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SAN JOAQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 304 E Weber Avenue 3rd Floor Stockton•CA 95202-2708
<br /> (209)468-3420•Fax.(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd
<br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST
<br /> SITE LOCATION: '- l j, �j CGLtw�� �Gl PA#:
<br /> REPORT DATE: _3
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<br /> 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. s I}�/Q4 /
<br /> d ❑ 1.2 Description of proposed development. I6o.,rnB �y3.,a,.,,,C:.. y �""�'4
<br /> ❑ ❑ 1.3 Parcel vicinity location map.
<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 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 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(number/types/dates of permits,age of system,permit numbers copies in repgrt)
<br /> .
<br /> ❑ ❑
<br /> 3.3 Discussion of on-site septic tank repair history. �/. /„g 7
<br /> ❑ 3.4 Description of existing septic tank usage in the general are (system types,ages,functioning/r pair rates,
<br /> proximity to parcel).
<br /> Ea ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system, permit numbers,copies in
<br /> report). wyee "qtr-&
<br /> ❑ 3.6 Discussion of general area septic tank repair history.
<br /> Ea ❑ 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 /> t� ❑ 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 /> >f Q ❑ 4.5 Description of how sample was obtained, handled,stored,and transported ranspod to the lab.
<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 /> d ❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel.
<br /> ❑� ❑ 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. -_ ^a3 .,,,,,w„rw/AL,Oa.�,�(,f 0'e
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<br /> END 2602-003 Page I of 3
<br /> 7/IM2003
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