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oP`11''"•c SAN JOAQUIN COUNTY 2` .z ENVIRONMENTAL HEALTH DEPARTMENT Q. ✓ '1 1868 East Hazelton Ave Stockton, CA 95205 (209)468-3420 • Fax:(209)464-0138 • Web:wNNrw.sjQov.org/ehd i pbo , Soil Suitability study Requirements Checklist SITE LOCATION: RECORD ID: K T(C(� REPORT DATE: S S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 I = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION + ❑ 1.1 Description of site, including zoning information. b 0" ❑ 1.2 Description of proposed development. _ a,,,CL,0 ►,)c� srr_�ii�Q-e._ V-0 Q Qti 4 Cbl bvkx�v ❑ 1.3 Parcel vicinity location map. ❑ 1.4 Site map showing location of all items on parcels (i.e., structures, drives,wells, septic systems, large trees, LT pastures, pools, natural drainage courses, ponds,waterways, etc.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). ❑ 3.3 Discussion of on-site septic tank repair history. (� ❑ 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 history (number/types/dates of permits, age of system, permit numbers, copies in report). ❑ 3.6 Discussion of general area septic tank repair history. �• ❑ 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 �C area. r usoar� i F-1 4.2 Descrption/discusiy�sting and/or ponagondwa a cdntimination issu s theral location of the site. &f"11 ` 14 f-ts" A-U UNS� ff edk_'' [ ❑ 4.3 Description of location (address/APN), type and construction of well and location (well head/kitchen tap)where �l water sample(s)were obtained. 5o 6-LV'4L,k sk.tit— ❑ 4.4 Djesc 1ption of constituents being tested for in the water sample. I b16..� �p--q;>� ( L' t vf�-� ❑ 4.5 escrlption of how sample was obtained, handled, stored, and transported to the lab. EHD 26-02-003 Pagel of 3 Soil Suitability Checklist 7n4nnn3