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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E Weber Avenue 3rd Floor Stockton • CA 95202-2708 <br />(209) 468-3420 • Fax: (209) 464-0138 • Web: www.co.san-joaguin.ca.us/ehd <br />SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br />SITE LOCATION: era 310 /t) Sez tiy Asi a, 14,4 f15-02- <br />PA #: <br />REPORT DATE: <br />S = Sufficient <br />I = Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br />1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> <br />1.1 Description of site, including zoning information. <br /> <br />1.2 Description of proposed development. <br /> <br />1.3 Parcel vicinity location map. <br /> <br />1.4 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 />2.0 PRESENT AND PAST USES OF THE SITE SECTION <br />0 2.1 Discussion of past and present uses at the site to assess potential problems. <br />3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br />fl 3.1 Description of exiting on-site septic tank usage (system types, age, functioning/repair rates). <br />3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report). <br /> <br />[I] • 3.3 Discussion of on-site septic tank repair history. <br />n 3.4 Description of existing septic tank usage in the general area (system types, ages, functioning/repair rates, <br />proximity to parcel). <br /> <br />KI 0 3.5 General area septic permit(s) history (number/types/dates of permits, age of system, permit numbers, copies in <br />report). <br /> <br />M 0 3.6 Discussion of general area septic tank repair history. <br />0 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br />4.0 GROUNDWATER INFORMATION SECTION eUQ 44A( vus.4-4 <br />0 4.1 Description of the depth and gradient of groundwater in the general area. <br />0 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br />of the site. <br />Vi/l, 0 4.3 Description of location (address/APN), type and construction of well and location (well head/kitchen tap) where <br />water sample(s) were obtained. <br />4.4 Description of constituents being tested for in the water sample. <br />0 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br /> <br />*IA El • 4.6 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. <br />5.0 SOIL PROFILE INFORMATION SECTION <br />5.1 Site map showing the location, with dimensions, of the soil profile pit on the parcel. <br />5.2 Description of soil profile pit including depth and dimensions. <br />5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br />5.4 Discussion of soil lithology as related to future onsite septic uses. <br />EHD 26-02-003 Page 1 of 3 Soil Suitability Checklist