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�c'''; SAN J O A Q U I N Environmental Health Department <br /> COUNTY <br /> Greatr+ess g -OW5 here. <br /> y 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: Z-k S 5 pt L q--)fs-- Date: 10 y/Zxa o. <br /> Test Performed by: p, ,gyp Permit#: V�2(p�-L2. PA#: A) <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 /> Jthe 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. <br /> Notes all man-made features(septic sstems,drives, bams,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. <br /> Diameter and depth of test hole 4"-12"diameter and 36"-42"depth), <br /> Dimensions and depth of deep test hole 4"-12"diameter and 42"-25'or minimum 10'above seasonal hi h water table . <br /> Test hole preparation(scoring of sidewalls,removal of loose material). <br /> J I Weather conditions at time of testing(raining,windy,etc. o Q—A <br /> j Soil type and condition encountered in test hole. S s w <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 pre-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 recordation sheet. <br /> Descri tion of type of perc test procedure used based on conditions Procedure#1,#2,or#3 . �F,- -2— <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 /> f Beginning 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 rofessional using industry standard protocol. <br /> COMMENTS <br /> - tw ti �rAO c��Arbc;-o a5 (� av�-'c 1J- e "A 0 MCI.) <br /> .,0, <br /> REHS Name: <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 minutesflnch 10 minutes=14.4"=.69 minutesfinch <br /> EHD 4200-xa 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 />