® ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> 3 <br /> ® ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). <br /> 3 <br /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> 3 <br /> ❑ 3.4 Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, <br /> proximity to parcel). 3 <br /> Ep ❑ 3.5 General area septic permit(s) history(number/types/dates of permits, age of system, permit numbers,copies in <br /> report). y <br /> Iq ❑ 3.6 Discussion of general area septic tank repair history. <br /> Q ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br /> S <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> © ❑ 4.1 Description of the depth and gradient of groundwatteer 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. S <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 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&Aody 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 INFORMATION SECTION <br /> ® ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. <br /> ® ❑ 5.2 Descriptionoil profile pit including depth and dimensions. <br /> 0 ❑ 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 /> 7 <br />
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