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o.Pqu I" cSAN JOAQUIN COUNTY <br /> � . od <br /> N ?\I ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> 4�i_F o_s? <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: j / ` PA#: ( _+0 0 q <br /> ( REPORT DATE: 1 <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. 1 ►j <br /> [� ❑ 1.2 Description of proposed development. y"a 3 +-1 i lRrs, <br /> [� ❑ 1.3 Parcel vicinity location map. <br /> Q ❑ 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 /> 1 2.1 Discussion of past and present uses at the site to assess potential problems. N c I—d,,( (y,(y S.e'P f;c S� <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ 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 /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> 1 y-�er <br /> E� ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, <br /> proximity to parcel). <br /> ® ❑ 3.5 General area septic permit history(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). <br /> !Q ❑ 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 site. <br /> A C ,O-e -f- <<i((4� it <br /> 4.0 GROUNDWATER INFORMATION SECTION k;5 <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. I4W <br /> ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination 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. Q <br /> F] 4.4 Description of constituents being tested for in the water sample. Z 3 �1�/L —N > N 7 D 3 <br /> ❑ 4.5 Description of how sample was obtained, handled, stored,and transported to the lab. <br /> n ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, condition of <br /> 4� 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. -? 3 I, 'T <br /> ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> S`'� y <br /> [ ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD 26-02-003 Page I of 3 Soil Suitability Checklist <br />