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SAN JOAQUIN COUNTY <br /> z ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> N � 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 /> SITE LOCATION: `� p Ave-, PA#: / / <br /> _3o "' I`�1 � /7 /I e'er REPORT DATE: �( O ! Z Z- <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> I = Insufficient <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> .� ❑ 1.1 Description of site, including zoning information. 2 &,cve -lZn <br /> I So S ft 3 by kun e- <br /> 1.3 <br /> !^ll S <br /> F11.2 Description of proposed development. I� �" <br /> ❑ 1.3 Parcel vicinity location map. 1.03 <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 /> ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. L1 "' t <br /> V&/ 100+- <br /> 3.1j <br /> 00+-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). I tun $G <br /> 3 hyo LC. <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:i' ❑ 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 pr expected maximum (including second unit dwellings) septic tank usage on site. <br /> �DvCC <br /> 4.0' GROUN WAT R INFORMATION SECTION <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. 14CO <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 constructyon of well and location (well head/kitchen tap)where <br /> water sample(s)were obtained. e'Yl.-S i�G VLo V� 110 f <br /> ❑ 4.4 Description of constituents being tested for in the water sample. NU3) D Q c e <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. /V63: (2 r)YA U 8 Cp=� <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 /> F15.2 Description of soil profile pit including depth and dimensions.d q <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 /> _P- 1 of 2 <br />