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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205 c4�%FORa�P Telephone: (209) 468-3420 Fax: (209)468-3877 Web:www.sjgov.org/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: (''P% q's2a(p PA#: S = Sufficient �`� 1�1i,•241103 I = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description of site, including zoning information. 4tne. hC,_% Gcgj ' 121J,2 ❑ 1.2 Description of proposed development. I' -rof iV1WIVrISI ),l ihp 'b - Oa) acrt pa.rc xs �e crw_ ❑ 1.3 Parcel vicinity location map. iid coynamiovi p nV0J4 3.2 aC're hov�necit-e PfArc'Q ❑ 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.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION 'R.e�tdtf�tl al � ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. ev2iCu�,t'ltTt)1 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). �Xisno �s� lC �U�tP,�Y►f ❑ 3.2 Site septic permit hinst (/nnuAlmber/types/dates of permits, age of system, permit numbers, copies in report). ❑ 3.3 Discussion of Inl�2 septic tank repair history. IPWAI W Avibm PW H(V aHW( M ❑ 3.4 Description of existing septic tank usage in the general area (system typ s, ages,functioning/repair rates, proximity to parcel). kgt(M area- MhMrA m W �Inw) emu se, A V f lit ❑ 3.5 General area septic permit history (number/types/dates of permits, age of system, permit numbers, copies In III report). YN ❑ 3.6 Discussion of general area septic tank repair history. ❑ 3.7 Description of propose or expected maximum (includinq second unit dwellings) septic tank usage on site. ��m�� bu�io�l '�¢r s he d jhCjUajj J i m 4.0 GROUNDWATER INFORMATION SECTION k_.Q ❑ 4.1 Description of the depth and gradient of groundwater in the general area. )Wi' -n Vjd_� qYQd(6►-fit ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location n of the site. Ll��{ ❑ 4.3 Description of location (address/APN), type and construction of well and location (well head/kitchen tap)where water sample(s)were obtained. I'1 ,, ❑ 4.4 Description of constituents being tested for in the water sample. a Urn��C W • �A'mrary T 1913cp ❑ 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. EHD 26-03 Page 1 of 3 SOIL SUITABILITY STUDY CKLST 4/24/12