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�P4 1 SAN JOAQUIN COUNTY <br /> EN TKONMENTAL HEALTH DEPARTMLfiIT <br /> 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 /> �a L�,OaNj� <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: PA: <br /> REPORT DATE: <br /> = Sufficient <br /> I Insufficient= San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> 35;�0" ❑ 1.1 Description of site, including zoning information. <br /> i B- ❑ 1.2 Description of proposed development. <br /> -lF e' ❑ 1.3 Parcel vicinity location map. <br /> �F� ❑ 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 /> 'i� ❑ 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 /> ' 2- ❑ 3.2 Site septic permit history (number/types/dates of permits, age of system, permit numbers,copies in report). <br /> ,,0' ❑ 3.3 Discussion of on-site septic tank repair history. <br /> e� ❑ 3.4 Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, <br /> proximity to Parcel). <br /> 3.5 General area se <br /> F-1 3.5 permit p p 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. <br /> 0 ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination 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 />"` _ ul ❑ 4.4 Description of constituents being tested for in the water sample. <br /> ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br /> ❑ 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 /> a � ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> � Ey ❑ 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 26-02-003 Page I of 3 Soil Suitability Checklist <br />