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pP.41✓tN SAN JOAQUIN COUNTY ENV k NMENTAL HEALTH DEPARTNIMT 304 E Weber Avenue 3rd Floor Stockton • CA 95202-2708 .. (209)468-3420 •Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd //'SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: /may S �/j //,/ �) // PA#: •' / V //-`wl j C/ G/'CC REPORT DATE: p Q S = Sufficient I = Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION Nf;/ ❑ 1.1 Description of site, including zoning informatioj!-jr l .tea E] 1.2 Description of proposed development'. 2) �� lJ�� Xl? ❑ 1.3 Parcel vicinity location map. 6>/ -A_> ® ❑ 1.4 Site map showing location of all items on parcels(i.e., structures, drives,wells, seeptic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.) �� t� W C_I' 2.0 PRESENT AND PAST USES OF THE SITE SECTION ,� El 2.1 Discussion of past and present uses at the site to assess potential problems. /� 2) � L 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION/ Id. 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates) z ) 0— ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). 1 �r I kR_ ❑ 3.3 Discussion of on-site septic tank repair histor(tk-N-) i ® ❑ 3.4 Description of existing septic tank usage in the general area (system 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). C/k:5) ❑ 3.6 Discussion of general area septic tank repair history. i ®- ❑ 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 are y) 3-_6 /[X], ❑ 4.2 Description/discussion of any existingg and/or potential groundwater con mination issues in the generalloic�tion of the site. y S +c s e F d V ti ..d 6 _f Of- 4.3 4.3 Description of location (address/APN),type and construction of well and location (well head/kitchen tap)where N� k water sample(s)were obtained. /. yd I ✓1A F-14.4 Description of constituents being/ested for in the water sample. i ❑ 4.5 Description of how sample was obtained, handled, stored, and tra sported to the lab. Nim ❑ 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 SECTIOP g0_ jF] 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parte(-� E] 5.2 Description of soil profile pit including depth and dimensions.Ccy 5) �((// f( Lam] ❑ 5.3 Description of soil lithology as noted from test pit by appropriate profepiona�ing industry standard protocol. [a El 5.4 Discussion of soil lithology as related to future onsite�� /\ ERD 26-02-003 Pagel of 3 / Sod Suitability checklist