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°p4UIN' SAN JOAQUIN COUNTY <br /> 2r ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton • CA 95202-3029 <br /> P (209)468-3420 • Fax:(209)464-0138 • Web: www.co.san-joaquin.ca.us/ehd <br /> 4�rFORN <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> F[ ITELOCATION: G� /� /. PA#: 12 OOrJ/� <br /> REPORT DATE: /P/q 25 2olL <br /> S = Sufficient <br /> 1 = Insufficient San 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 /> 9— <br /> ®El <br /> ❑ 1.2 Description of proposed development. <br /> I <br /> ® El1.3 Parcel vicinity location map. <br /> ❑ 1.4 Site m 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 /> y <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> [°�L ❑ 3.1 Description 'f exiting on-site septic tank usage (system types, age,functioning/repair rates). <br /> ® ❑ 3.2 Site septic permi[history(number/types/dates of permits,age of system, permit numbers, copies in report). <br /> Z <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). Z <br /> F. ❑ 3.5 General area septic permit(s) history(number/types/dates of permits, age of system, permit numbers,copies in <br /> report). 2— <br /> El ❑ 3.6 Discussion of general area septic tank repair history. <br /> v <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 /> ❑ 4.1 Descrption of the depth and gradient of groundwater in the general area. <br /> [� ❑ 4.2 Desdription/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. 0 <br /> [ ❑ 4.4 Description of constituents being tested for in the water sample. <br /> �. ❑ 4.5 Description of how sample was obtled, handled, stored,and transported to the lab. <br /> 4 <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 040304 E INFORMATION SECTION <br /> ❑ 5.1 Sitemap showing the location,with dimensions, of the soil profile pit on the parcel. <br /> ® E] 5.2 Desc/q� tionof 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 soilI�ology as related to future onsite septic uses. <br /> EHD 26-02-003 y Page I of 3 Soil Suitability Checklist <br />