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SAN JOAQUIN COUNTY v ` ENVIRONMENTAL HEALTH DEPARTMENT 3. 600 East Main Street, Stockton■CA 95202-3029 (209)468-3420 -Fax(209)464-0138 - Web:www.co.san-joaquin.ca.us/ehd cR i o SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: �$ � /s'Z�t'r?/fit , '/C/�b � PA 00 REPORT D S/y/i Ah� it 3v S = sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 I = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ® ❑ 1.1 Description of site, including zoning information. � 2 ® El 1.2 D crip on of pro osed development. ❑ 1.3 Parcel viciniiy location map. �– ® ❑ 1.4 Site map showing location of all items on parcels(i.e.,structures, drives, wells,septic systems,large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.) pWk CA 2.0 PRESENT AND PAST USES OF THE SITE SECTION ® ❑ 2.1 Discusssion of past and present uses at the site to assess potential problems. rc 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ® ❑ 3.1 DescriptionZof exiting on-site septic tank usage(system types, age,functioning/repair rates). ® ❑ 3.2 Site sac permit history(number/types/dates of permits, age of system, permit numbers,copies in report). ® ❑ 3.3 Discu 4f on-site septic tank repair history. E ❑ 3.4 DescripQ of existing septic tank usage in the general area(system types,ages,functioning/repair rates, proximity to parcel) FA ❑ 3.5 General area se 'c permit(s)history(numberltypesldates of permits, age of system,permit numbers,copies in report). I,-3 [� ❑ 3.6 Discussion general area septic tank repair history. F-13.7 Description of pro31 posed or expected maximum(including second unit dwellings)septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION ® ❑ 4.1 Description of the depth and gradient of groundwater in the general area. ] ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location J of the site.r,5'5 fA ❑ 4.3 Description of location(address/APN),type app construction of well and location(well head/kitchen tap)where water samplle(s)w r ,pbtained. y� 111A ® E] 4.4 DescripgzRpf corfstituf�ents being tested for in the water sample. tJ/A- r� [�. ❑ 4.5 Description f how sample was obtained, handled, stored,and transported to the lab. ❑ '4.6 Complet 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 information. PA- 5.0 SOIL PROFILE INFORMATION SECTION ® ❑ 5.1 Site map sowing the to ton,with dimensions,of the soil profile piton the parcel. ❑ 5.2 Description dsoilp�bfile pit including depth and dimensions. � 6 ❑ 5.3 DescriptiX of sfail lithology as noted from test pit by appropriate professional using industry standard protocol. E ❑ 5.4 Discussior9f,spoil lithology as related to future onsite septic uses. EHD 2b-02-003 6 Page ] of 3 Soil Suitability Checklist