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Fo\ SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT I <br /> 304 E Weber Avenue 3"Floor Stockton•CA 95202-2708 �P <br /> (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquimca.us/chd <br /> a4ipouS�-' <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: /A S—J 6 .11, PA#: 07 <br /> REPORT DATE: Z/// 07 <br /> S = Sumcicm San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> 1 Insufficient <br /> �S7f I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> l� ❑ 1.1 Description of site, including zoning information. /J„__y r,/ <br /> ❑ 1.2 Description of proposed development.,?. F/ <br /> 2- ❑ 1.3 Parcel vicinity]oration 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.) ;r <br /> �- <br /> y 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> E ❑ awxo.- tJ�' <br /> 2.1 Discussion of past and present uses at the site to assess potential problems. /U y/-r /Pl / d. •4 r f <br /> r <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION �(v rf 1 �,N i` JZ/ �"``c/� <br /> �����,'y ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioning/repair rates). "-f"" - <br /> r✓I ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system,permit numbers,copies in report)N�. <br /> ❑ 3.3 Discussion of on-site septic tank repair history. //� SF--o /p/a 3 <br /> Ea ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). je(' / <br /> ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers,copies in <br /> report). oy/ <br /> ® ❑ 3.6 Discussion of general area septic tank repair history./70, L <br /> Ef ❑ 3.7 Description of proposed or expected maximum(including se6br d-unit dwellings)septic tank usage on site. Nv ZnJ <br /> Ell4.0 GROUNDWATER INFORMATION SECTION <br /> E, <br /> ❑ 4.1 Description of the depth and gradient of groundwater In the general area. G y✓,+�(,U <br /> ❑.- ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> f� of the site. Ptf 2- <br /> LU ❑ 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. rt, 2— <br /> ❑ 4.4 Description of constituents being tested for in the water sample. <br /> P y✓"frn-G- <br /> ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. /'y t <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. /'l r^ of x OBC p= o 2µp It- <br /> /1/J3= <br /> �-y 5.0 SOIL PROFILE INFORMATION SECTION 0 <br /> El5.1 Site map showing the location,vhth dimensions,of the soil profile pit on the parcel. <br /> ❑/ ❑ 5.2 Description of soil profile pit including depth and dimensions.Pf 3 <br /> E' ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> - ED" ❑ 5.4 Discussion of soil Iithology as related to future onsite septic uses. S,y� Gam".•' Py& <br /> EHD26-02-003 Page I of v <br /> 71142003 <br />