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"4W" SAN JOAQUIN COUNTY <br />w= ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />aii.::- Y Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br />SITE LOCATION: (e 'N , i� u I`'` 5 vt� PA #: z 10 07 q I <br />RFPORT DATE- I I ( 4l / <br />Z Z <br />S = Sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br />1 = Insufficient <br />S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br />X0 ❑ 1.1 Description of site, including zoning information. <br />X3 ❑ 1.2 Description of proposed development. <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 />G ■ <br />2.0 PRESENT AND PAST USES OF THE SITE SECTION <br />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 />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 />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. <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 />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 />EHD 26-03 Page 1 of 3 SOIL SUITABILITY STUDY CKLST <br />4/24/12 <br />