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. SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton • CA 95202-3029 '. (209)469-3420 •Far:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY (STUDY REQUIREMENTS CHECKLIST SITELOCATION: yrLl.�gC7 IYtO+st/`."<cQ.�,�: \ Alc '�" - �.,/ PAM 07—d LL1t7 �5 � (� REPORT DATE: S = Sufficietit Insutficirnt San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 1 = S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ® ❑ 1.1 Description of site, including zoning information. ❑ 1.2 Description of proposed development.�11 j ❑ 1.3 Parcel vicinity location map.QE ) G tjl 1 ❑ 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.) 2.0 PRESENT AND PAST(USES OF THE SITE SECTION ® ❑ 2.1 Discu��srr/sio�of st and present uses at the site to assess potential problems. 3.0 EXITIN))G AND PROPOSED SEPTIC TANK USAGE SECTION [� ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). 2 ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). ❑ 3.3 DiscusSiXn of en-site septic tank repair history. ❑ 3.4 Descripti9of existing septic tank usage in the general area (system types, ages, functioning/repair rates, proximity to parcel). ❑ 3.5 General area(ieptic permits)history(number/types/dates of permits, age of system, permit numbers, copies in report). uJ[7� ❑ 3.6 Discussion ooff general area septic tank repair history. Lt. F] 3.7 Description oT proposed or expected maximum (including second unit dwellings)septic tank usage on site. 4.0 GROUNDi ATER INFORMATION SECTION ❑ 4.1 Description of t%depth and gradient of groundwater in the general area. E3, ❑ 4.2 Description/dldYcussion of any existing and/or potential groundwater contamination issues in the general location of the site. Y' f ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where water sample(s)were obtained. ,® ❑ 4.4 Description of coWsfituents being tested for in the water sample. Q ❑ 4.5 Description of hoW inp/i�ee)was obtained, handled, stored, and transported to the lab. ❑ 4.6 Complete 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 LLi__n��formation. 5.0 SOIL PROFILE INFORMATION SECTION ® ❑ 5.1 Site map showing the location, with dimensions, of the soil profile pit on the parcel. ® ❑ 5.2 Descilion of Soil profile pit including depth and dimensions. � I `{ ® ❑ 5.3 DescrlIlPion of Soil lithology as noted from test pit by appropriate professional using industry standard protocol. �, Z � \ '�] ❑ 5.4 Discus3ion°f-§9'�lithology as related to future onsite septic uses. L I HD 26-02-003 y Paget of 3 Soil Suitability Checklist