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xo.�aq "' SAN JOAQUIN COUNTY y .� Et. JIRONMENTAL HEALTH DEPART tv1ENT 600 East Main Street, Stockton CA 95202-3029 (209)468-3420 •Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: PA#: j�7 AJ REPORT DATE: S = Sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 1 1 = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ® ❑ 1.1 Description of site, including zoning information. ® ❑ 1.2 Description of proposed development. 0 F] 1.3 Parol viic'nilly location map. L❑ too C2 61— F-1 1.4 Site magi showing location of all items on parcels(i.e., structures, drives, wells, septic systems, large trees, pastures, pool$, natural drainage courses, ponds, waterways, etc.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION [ ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. /�- .I . 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION El ❑ 3.1 Description of exiting on-site septic tank usage(system types, age, functioning/repair rates). ® ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). F] ❑ 3.3 Discussion of on-site septic tank repair history. r ® F-13.4 Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, proximity to parcel). Z] ❑ 3.5 General ar8a septic permit(s) history(number/types/dates of permits, age of system, permit numbers, copies in report). 1. ❑ ❑ 3.6 Discussion of general area septic tank repair history. �] ❑ 3.7 Description&prropoosed or expected maximum(including second unit dwellings)septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION ❑ 4.1 Description of the depth and gradient of groundwater in the general area. 0 ❑ 4.2 Description/discu4ori of any existing and/or potential groundwater contamination issues in the general location of the site. ❑' ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where water sample(s)were obtained. ❑ 4.4 Description of corWdu'ets being tested for in the water sample. 0 ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. ❑ ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, condition of sample and date and time the sample was submitted to the lab. For laboratory samplers, complete laboratory report to include the above noted information. 5.0 SOIL PROFILE I FORMATION SECTION ® ❑ 5.1 Site map showin the I/oL�action,with dimensions, of the soil profile pit on the parcel. © ❑ 5.2 Descrip�i6n o�it�ro ile pit including depth and dimensions. © ❑ 5.3 Descriwi4 Of soil lithology as noted from test pit by appropriate professional using industry standard protocol. ❑ 5.4 Disc uss i of soil lithology as related to future onsite septic uses. EHD 26-02-003 C S Pagel of 3 Soil Suitability Checklist iii a11—