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<br />yF.r"''"`�•.� SAN .TOAQUIN COUNTY
<br />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 />�1FOR
<br />SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST
<br />PA #:
<br />SITE LOCATION:
<br />19 SV _�_t }7 _� j REPORT DATE:
<br />S = Sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2
<br />I = Insufficient
<br />S
<br />I
<br />1.0
<br />INTRODUCTION & PROPOSED DEVELOPMENT SECTION
<br />E33
<br />❑
<br />1.1
<br />Description of site, including zoning information.
<br />Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report).
<br />❑
<br />1.2
<br />Description of proposed development.
<br />❑
<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 />General area septic permit(s) history (number/types/dates of permits, age of system, permit numbers, copies in
<br />pastures, pools, natural drainage courses, ponds, waterways, etc.)
<br />2.0 PRESENT AND PAST USES OF THE SITE SECTION
<br />VK ❑ 2.1 Discussion of past and present uses at the site to assess potential problems.
<br />4.0 GROUNDWATER INFORMATION SECTION
<br />[9/ ❑ 4.1 Description of the depth and gradient of groundwater in the general area.
<br />❑ 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 />[ 4.4 Description of constituents being tested for in the water sample.
<br />I J 4.5 Description of how sample was obtained, handled, stored, and transported to the lab.
<br />❑ LK 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 />[,_I ❑ 5.1 Site map showing the location, with dimensions, of the soil profile pit on the parcel.
<br />LTJ' ❑ 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 />3.0
<br />EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION
<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 />❑
<br />3.3
<br />Discussion of on-site septic tank repair history.
<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 />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 />3.6
<br />Discussion of general area septic tank repair history.
<br />❑
<br />3.7
<br />Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site.
<br />4.0 GROUNDWATER INFORMATION SECTION
<br />[9/ ❑ 4.1 Description of the depth and gradient of groundwater in the general area.
<br />❑ 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 />[ 4.4 Description of constituents being tested for in the water sample.
<br />I J 4.5 Description of how sample was obtained, handled, stored, and transported to the lab.
<br />❑ LK 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 />[,_I ❑ 5.1 Site map showing the location, with dimensions, of the soil profile pit on the parcel.
<br />LTJ' ❑ 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.
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