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opg N .c SAN JOAQUIN COUNTY <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave, Stockton • CA 95202-3029 <br /> c P (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> QCIFORN\ <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> FITELOCATION: �y <br /> PA#: <br /> / REPORT DATE: <br /> S = Sufficient <br /> I = Insufficient <br /> San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> E�- ❑ 1.1 Del crip�ion of site, including zoning information. <br /> F1 ❑ 1.2 Description of proposed development. <br /> ( <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 <br /> drainage courses, ponds,waterways,etc.) <br /> ra <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 /> '1 <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ ❑ 3.1 Description exiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> I <br /> E] ❑ 3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report). <br /> 2_ <br /> [� ❑ 3.3 Discussion of on-site septic tank repair history. <br /> [�] ❑ 3.4 Descriptionof existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to•oarcel). <br /> 0 ❑ 3.5 General area septic permit(s) history (number/types/dates of permits, age of system, permit numbers, copies in <br /> report). Z <br /> k] ❑ 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. <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. Z/ <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. N� <br /> ❑ 4.4 Description of constituents being tested for in the water sample. <br /> ❑ 4.5 Description oow sample was obtained, handled,stored,and transported to the lab. <br /> FA ❑ 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 jtthe abgvg,noted information. <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> ❑ 5.1 Sitemap 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 /> L <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. <br /> 3, <br />