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o.P° `''" •.c SAN JOAQUIN COUNTY <br />?, ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E Hazelton Ave, Stockton • CA 95205 <br />• cP.. (209) 468-3420 • Fax: (209) 464-0138 •Web: www. sjgov.org/ehd <br />q<%FORS <br />SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br />SITE LOCATION: (� n /� ,_� .0 C4 15-72--0 <br />� 5-.�2- PA #: <br />11 4 -A � �,vp� h I �TLG �1 �'" / � REPORT DATE: <br />S = Sufficient San <br />I = Insufficient Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br />S <br />I <br />1.0 <br />INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br />❑ <br />1.1 <br />Description of site, including zoning information. <br />'q] <br />❑ <br />1.2 <br />Description of proposed development. <br />ITI <br />❑ <br />1.3 <br />Parcel vicinity location map. <br />❑ <br />1.4 <br />Site map showing location of all items on parcels (i.e., structures, drives, wells, septic systems, large trees, <br />[] <br />❑ <br />3.5 <br />pastures, pools, natural drainage courses, ponds, waterways, etc.) <br />2.0 <br />PRESENT AND PAST USES OF THE SITE SECTION <br />[ <br />❑ <br />2.1 <br />Discussion of past and present uses at the site to assess potential problems. <br />3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br />t4 <br />❑ <br />3.1 <br />Description of exiting on-site septic tank usage (system types, age, functioning/repair rates). <br />❑ <br />3.2 <br />Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report). <br />'q] <br />❑ <br />3.3 <br />Discussion of on-site septic tank repair history. <br />ITI <br />❑ <br />3.4 <br />Description of existing septic tank usage in the general area (system types, ages, functioning/repair rates, <br />proximity to parcel). <br />[] <br />❑ <br />3.5 <br />General area septic permit(s) history (number/types/dates of permits, age of system, permit numbers, copies in <br />report). <br />[� <br />❑ <br />3.6 <br />Discussion of general area septic tank repair history. <br />411 <br />❑ <br />3.7 <br />Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br />4.0 <br />GROUNDWATER INFORMATION SECTION <br />Lp❑ <br />4.1 <br />Description of the depth and gradient of groundwater in the general area. <br />� <br />F-]4.2 <br />Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br />T <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 />❑ <br />4.5 <br />Description of how sample was obtained, handled, stored, and transported to the lab. <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 />`p ❑ 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 />EHD 26-02-003 Pagel of 3 Soil Suitability Checklist <br />