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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ORa`P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> PA#: — <br /> SITE LOCATION: 1��g L ( f�� <br /> I s'( 2 Z.. <br /> = Sufficient <br /> I = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> a ❑ 1.1 Description of site, including zoning information. <br /> ,] ❑ 1.2 Description of proposed development. <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 /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> 2- ❑ 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 /> Ef ❑ 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 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 /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> _4��r_ ❑ 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 construction of well and location (well head/kitchen tap)where <br /> water sample(s)were obtained. <br /> eo ❑ 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 /> EHD 26-03 Page 1 of 3 SOIL SUITABILITY STUDY CKLST <br /> 4/24/12 <br />