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i•41u.f i_11A <br /> SAN°o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> t 304 E Weber Avenue 3`a Floor Stockton•CA 95202-2708 <br /> (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd <br /> . . <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> FSIITEL70CATIONW.: ZZ179ra /� � Yj PA III: <br /> REPORT DATE: 7L�L <br /> S = Insufficient <br /> ic <br /> nt <br /> 1 = Insuf7mient q San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> 1 ' ❑ 1.1 Description of site,including zoning information. <br /> ❑ ❑ 1.2 Description of proposed development. <br /> -�� ❑ 1.3 Parcel vicinity location map. P lu-fa z- <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 /> may( 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> (J ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> I . <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). I <br /> I©-_ [:13.2 Site septic permit history(number/types/dates of permits,age of system,permit numbers,copies in report). <br /> (j� ❑ 3.3 Discussion of on-site septic tank repair history. rr v FY ,, L rq J 3 <br /> ❑✓ ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). <br /> �� ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers,copies in 3 <br /> report). <br /> F-71buaK <br /> ❑ 3.6 Discussion of general area septic tank repair history. Y, `J 3 <br /> ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. h 4 <br /> IJ <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> D� ❑ 4.1 Description of the depth and gradient of groundwater in the general area. p y `/ <br /> Ea-" El 4.2 Description/discussion of any existing and/or potential groundwater contaiminatlon issues in the general location <br /> ^ of the site. <br /> E-L ❑ 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. p r) i - 4 <br /> ��❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. p'T a; <br /> I��❑ 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 /> 0/0 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. 016'x <br /> / (� <br /> 0.i ❑ 5.2 Description of soil profile pit including depth and dimensions. b L9(p <br /> 0-�❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. �y L <br /> �❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. G <br /> EHD 2602-003 Page I of 3 / <br /> 7/142003 <br />