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p4u�" SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 C'9�jF.ORt�`P Telephone: (209) 468-3420 Fax: (209) 468-3877 Web:www.sjgov.org/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST Ig01 a�fite�so� �IvehUt' ,StOGK1�h Gra a15215 SITE LOCATION: PA#: 2N' 00 401l-N JV-2100119V REPoRT DATEn En9ruar0__LL,= S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 aN I = Insufficient S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description of site, including zoning information. -20he: k? "�_' affe, Z9.2b ❑ 1.2 Description of proposed development. MPOCIN: -WO-NmrnzrD ❑ 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.) Div PIV) li►r7s not been Gompleta no 67ar RUM in r1tpver 2.0 PRESENT AND PAST USES OF THE SITE !SECTION �] ❑ 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). ❑ 3.2 Site septic permit histo (number/types/dates of permits, age of system, permit numbers, copies in report). s01 G�1 - t2 f and Gnaw m ftmi k ❑ 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).SIzD�11G31511 ` Ig2a N. Pa11-LYSOh rVG,R0(, Vr i NOT ih 126p0r-t ❑ 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. Sits qn 4.0 GROUNDWATER INFORMATION SECTION S00hect YccvYolr',d chight6t IGv(aS Iq�3 Qnd t°K�� - �2 �r�i;'�3 YvT1 - f- 2m2T rYl ❑ 4.1 Description of the depth and gradient of groundwater in the general area. ecttlol ditzktidk) roOVe r{,,,,h ❑ 4.2 Description/discussion of any e is nq and/or potential groundwater contamination issues in the general location IVD of the site. QgI?il�Gt( i(IZC 1h'SUr"WtViy14 area ❑ ❑ 4.3 Description of location (address/APN),type and construction of well and location (well head/kitchen tap)where water sample(s)were obtained. ❑ ❑ 4.4 Description of constituents being tested for in the water sample. ❑ ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. ❑ ❑ 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. vj*r sgmpv wal mt t wt of 5tv?oCe VUGII EHD 26-03 Page 1 of 3 SOIL SUITABILITY STUDY CKLST 4/24/12