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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3`d Floor Stockton • CA 95202-2708 (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST F[S�IITELOCATION: � 7� 6/0 /� t�. /� c >7� PA#: Oy 2, �'] REPORT DATE: S = Sufficient San Joaquin County Development p 1 = Insufficient 9 ty evelo ment Title Chapter 9-1105, Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description of site, including zoning informatior6e l 7 2) rVL // ❑E] 1.2 Description of proposed development. �VZ 1.3 Parcel vicinity 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, porAs,viate ays, etc.) 4c ,�,1A�13, � ,�,// 2.0 PRESENT AND PAST USES OF TN SITE SECTION L/ ❑ 2.1 Discussion of past and present uses at the site to assess potential problems ) / 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION cf,uo LfI ❑ 3.1 Description of exiting on-site septic tank usage(system types, age, functioning/repair rate I I ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit nymgat�opies in report). Lh ❑ 3.3 Discussion of on-site septic tank repair history d ❑ 3.4 Description of existing septic tank yyysssage in proximity to parcel). the\Jeneral area (system types, ages, functioning/repair rates, F1—/ �r� ��3.5 General area septic permit(s) hist 1(numljer/types/dates of permits, age of system, permit numbers, copies in report). / y y ❑ 3.6 Discussion of general area septic tank repair histgry. fell)ll) ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on sit f y 3 4.0 GROUNDWATER INFORMATION SECTION sem' ❑ 4.1 Description of the depth and gradient of groundwater in the general areas F-14.2 Description/discussion of any existing and/qr potential groundwater cont ation issues in the general location of the site. 68 >/ ❑ 4.3 Description of location (address/API), type and constructi of well and location (well head/kitchen tap)where water sample(s)were obtained. / ffi Z ❑ 4.4 Description of constituents being tested for in the water mple.�, ❑ 4.5 Description of how sample was obtained, handled, storC, an7transported to the latr:� ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third(Rorty sampler,condition of sample and date and time the sample was submitted to the lab. Fo boratQgry gamplers, complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION ❑ 5.1 Site map showin the or 5.1 with dimensions, of the soil profile pit on the p»rce ❑ 5.2 Description of sWr� pit including depth and dimension`'Sl ❑ 5.3 Descriptio i)lithology as noted from test pit by appropriate profe(s '`nalusing/industry standard protocol. ❑ 5.4 Discus of soil I)itholloogy as related to future onsite septic uses. EHD 26-02-003 \- r o > Page 1 of 3 Soil Suitability Checklist