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9 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N. { 304 E Weber Avenue 3`d Floor Stockton • CA 95202-2708 <br /> c (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: 4011 L. .)0,& - , J4 ca O PA#: <br /> REPORT DATE: 5-3 <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> 1 = Insufficient <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information. lva <br /> �cf ❑ 1.2 Description of proposed development. <br /> r� ❑ 1.3 Parcel vicinity location map. <br /> Dq ❑ 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 /> �] ❑ 2.1 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). *,"-Z <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). eithtistory <br /> ❑ 3.5 General area per (number/types/dates of permits, age of system, permit numbers, copies in <br /> report). tv L <br /> [ ❑ 3.6 Discussion of general area septic tank repair history. <br /> ❑ 3.7 Description of proposed or expected maximum (includin se on u itdellings) 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. 3 <br /> ❑ 4.2 Description/discus 'on of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. P' 3 <br /> ❑ 4.3 Description of Acation (address/APNe and construction of well and location (well head/kitchen tap)where <br /> water sample(s)were obtained. 'f <br /> ® ❑ 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. �� Y <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 /> [R ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. *F-Pl4& 12- <br /> to <br /> Z® ❑ 5.2 Description of soil profile pit including depth and dimensions. �a'* 13 <br /> kj ❑ 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 />