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o? " SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3`"Floor Stockton • CA 95202-2708 (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd Oq��F OO RN'P SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: 2 l /LrL� /L� _. �} y.� PA#: 06- 000S3(4t_5.) REPORT DATE: '� = Sufficient I = Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION fs� [3/ ❑ 1.1 Description of site, including zoning information. C,lS_/�Zi El �t 1.2 Description of proposed development. ❑ 1.3 Parcel vicinity location map. ❑ 1.4 Site map showing location of all items on parcels (i.e., structures, drives,wells, sieptic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.) / G 2.0 PRESENT AND PAST USES OF THE SITE SECTION ria /3� ❑ 2.1 Discussion of past and present uses at the site to assess potential problem d3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION Sµ� ❑ 3.1 Description of exiting on-site septic tank usage (system types, age,functioning/repair rates). �oee�Ywh- ❑ 3.2 Site septic permit history (number/types/dates of permits, age o ystem, permit numbers, copies in report). ❑ 3.3 Discussion of on-site septic tank repair histor ,'+ .' ) ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, proximity to parcel). ❑ 3.5 General area septic per (s)history(number/types/dates of permits,age of system, permit numbers, copies in 0,)I report). El 3.6 Discussion of general area septic tank repair history. L/) Lg ❑ 3.7 Description of proposed or expected maximum (including secondnit dwellings) septic tank usage on site. /' GF"� 4.0 GROUNDWATER INFORMATION SECTIOW [� ❑ 4.1 Description of the depth and gradient of groundwater in the general ar� ( ❑ 4.2 Description/discussion of any/exisling and/or potential groundwater contamination i3sues in the general location of the site. 1 �. C 5 J ❑ 4.3 Description of location (address/APN),type and construction of well and location (well head/kitchen tap)where water sample(s)were obtained., C. � ❑ 4.4 Description of constituents beimtested for in the water sample-J6 I [-� ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the I �- 6 [� ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third tity sampler, condition of sample and date and time the sample was submitted to the lab. For LaboratYYY samplers,ca�nplate laboratory report to include the above noted information. / p�'67 �`l 5.0 SOIL PROFILE INFORMATION SECTION V E/ ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the par Ey ❑ 5.2 Description of soil profile pit including depth and dimensions.(/? ❑ 5.3 Description of soil lithology as noted from test pit by appropriate pre ieyijI using industry standard protocol. ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses./J 7) EHD 26-02-003 Pagel of 3 �-/ Sail Suitability Checklist