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SAN J O A Q U I N Environmental Health Department <br /> COUNTY <br /> cq IF:0, Greatness grows here. <br /> PERCOLATION TEST/SOIL PROFILE INSPECTION CHECKLIST <br /> SJC Ordinance Code,Title 9,Section 9-1105.2 <br /> EHD Policy for Percolation Test Procedure 98-01 <br /> Site Location: Date: �f <br /> Test Performed by: r Permit#: 5060 Oj(%2_I PA#: <br /> SITE MAP <br /> Includes perc test and soil profile locations with accurate measurements from a fixed reference point(must be able to locate <br /> the test hole areas in the future). Perc/soil profile holes must meet distance setbacks as noted in the sewage standards for <br /> septic system locations. Percolation test holes and soil profile pits must be conducted in the area proposed for future septic <br /> systems. <br /> Notes any changes in elevation on the subject property. <br /> Notes all water wells. > a S'O -� n' a el S e <br /> Notes all man-made features septics stems, drives, barns,outbuildings, animal pens, etc. <br /> Notes all natural features(ephemeral drainage courses, large stands of trees, ponds, rivers, etc. <br /> PERC TEST PREPARATION PROTOCOL <br /> Date and time of test hole preparation. C9 /(2- <br /> \,,,,-Diameter <br /> l2Diameter and depth of test hole 4"-12"diameter and 36"42"depth). q 2 f CS_f' I c <br /> Dimensions and depth of deep test hole 4"-12"diameter and 42"-25'or minimum 10'above seasonal high water table). 1 . <br /> Test hole preparation (scoring of sidewalls, removal of loose material). <br /> Weather conditions at time of testing (raining,windy, etc. 5 G(1-7 rl <br /> Soil type and condition encountered in test hole. <br /> Addition of 2"of course sand or fine gravel to test hole. <br /> Pre-soak by addition of minimum 12"of water over gravel 24-hours before test). <br /> PERC TEST CONDITIONS, MEASUREMENTS,AND REPORTING <br /> Condition of test hole after the 24-hour re-soak amount of water remaining in the hole,any soil sloughing noted). <br /> Correct amount of water used to refill hole 6"over gravel). Documented on the recor ion sheet. <br /> L,,-Description of type of perc test procedure used based on conditions Procedure#1, 2, r#3). <br /> Accurate recordings of drop and refill of water in same measurements. <br /> Same fixed reference point used for each reading. Description of reference point used to be included in the final report. <br /> Math calculations checked for accuracy. <br /> Be inning and end measurements of the last reading verified by REHS.All above reviewed and verified by REHS. <br /> SOIL PROFILE <br /> Description of the date, time, and protocol used to prepare soil profile pit. <br /> Description of soil profile pit including depth and dimensions. <br /> Soil lithology described by appropriate professional using industry standard protocol. <br /> COMMENTS ��� /�S ! <br /> TC,S+ fro je. � �+c �'�-� . n c <br /> � o 0 O <br /> REHS Name: J�-✓r d• �-�/� �� <br /> Calculations Examples: <br /> Last drop reading=.07'over 30 minutes time. Last drop reading=1.2'over 10 minutes time. <br /> .07'x 12"=.84"(convert from feet to inches) 1.2'x 12"=14.4"(convert from feet to inches) <br /> 30 minutes-.84"=35.7 minutes/inch 10 minutes—14.4"=.69 minutes/inch <br /> EHD 4200-xx 8-1-2018 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />