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<br />SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 E. Hazelton Ave, Stockton CA 95202-3029
<br />(209) 468-3420 • Fax: (209) 464-0138 • Web: www.co.san-joaquin.ca.us/ehd
<br />SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST
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<br />'1.0.g ....
<br />SITE LOCATION: WI- )61 6 &Art SA0 r4 e wik) PA #:
<br />REPORT DATE: 7- k
<br />S = Sufficient
<br />= Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2
<br />S I 1.0
<br />El El 1.
<br />121. El 1.2
<br />E 1.3
<br />17( E1.4
<br />2.1
<br />Er 1=1 3.1
<br />ff 3.2
<br />127 El 3.3
<br />Er 1=1 3.4
<br />Et 0 3.5
<br />Er El 3.6
<br />5 El 3.7
<br />4.0
<br />El 4.1
<br />El El 4.2
<br />El 4.3
<br />17f D 4.4
<br />El' 0 4.5
<br />El El 4.6
<br />5.0
<br />5.1
<br />1=1 0 5.2
<br />Ld 5.3
<br />El El 5.4
<br />INTRODUCTION & PROPOSED DEVELOPMENT SECTION
<br />Description of site, including zoning information. ( ieip;,./A 4 I
<br />Description of proposed development.
<br />Parcel vicinity location map.
<br />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 />Discussion of past and present uses at the site to assess potential problems.
<br />Description of exjtirlg on-Aite.e_ptic tank usage (system types, age, functioning/repair rates). -Pyd-
<br />6
<br />Site septic permithistory (number/tyi3es/dat of permits, age of system, permit numbers, copies in report).
<br />" 73 47 r .
<br />Discussion of on-site septic tank repair historyikj h . <'e , i/j 4.-- 41,
<br />Description of existing septic tank usage in the general area (system types, ages, functioning/repair rates,
<br />proximity to parcel). pj'ew", V
<br />General area septip permit(s) history (number/types/dates of permits, age of system, permit numbers, copies in
<br />report). ,,-',
<br />Discussion of general area septic tank repair history.
<br />Description of proposed or expected maximymfincluding second unit dwellings) septic tank usage on site.
<br />
<br />zr -I •
<br />GROUNDWATER INFORMATION SECTION
<br />Description of the depth and gradient of groundwater in the general area.
<br />Description/discussion of any existing and/or potential groundwater contamination issues in the general location
<br />of the site. Per3 , P, 4-, •
<br />Description of location (address/APN), type and construction of well and location (well head/kitchen tap) where
<br />wategample(s) were obtained. j yty- A..r) £4,Ø ?4e .1•••••Pk_ eel k
<br />Description of constituents being tested for in the water sample.
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<br />Description of how samplrws obtained, handled, stored, and transported to the lab.
<br />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. ,v4
<br />SOIL PROFILE INFORMATION SECTION
<br />Site map showing the location, with dimensions, of the soil profile pit on the parcel.
<br />/ y 7 ef 7-) 11') /2
<br />DeSeptiOn of soil profile pit including depth and dimensions.
<br />1
<br />Description of soir lithology as noted from test pit by appropriate professional using industry standard protocol.
<br />Discii‘sion of soil lithology as related to future onsite septic uses.
<br />2.0 PRESENT AND PAST USES OF THE SITE SECTION
<br />3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION
<br />Darr,. 1 rvf
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