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quN''�o SAN JOAQUIN COUNTY y: ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue P Floor Stockton • CA 95202-2708 • (iq;; :J_ .,iP • (209)468-3420 •Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd \..Fos+ SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST FFITELOCA--nON. Z 6/0 /X / A — — /c 3 PA r asj A14 / - 5`7� REPORT DATE: S = Sufficient San Joaquin County p p I = Insufficient 4 ty Develo ment Title Chapter 9-1105, Section 9-1105.2 SI 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION l ❑ 1.1 Description of site, including zoning informatior6e I )Z) r l // LTJ// ❑ 1.2 Description of proposed development. L.,�,/❑ 1.3 Parcel vicinity location map. �y ❑ 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, po terways,etc.) �'� �.1i1A�13, 2.0 PRESENT AND PAST USES OF TH SITE SECTION L� ❑ 2.1 Discussion of past and present uses at the site to assess potential problemsl�) / 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION cuy:) L I ❑ 3.1 Description of exiting on-site septic tank usage (system types, age, functioning/repair rats; 1J ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit nym�er �opies in report). ❑ 3.3 Discussion of on-site septic tank repair history\ T) � 6 Jj ❑ 3.4 Description of existing septic tank age in thetjeneral area (system types, ages,functioning/repair rates, / proximity to parcel). �v}" ❑ 3.5 General area septic permit(s) hist I(num er/types/dates of permits, age of system, permit numbers, copies in report). C 0 1 ❑ 3.6 Discussion of general area septic tank repair histgry. ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on sit f. V.4 4.0 GROUNDWATER INFORMATION SECTION ❑ 4.1 Description of the depth and gradient of groundwater in the general area(/G ; S ❑ 4.2 Description/discussion of any existing and/ r potential groundwater contAmination issues in the general location of the site. l/68 55 ❑ 4.3 Description of location (address/APN),type and constructiop of well and location (well head/kitchen tap)where / water sample(s)were obtained. ❑ 4.4 Description of constituents being tested for in th water§ mple. ❑ 4.5 Description of how sample was obtained, handled, stor , and transported to the I?tr W() ,,,LLL��"`SSS,,,/// ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third'pimty sampler, condition of sample and date and time the sample was submitted to the lab. F L boratgry samplers, complete laboratory report to include the above noted information. C C c° r�� J/ 5.0 SOIL PROFILE INFORMATION SECTION V7 Ul- u ❑ 5.1 Site map showin(Q.thr�ation, with dimensions, of the soil profile pit on the p cey. )`� 6 L� ❑ 5.2 Description of sd#t,profile pit including depth and dimensions,' f\l a' CALc �.J/ ❑ 5.3 Description ofIJ�ithology as noted from test pit by approp ate profe�nal using industry standard protocol. LvJ F-15.4 Discus of soil I)ithollTloogy as related to future onsite septic uses. EHD 26-02-003 �" Page I of 3 Soil Suitability Checklist