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SAN JOAQUIN COUNTY EN)"790NMENTAL HEALTH DEPARTMP-"T 304 E Weber Avenue 3`d Floor Stockton • CA 95202-2708 (209)468-3420 • Fa-v:(209)464-0138 • Web: vvww.co.san-joaquin.ca.us/ehd `:=iii` ...•�.;� SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: I a� �a h,L �ScQ�pyo PA#: o zj — 3 y c( v REPORT DATE: 1 a �cc S = Sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 I = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description of site, including zoning informatio /) ❑ 1.2 Description of proposed developmeni�� ® ❑ 1.3 Parcel vicinity location map. /�; ��^ l Z F-] 1.4 Site map showing location ofall/items on parcels (i.e., structures, drives,wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds, waterways, et�L /,�eliC,B-)�� 2.0 PRESENT AND PAST USES OF THE SITE SECTION ® ❑ 2.1 Discussion of past and present uses at the site to assess potential problems, /i 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION F ❑ 3.1 Description of exiting on-site septic tank usage (system types, age, functioning/repair rate ).GT ❑ 3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers,copies in repel)* ® ❑ 3.3 Discussion of on-site septic tank repair histo ® ❑ 3.4 Description of existing septic tank usage in th8 general_afje-a stem types, ages, functioning/repair rates, proximity to parcel). © ❑ 3.5 General area septic permit(s) history (number/types/dates of permits, age of system, permit numbers, copies in report). ❑ ❑ 3.6 Discussion of general area septic tank repair historni. /J ® ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION ® ❑ 4.1 Description of the depth and gradient of groundwater in the general area. �G, / ❑ 4.2 Description/di ussion of any existing and/or potential groundwater conterrtination issues in the general location of the site. GfG ❑ 4.3 Description o` location (address/APN), type pnd construction of well and location (well head/kitchen tap)where water sample(s)were obtained. ❑ 4.4 Description of constituents being tested for In the water sample.,, ,vin V] ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab(oe7 P9 ❑ 4.6 Complete Chain of Custody 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 l [� ❑ 5.1 Site map showing the location, with dimensions, of the soil profile pit on the parcels! Q'7' E ❑ 5.2 Description of soil profile pit including depth and dimensions(_j, ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry stan and protoc I. Z 5.4 Discussion of soil lithology as related to future onsite septic use ?� i EHD 26-02-003 Pagel of 3 Soil Suitability Checklist