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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E. Hazelton Ave, Stockton • CA 95202-3029 <br />(209) 468-3420 • Fax: (209) 464-0138 • Web: www.co.san-joaquin.ca.us/ehd <br />SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br />-J PA #: <br />SITE LOCATION: L`� {, ��, I REPORT DATE: <br />=Sufficient <br />I =Insufficient <br />S an Joaquin County Development Title Chapter 9-1105 Section 9-1105.2 <br />J� <br />, �/ `% evU <br />S <br />I <br />1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br />�Ir <br />❑ <br />1.1 Description of site, including zoning information. <br />� <br />2( <br />❑ <br />1.2 Description of proposed development. <br />[Oe",❑ <br />1.3 Parcel vicinity location map. <br />' /P5 <br />r V � u <br />❑ <br />1.4 Site map showing location of all items on parcels (i.e., structures, drives, wells, <br />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 />[v� ❑ 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 />L3 ❑ 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 />❑ 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(s) 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 L�j <br />❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br />❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination 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. to �V�M <br />❑ 4.4 Description of constituents being tested for in the water sample. CD ti, V11 <br />l� ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br />❑ 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. LA w, 91 L — <br />5.0 SOIL PROFILE INFORMATION SECTION J <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 />Pana 1 of 2 <br />