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SAN .JOAQUIN COUNTY ■ <br /> EN\/IRONMENTAL HEALTH DEPART1'vi.6N i <br /> �. 30=1 E Weber Avenue 3rd Floor Stockton • CA 95202=2708 <br /> '• (209)46$-3420 Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd � �— <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> PA 0200013 <br /> SITE LDCATION: <br /> 17238 N Bruella Rd, Victor, CA #: <br /> REPORT DATE: 7124R003 <br /> S - sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> I = Insufficient <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑✓ 0 1.1 Description of site, including zoning information. <br /> 0 ❑ 1.2 Description of proposed development. <br /> 0 ✓❑ 1.3 Parcel vicinity location map. <br /> ❑ 0 1.4 Site map showing location of all items on parcels(i.e.,structures, drives,wells, septic systems, lame trees, <br /> pastures,-pools, natural drainage courses, ponds,waterways,etc.) <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> a ❑ 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 existing on-site septic tank usage(system types, age,functioning/repair rates). <br /> ❑✓ ❑ 3.2 Site septic permit history(numberhypes/dates of permits, age of system, permit numbers, copies in report). <br /> ❑✓ ❑ 3.3 Discussion of on-site septic tank repair history. <br /> a ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, <br /> proximity to parcel). <br /> ✓V ❑ 3.5 General area septic permit history(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). <br /> ❑✓ ❑ 3.6 Discussion of general area septic tank repair history. <br /> h 7V ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings)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. <br /> ❑ 0 4.2 Description/discussion of any existing and/or potential groundwater contaimination 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. <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 tab. <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 /> 7V ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. <br /> a ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> ❑ ❑ 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 /> Erin 26-02-003 Page 1 of 3 <br /> 7/14/2003 <br />