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p4 '" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: k <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Far: (209)464-0138 Web:www.sjgov.org/ehd <br /> CgCI F O RN`P <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> �t� �1etn <br /> SITE LOCATION: PA#: OOD 65 <br /> REPORRTT•D(AjTE: A Zo Ip <br /> 06 <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 rj ft 5-p O <br /> I = Insufficient <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> [_�J ❑ 1.1 Description of site, including zoning information. <br /> p� ❑ 1.2 Description of proposed development. Z q arC e Parc- <br /> �/ gZcre, _ <br /> [l� ❑ 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 drainage courses, ponds,waterways, etc.) <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 /> 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). <br /> ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report). <br /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> [� ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, <br /> proximity to parcel). <br /> [S ❑ 3.5 General area septic permit history(number/types/dates of permits, age of system, permit numbers, copies in <br /> report). <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. <br /> 4.0 GROUNDWATER INFORMATION SECTION / <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. ( V <br /> [� ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> of the site. <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. <br /> ,C—J! ❑ 414 Description of constituents being tested for in the water sample. <br /> �j ❑ 4.5 Description of how sample was obtained, handled, stored,and transported to the lab. <br /> L]-1/ ❑ 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 /> ❑ 5.1 Site map 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 /> ❑ 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 /> Etm2e-0z-oos Page 1 of Soil Suitability Checklist <br />