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SAN JOAQUIN COUNTY z' � ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue P Floor Stockton- CA 95202-2708 (209)468-3420 -Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd �?fas3J SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST _ _ PA#• Q — —00 676-0` i SIVE LOCATION: 7�� /7t"AHkC REPORT DATE: 3 S = sufficient San Joaquin County Development Ttle Chapter 9-1105,Section 9-1105.2 I = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ® ❑ 1.1 Desscriptioyjof site, including zoning information. ❑ 1.2 Dbscr ion"/� pr posed development. ❑ 1.3 Parce icinity lotion map. 4,4-t) R ❑ 1.4 Site map showing location of all items on parcels(i.e., structures,drives,wells, septic systems, large trees, pastures, pools, natural drai ge courses, ods waterways, etc.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION ® ❑ 2.1 Discussion of past and present uses at the site to assess potential problem //�2') 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION [� ❑ 3.1 Description of exiting on-site septic tank usage(system types,age,functioning/repair rateoj� *4)c3) ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers,pepirppart_), ❑ 3.3 Discussion of on-site septic tank repair history rvY�3 �- .) ® ❑ 3.4 Description of existing s ptic tank usage in the eneral area(system types, ages,functioning/repair rates, proximity to parcel)�P E ❑ 3.5 General area sec permit(s)history(number/types/dates of permits,age of system, permit numbers, copies in 1 report . � ❑ 3.6 Discussion of general area septic tank repair hist ry: j � ❑ 3.7 Description(� of proposed or expected maximum (incIU ng second unit dwellings)septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION JA ❑ 4.1 Description of the depth and gradient of groundwater in the general areo&3) ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location of the site. ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where water sample(s)were obtained. t��.�h �- ❑ 4.4 Description of constituents being test r in the water sample. �� 3 41(x' ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the laCA__ , ,® ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers, complete laboratory report to include the above noted informatior�. s, 5.0 SOIL PROFILE INFORMATION SECTION 0- ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parc-e ❑ 5.2 Description of soil profile pit including depth and dimensions. fl-1- 5.3 5.3 Description of soil lithology as noted from test pit b apprppte professional using industry standard protocol. ❑ 5.4 Discussie of soil lithology as related to future onsite septic uses- Y 3 � h� EHD 26-02-003 ` Pagel of 3 so;i su;tab;;;ry Checklist fit A MIV1'1 �