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SAN JOAQUIN COUNTY <br /> l �1 ENV �� NMENTAL HEALTH DEPARTME -rf <br /> 304 E Weber Avenue 3" Floor Stockton - CA 95202-2708 <br /> (209)468-3420 • Fax:(209)464-0138 - Web:www.co.san-joaquin,ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE Lacgrlonl: PA#: <br /> REPORT DATE: <br /> S = Sufficient <br /> Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> 1 = <br /> S I 9.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> g] ❑ 1.1 Description of site, including zoning information. <br /> ® ❑ 1.2 Description of proposed development. <br /> Q ❑ 1.3 Parcel vicinity location map. <br /> 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 /> 0 ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> Q ❑ 3.1 Description of exiting on-site septic tank usage (system types, age, functioning/repair rates). <br /> ❑ 3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report). <br /> 0 ❑ 3.3 Discussion of on.-'•- <br /> ❑ ❑ 3.4 Description of ex <br /> proximity to pare,�j <br /> ❑ ❑ 3.5 General area sel / n <br /> report). ( /, <br /> ❑ 3.6 Discussion of ge <br /> ❑ 3.7 Description of pr <br /> 4.0 G RO U N D WA <br /> 0 ❑ 4.1 Description of th <br /> 0, ❑ 4.2 Description/disc, ation <br /> of the site. f <br /> E] ❑ 4.3 Description of to � ` <br /> sere <br /> water sample(s) <br /> ❑ ❑ 4.4 Description of cc <br /> ❑ ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br /> 0 ❑ 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 <br /> �' Soil Suitability Checklist <br />