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u,. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> J 304 E Weber Avenue 3rd Floor Stockton•CA 95202-2708 <br /> (209)468-3420•Fax:(209)464-0138 • Web:www-co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> EITELOCAT7ION' Z FSO . PA#: J;�/, - Ys-2-,l <br /> REPORT DATE: O <br /> S = Sumcicnt San Joaquin Count Development Title Chapter 9-1105, Section 9-1105.2 <br /> 1 = Insufficient q Y P <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information. /cif <br /> ❑ 1.2 Description of proposed development. /9y 7 <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 drainage courses,ponds,waterways,etc.) <br /> I�'Dh.+swl ♦C <br /> �—y 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> U ❑ 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 /> I� ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioningtrepair rates) / f�enc2•ar <br /> L`�I/❑ 3.2 Site septic permit history(number/types/dates of permits,age of system,permit numbers,copies in report)./� f <br /> l�I ❑ 3.3 Discussion of on-site septic tank repair history. �o. <br /> ❑� ❑ 3.4 Description of existing septic lank usage in the general area(system types,ages,functioning/repair rales, <br /> Proximity to parcel).� - <br /> ❑ J 7 > i�p/7aK/iar <br /> 3.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers,copies in <br /> L2--- <br /> '-� report). /'j j " <br /> ltd ❑ 3.6 Discussion of general area septic tank repair history. /?q <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 /> Er ❑ 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 contaiminalion issues in the general location <br /> of the site. /r y 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.,V,, <br /> D' - El 4.4 Description of constituents being tested for in the water sample. <br /> E2 ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. <br /> D-� 'o 4-6 Complete Chain of Custody document,including printed and.signed name of third party sampler,condition of <br /> sample and dale and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory <br /> report to include the above noted information. /7_7 Z S <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> L20*�❑ 5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel.Py 'Z >0 <br /> EY ❑ 5.2 Description of soil profile pit including depth and dimensions- /dc✓ y 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 /> EHD 26-02-001 Page I of 3 <br /> 7/14/1001 <br />