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[� ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br />of the site. N �c - �`�5 ��p Q ��S e,1Jc� <br />scn� tL <br />Ei ❑ 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\� CQ�'&�—M S��► �f��Nc� �— Pr Q.S ZL <br />[7� ❑ 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 />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 />Q ❑ 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 />F) M <br />[� ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br />S n I 6.0 PERCOLATION TEST INFORMATION SECTION <br />0 ❑ 6.1 Site map showing the location, with concise and accurate dimensions of the percolation test holes on the parcel. <br />[� ❑ 6.2 The minimum number of shallow and deep percolation tests was performed for each parcel. <br />[� ❑ 6.3 Description of the date, time and protocol used to prepare the test hole, including depth and dimensions of hole, <br />preparation of hole, and depth of water used to presoak (minimum 12 inches). <br />d❑ 6.4 Description of the date, time and condition of the test hole after the 24-hour soak period (hole still intact, hole dry, <br />depth to water remaining in hole, etc.) <br />[� ❑ 6.5 The test conformed to SJC Policy EHD 02-02 (correct depth, diameter, 2" gravel, 6" water refill, correct readings <br />recorded). <br />[� ❑ 6.6 Complete Percolation Test Form (including readings) was provided with REHS verification signature. The rate <br />was correctly calculated using the last reading. <br />[� ❑ 6.7 Discussion of any potential problems predicted and/or the need for an engineered or alternative septic system. <br />❑ 6.8 Discussion of percolation rates in relation to the type, size and location of future leach fields needed at the site. <br />\, *' 4�-* L�'\ d c F 'x..".-,,; rc Q-- '5 F O S <br />7.0 CONCLUSION SECTION <br />[7f ❑ 7.1 The report was signed and mpe t appropriately registered individual <br />Reviewed By: Reviewed Date: 2'A AVVLA <br />EHD 26-02-003 Page 2 of 3 Soil Suitability Checklist <br />7/14/2003 <br />