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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> { 304 E Weber Avenue 3rd Floor Stockton• CA 95202-2708 <br /> Q;i(►`' ' (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 PA#: 66 - eo 3 sj <br /> REPORT DATE: S13olo-f <br /> = Sufficimt <br /> I = InsuImufficicie San Joaquin County Development Title Chapter 9-1105, Section 9.1105.2 <br /> rnt <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ® ❑ 1.1 Description of site, including zoning information. 1',)4, / <br /> ® ❑ 1.2 Description of proposed development. <br /> © ❑ 1.3 Parcel vicinity location map. �r�1, .//� fyz4tc 2 <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.)' �L 1 - 2- <br /> 2.0 <br /> _ Z2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> m ❑ 2.1 Discussion of past and present uses at the site to assess potential problems.1 L <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ 3.1 Description of exiting on-site septic tank usage(system types, age, functioning/repair rates). /,//I <br /> ® ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). <br /> m ❑ 3.3 Discussion of on-site septic tank repair history. /\i/ A �f.�.fcy <br /> ❑ 3.4 Description of existing septic tank usage in the general area (system types, ages, functioning/repair rates, <br /> proximity to parcel). pyy pb & y <br /> ❑ 3.5 General area septic permit(s) history(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). ne.7/ p ja- e 4/ <br /> ® ❑ 3.6 Discussion of general area septic tank repair history.�� <br /> ® ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings)septic tank usage on site. /'y <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 contamination issues in the general location <br /> of the site. Of y <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. 1,)a t,) /�'f y <br /> J ❑ 4.4 Description of constituents being tested for in the water sample./J� 06efoP� y <br /> m ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. �� _> <br /> [4 ❑ 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. / /! -Z/ 'y <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> ❑ 5.1 Site map showing the location, with dimensions, of the soil profile pit on the parcel. pL.r'tcc Z <br /> ® ❑ 5.2 Description of soil profile pit including depth and dimensions. /�y Ll <br /> ] ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> /fpperial,k <br /> 41 <br /> ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> ry6- -� <br /> EHD2602-003 Pagel of3 Soil Suitability Checklist <br />