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P°"•" SAN JOAQUIN COUNTY <br />N ` 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 />PA #: <br />SITE LOCATION: I %0 �(-Q�xAv <br />` �\ _ REPORT DATE: rj 1'Z1k) 2Z <br />S= Sufficient S <br />I =Insufficient an Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br />P � <br />S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br />❑ 1.1 Description of site, including zoning information. c;V_r4aj,2 0 <br />1K] ❑ 1.2 Description of proposed development. Gkm-6b1F5 %►my`ItiG u <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 />WIN= <br />r"d ❑ <br />C9 ❑ <br />❑ <br />n 012. <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(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 />❑ 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 Q -:i <br />4.0 <br />GROUNDWATER INFORMATION SECTION <br />❑ <br />4.1 <br />Description of the depth and gradient of groundwater in the general area. 3,x-3 <br />❑ <br />4.2 <br />Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br />of the site. <br />❑ <br />4.3 <br />Description of location (address/APN), type and construction of well and location (well head/kitchen tap) where <br />water sample(s) were obtained. <br />`\ <br />❑ <br />4.4 <br />Description of constituents being tested for in the water sample. <br />❑ <br />4.5 <br />kv i-�54 <br />Description of how sample was obtained, handled, stored, and transported to the lab. i ki <br />❑ <br />4.6 <br />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 <br />SOIL PROFILE INFORMATION SECTION <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 Q -:i <br />