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2' SQN _JOQQUIN Environmental Health Department <br /> COUNTY <br /> c�t, P 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: '!j- ;Z ;Z q5 5. 4L.-S&4, Date: I 2Ozo <br /> Test Performed by: -Lk', . Permit#: 00 2 PA#: <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 changes in elevation on the subject property. <br /> Notes all water wells. <br /> otes 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 /> Date and time of test holere aration. 2C�2C7 <br /> Diameter and depth of test hole 4)-12"diameter and 36" 42' depth). P2— <br /> Dimensions <br /> ZDimensions and depth of deep test hole 4"-12"diameter and 42"-25' or minimum 10'above seasonal high water table). <br /> Test hole preparation (scoring of sidewalls, removal of loose material . <br /> Bather conditions at time of testing (raining, windy, etc. Su rah <br /> oil type and condition encountered in test hole. a,„` <br /> ddition 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 /> ? RC TEST CONDITIONS, MEASUREMENTS,AND REPORTING <br /> Condition 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 rt-ordation sheet. <br /> Description of a of erc test procedure used based on conditions Procedure)lt1�-'2, of #3 <br /> ccurate recordin s of dropand 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 /> 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 lith logy described by appropri to professional using industry standard protocol. <br /> C MMENTS C)o t y s�e� 0 vkiy ,P%4 J O Pl <br /> Per- <br /> e 1. '5 q j"n;nl� Inc 4 . raric t. 1'3e&4i,7&c L7 <br /> ctt <br /> 04 S e�kqt,A-- ( ki� vo-ls <br /> d� <br /> REHS Name: <br /> Calculations Example <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 minutes/inch 10 minutes-14.4"=.69 minutes/inch <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 />