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S A N A O A Q U I N Environmental Health Department <br /> —COUNTY <br /> — <br /> 4 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: O' j Date: 1 7— Za <br /> Test Performed 6y: I Aal. Pe it#: I S j 1 PAM <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 Chan es in elevation on the subject property. <br /> Notes all water wells. <br /> Notes all man-made features(septic sstems,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 /> ate and time of test hole preparation. "Z 6 -00 1 - 3o Al <br /> -Diameter and depth of test hole - "diameter and 36" 2"depth). <br /> Dimensions and depth of deep test hole 4"-12"diameter and 42"-25'or minimum 10'above seasonal high watertable . <br /> Test hole preparation(scoring of sidewalls, removal of loose material). <br /> Bather conditions at time of tesbn (raining,windy,etc. ,xkgyl <br /> Soil type and condition encountered in test hole. <br /> Addition of 2"of course sand or fine gravel to test hole. <br /> re-soak by addition of minimum 12"of water over gravel 24-hours before test). <br /> PERC TEST CONDITIONS,MEASUREMENTS,AND REPORTING <br /> u,4311fidition 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 recordation sheet. <br /> Description of type of perc test procedure used based on conditions Procedure#1, , <br /> , Z#3). <br /> Accurate recordings of drop and refill of water in same measurements. <br /> .game fixed reference point used for each reading. Description of reference point used to be included in the final repo <br /> Math calculations checked for accuracy. <br /> Beginning and end measurements of the last reading verified by REHS.All above reviewed and verified by RENS. <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 /> C r <br /> REHS Name: I A a,-- <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) 11 x 12"=14.4"(convert from feet to inches) <br /> 30 minutes.+..84"=35.7 minutes/inch 10 minutes+14.4"=.69 minutesrnch <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 />