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oPq`''"' c SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Ave Stockton, CA 95205 <br /> (209)468-3420 • Fax:(209)464-0138 • Web:www.sjgov.or-/siehd <br /> Soil Suitability study Requirements Checklist <br /> SITE LOCATION: RECORD ID: <br /> REPORT DATE: <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> [ = Insufficient <br /> I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information. <br /> ❑ 1.2 Description of proposed development. <br /> V�t�9S—S�GX Z�� <br /> 4JY <br /> ❑ 1.3 Parcel vicinity location map. <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 /> 1 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> [J] ❑ 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 /> ❑ 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 /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> n oexisting septic tank usage in the general area (system types, ages,functioning/repair rates, <br /> F-1 3.4 Desdripid <br /> proximity to parcel). <br /> ❑ 3.5 General area septic permit history(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> 2tD <br /> ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> of the site. <br /> ❑ 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 /> (o .y '6a&r NOS^ k-Z <br /> ❑ 4.4 Description of constituents being tested for in the water sample. <br /> d ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br /> EHD 26-02-003 Page I of 3 Soil Suitability Checklist <br /> 7/14/2003 <br />