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pPgb i N SAN JOAQUIN COUNTY <br /> r. a ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q �a <br /> ": 304 E Weber Avenue 3`d Floor Stockton • CA 95202-2708 <br /> j (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> c4<i'2 oaH`% <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> PA: y� <br /> FFS ITE LOCATION: <br /> �TcL z��— r�;/q <br /> REPORT DATE: <br /> w�C� <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 /> i [] ❑ 1.1 Description.-of site including zonin information. <br /> /J//� ❑ 1.2 Descriptio) <br /> .4�Q' ❑ 1.3 Parcel vici <br /> , j ❑ 1.4 Site map <br /> pastures, <br /> ,�/ 2.0 PRESET <br /> 1 ✓70 :.x, /p !�' <br /> ,a /,CJ ❑ 2.1 Discussio <br /> 3.0 EXISTI I r7 <br /> Er ❑ 3.1 Descripti( y6'7 rf Le'.�i7•�-�iG <br /> > , <br /> ❑ 3.2 Site septi �•X hpr�is y��� r� I �� G" <br /> ie' ❑ 3.3 Discussi(V <br /> s❑' ❑ 3.4 Descripti <br /> proximity to parcel). <br /> ❑ 3.5 General area septic permit history(number/types/dates of permits, age of system, permit numbers, copies In <br /> 00' report). <br /> I3.6 Discussion of general area septic tank repair history. <br /> '�aEj ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> a®' ❑ 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 /> G✓ <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 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. <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 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 /> EHD 26-02-003 Pagel of 3 Soil Suitability Checklist <br />