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C, SAN JOAQUIN COUNTY
<br /> ' ENVIRONMENTAL HEALTH DEPARTMENT
<br /> SU o01 132.5
<br /> j 304 E Weber Avenue 3'Floor Stockton •CA 95202-2708
<br /> 209
<br /> � : ( )468-3420• Fax:(209)464-0138 • Web:www.cosan-joaquin.ca.us/ehd
<br /> F�iFQR�•1`
<br /> SOIL SUITABILITY STUDY c REQUIREMENTS CHECKLIST
<br /> SITE LOCATION: 2 VY e- IJrleS r Lo (y r PA#' C) � L{-
<br /> 7 YY REPORT DATE: p
<br /> S = Sufficient
<br /> 1 = Insufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 JC txt` 20'0
<br /> SI 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION
<br /> Ly / ❑ 1.1 Description of site, including zoning information. A R-40
<br /> L__g,,/// ❑ 1.2 Description of proposed development. I it 5aC 4C 1 x 4""C, I x35 P4.S�1 4
<br /> /❑ 1.3 Parcel vicinity location map.
<br /> I / ❑ 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 USES OF THE SITE SECTION
<br /> ❑ 2.1 Discussion of past and present uses at the site to assess potential problems.
<br /> — 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTIO , + 517
<br /> E(�'/ r-13.1 Description of exiting on-site septic tank usage(system types, age,furcfioning/JJrepair rates).
<br /> [l]/ ❑ 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 /> Ly' ❑ 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 /> 3.7 Description of proposed or expected maximum (including second unit dwellings)sepN, is tank usage on site.
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<br /> 4.0 GROUNDWATER INFORMATION SECTION ��11 (.,.�
<br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. 40 ' Qa114✓ L4-a A)
<br /> ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location
<br /> the site.
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<br /> 4.3 Description of location (address/A ),type and constru ion of well an Iocat�'on (well head/kitchen tap)where
<br /> water sample(s)were obtained. /� . �? Vrr�f I Z_�� �/�
<br /> [2 ❑ 4.4 Description of constituents being tested for in the water sample. /J 03 /�oe / - C� N
<br /> L� ❑ 4.5 Description of how sample was obtained, handled,stored,and transported to the lab. ��q/
<br /> 4.6 Complete Chain of Custody document, including L
<br /> ❑ p y g 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,cgQgplete laboratory
<br /> report to include the above noted information. d
<br /> 5.0 SOIL PROFILE INFORMATION SECTION J Q 9, 1 P4e VeS
<br /> 0-3'1 0 U'
<br /> ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. S0",k"
<br /> I Lab * fhN5
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<br /> ❑ 5.2 Description of soil profile pit including depth and dimensions. ��-�� ', Glc,uf
<br /> �n5�rm vrk"k- s,,;
<br /> E3// ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry
<br /> industry standard protocol.
<br /> ❑`/ ✓ �"0
<br /> ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. F 1 I"-t 1
<br /> -Iry u(\ l Oct,m 50,A d
<br /> E D 26-02-003 Page 1 of 3 J J soii suaaba Checklist
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