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SAN JOAQUIN COUNTY <br /> ENVVr,0NMENTAL HEALTH DEPARTM-r-_KT <br /> 304 E Weber Avenue 3rd Floor Stockton • CA 95202-2708 <br /> g. . 209 4 ( ) J Q <br /> ( ) 68-3420 • Fax: 209 464-0138 • Web:www.co.san- oa uin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: — PA#: QS — <br /> a S o07 �. //` / 1-17 n42— �s e'4�v` REPORT DATE: <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 /> ❑ 1.1 Description of site, including zoning information. <br /> ❑ 1.2 Description of proposed development'p <br /> { ❑ 1.3 Parcel vicinity location map. A) <br /> y ❑ 1.4 Site map showing location of all items 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 /> D_ ❑ 2.1 Discussion of past and present uses at the site to assess potential problems., r6) <br /> r <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> N(a S ❑ 3.1 Description of exiting on-site septic tank usage (system types, age, functioning/repair rates(fL <br /> ❑ 3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers,copies in �eport)(g I) <br /> ( x C <br /> � ® ❑ 3.3 Discussion of on-site septic tank repair history. <br /> ❑ 3.4 Description of existing septic tank usage in the general area (system types, ages, functioning/repair rates, <br /> proximity to parcel). (V,/ ) ✓ <br /> �® ❑ 3.5 General area septic permit(s) history (number/types/dates of permits, age of system, perms' umbers, copies in <br /> report). <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on s .� <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ® ❑ 4.1 Description of the depth and gradient of groundwater in the general area. ? <br /> ❑ 4.2 Description/discu n of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. <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 /> ��R ❑ 4.4 Description of constituents being tested for in the water sampler/ <br />�„E [� ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br /> 8 ❑ 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. /yam <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 Inddstry standard protocol. <br /> ✓ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses.���l <br /> EHD 26-02-003 Pagel of 3 / <br /> g Soil Suitability Checklist <br />