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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Ave Stockton, CA 95205 <br />(209) 468-3420 • Fax: (209) 464-0138 • Web: www.sjgov.org/ehd <br />Soil Suitability study Requirements Checklist <br />SITE LOCATION: c p (2SQ <br />RECORD ID: <br />REPORT DATE: CA /317(10 2,/ <br /> <br />S = Sufficient <br />I = Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> <br />I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br />1.1 Description of site, including zoning information. <br /> <br />E 1.2 Description of proposed development. <br />1-x• Q-A—v.-4N 1/4._ s.‘-te -rx,s— s1/4-t_61- • <br /> <br />111 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 />2.0 PRESENT AND PAST USES OF THE SITE SECTION <br />El 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 />212// <br />0 3.1 <br />3.2 <br />Description of exiting on-site septic tank usage (system types, age, functioning/repair rates). <br />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. scz, • <br />3.4 Description of existing septic tank usage in the general area (system types, ages, functioning/repair rates, <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 />fl 4.1 Description of the delith and gradient of groundwater in the general area. <br />0 El 4.2 Description/discusn of any =ing and/or potential groundwater contaimination issues in the general location <br />of the site. <br />, <br />t. cl 1,43/1- <br />4.4 Description of constituents being tested for in the water sample. <br />4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br />111 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 />EHD 26-02-003 <br /> Page 1 of 3 <br />Soil Suitability Checklist <br />7/14/2003