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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton •CA 95202-3029 <br /> (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd <br /> �4t!_F okH�p <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST �{ <br /> SI � � I C �1 PA#. O U <br /> TE LOCATION: <br /> 7 5�) 1.A1/t s L 01 �J��/� REPORT DATE: <br /> � 7/2-2—/�3 <br /> I = Insufficient= InsuSufficientSan Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> © ❑ 1.1 Description of site, including zoning information. <br /> ❑ 1.2 Description of proposed development. <br /> ® ❑ 1.3 Parcel vicinity'iocation map. 4lr,,; I" <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 /> 2.0 PRESENT AND PAST SES OF THE SITE SECTION <br /> ® ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> 2- <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> { ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> 4 <br /> ❑ 3.2 Site septic permit history(number/typeYd tes of permits,age of system, permit numbers,copies in report). <br /> - 1 <br /> ❑ 3.3 Discussion of on-site septic tank repD hiitory. <br /> ® ❑ 3.4 Description of existing septic tank usa6e inthegeneral area(system types, ages,functioning/repair rates, <br /> proximity to parcel). <br /> 0 ❑ 3.5 General area septic permit(s)history(number/types/dates of permits,age of system, permit numbers, copies in <br /> report). Go 3-H <br /> © ❑ 3.6 Discussion of general area septic tank repair history. <br /> ra z- <br /> ® ❑ 3.7 Description of proposed or expe ed maximum(including second unit dwellings) septic tank usage on site. <br /> Fr-3- 't <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 contamination issues in the general location <br /> of the site. : <br /> Q ❑ 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 /> S <br /> ❑ 4.5 Description of how sample was obtained, handled,stored,and transported to the lab. <br /> ❑ 4.6 Complete Chin 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. /1 __ A"s <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 /> �] ❑ 5.2 Descript'ib of soil profile pit including depth and dimensions. <br /> Q ❑ 5.3 Descrip`tion of soil IRhology 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 /> 0 <br /> EHD 26-02.003 Page I of 3 Soil Suitability Checklist <br />