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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c9�%FaRa�P Telephone: (209) 468-3420 Fax: (209) 468-3877 Web:www.sjgov.org/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: 44go �.Gheagt 0 W-off'' G11 aSZjr::' PA#: <br /> 41AH �- Ghent" 2Dctd,SM"h on �5 5 <br /> S = Sufficient U'IWW712 Kti-- <br /> I = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information. Q(,Ir>! (�� �Olrt G% 12—L <br /> ❑ 1.2 Description of proposed development. p0.��hJ0 (� C�� tom a� 0t d�Ue�� I�YII{ rQ�pNe(k) <br /> ❑ 1.3 Parcel vicinity location map. <br /> ❑ 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 /> POWS-hO WeA to 06-)no� 14caredl where SDK 1Au.r Otvi rJ , cxw A� -Me. d wecsr <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION Cpr-w),L tlF ve ltyzN <br /> ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. hom,6 <br /> \Wk WAtIun Nw' <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION g-,gol( l-IS , <br /> ❑ lu•24.tZ4�t�o 3.1 Description of existing on-site septic tank usage(system types, age,functioning/repair rates). �\C 1o1�(p <br /> 108*► S.T. 5p' LL 3 33'1 -. 25 d.&Ppit, <br /> ❑ 3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report). <br /> N0 ► PAN, pwmt�f tw -me Sii-e <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). <br /> ❑ 3.5 General area septic permit history (number/types/dates of permits, age of system, permit numbers, copies in <br /> report). g"a1 OU 6A- I l a(h I(V)IJ-c IV) Setracp pltj <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> TF] <br /> 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ' (�aD' -Flow hD,(�(J- <br /> ❑ 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. 09#1 VAi NK(C'e ID Gtbai-C <br /> ❑ 4.4 Description of constituents being tested for in the water sample. 17P�GI° lylfirgKd <br /> ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <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 /> EHD 26-03 Page 1 of 3 SOIL SUITABILITY STUDY CKLST <br /> 4/24/12 <br />