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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 t Weber Avem:e 3d Floor Stockton• CA 95202-2708 <br /> (209)46$-3420•Fax:(209)464-0138• Wed:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: <br /> 17238 N Bmella Rd, Victor, CA PA#: 0200013 REPORT DATE: 7/24/2003 <br /> s = sufficient San Joaquin County Development Tdie Chapter 9-1105,Section 9-1105.2 <br /> i = Insufficient <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑✓ ❑ 1.1 Description of site,including zonirsg information. <br /> ✓❑ ❑ 1.2 Description of proposed development <br /> ❑• ❑ 1.3 Parcel vicinity location map. <br /> p <br /> 1.4 Site ma showing location of all iterns on parcels(i.e.,structures,drives,wells,septic systems,large trees, <br /> ✓ <br /> ❑ pastures,pools,natural drainage courses,p d <br /> 2.0 PRESENT AND PAs,waterways,etc.) <br /> ST USES OF THE SITE S> TION <br /> II ✓ 2.1 Discussion of past and present rases at the site to assess potential problems. <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ f V 3.1 Description of existing on-site septic tank usage(system types,age,functioning/repair rates). <br /> ✓❑ ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system,permit numbers,copies in report). <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). <br /> ✓❑ ❑ 3.6 Discussion of general area septic tank repair history. <br /> RD ❑ 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 /> ❑ '� 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 lab. <br /> 4.6 Complete Chain of Custody document,including printed and signed name of third party sampler,condition of <br /> El El <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 /> ❑✓ ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. <br /> 0 ❑ 5.2 Description of soil profile pit inckding 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 rNated to future onsite septic uses. <br /> EHD 2602-003 Page 1 of 3 <br /> 7114/2003 <br />