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SAN JOAQUIN COUNTY �.•.T.cOG Z ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 °9�FOR��P Telephone: (209) 468-3420 Fax: (209) 468-3877 Web:www.sjgov.org/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST K 0 000 U16. �uCz r�Iha pa-2a 1z}.st,�om Is 3 SITE LOCATION: 3I32 A bm) tI wn'^ y�„� ' rnxnti PA#: IV +f , 1�6 I 1 (�J 'nJ Rr-prm S = Sufficient Mpg- 12)1-04 - V SW 201 92 I = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Descrition of site, includin n information. Cwr( fitly �sr�l�r of Cl f�zo Tr-W- P4ar-INaar4 ❑ 1.2 Description of proposed development. �iA�iGlin�S p4Fi�f builQ�� ShO�,�hOIU(IZ -dispoma arm povAlW 10 m t n- in auAv)w at coYcmr Of prq ect ❑ 1.3 Parcel vicinity location map. ❑ 1.4 Site map showing location of all items on parcels (i.e., structures, drives,wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.) VOM esti C (t)6/ if Ggq)eiC4,1yj irtcQ -V „ Wv6�/6 i 2.0 PRESENT AND PAST USES OF THE SITE SECTION V V ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ❑ 3.1 Description of existing on-site septic tank usage (system types, age, functioning/repair rates). G�jtr�mit� WaJ ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). ❑ 3.3 Discussion of on-site septic tank repair history. ❑ 3.4 Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, proximity to parcel). ❑ 3.5 General area septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). ❑ 3.6 Discussion of general area septic tank repair history. ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION ❑ 4.1 Description of the depth and gradient of groundwater in the general area. SOWW olrCCfi oh ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location of the site. AlejCU(%r-al pr0A (,n0 n $, f0l,i2MO fD>2 0�66d6f ❑ ❑ 4.3 Description of location (address/APN), type and construction of well and location (well head/kitchen tap)where ��G water sample(s)were obtained. Pt!p01'1' Ja� NO 100MtSAI G 11 01 , �ttb VW f1D ❑ ❑ 4.4 Description of constituents being tested for in the water sample. au l-d of lv_ ptrrvfir' lWl ❑ ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. wIV7, 9 W%% t ❑ ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers, complete laboratory report to include the above noted information. EHD 26-03 Page 1 of 3 SOIL SUITABILITY STUDY CKLST 4/24/12