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Pauly SAN JOAQUIN COUNTY <br /> z: 'y ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> { 304 E Weber Avenue 3`d Floor Stockton • CA 95202-2708 <br /> (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> ..cgCIF.oR�`e <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> PAM <br /> [[SITE LOCA:::W.:: 99. jD &�k)63L �'�n4v j <br /> r� REPORT DATE: <br /> s = sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> I = Insufficient <br /> I OPOSED DEVELOPMENT SECTION <br /> S 1.0 INTRODUCTION & PR <br /> ® 1.1 Description of site, including zoning information. <br /> ®✓' 1.2 Description of proposed development. <br /> ®✓ (] 1.3 Parcel vicinity location map. <br /> rcels® ✓ 1.4 Site map showing location <br /> nof ll items con pponds,(waterways retch rives,wells, septic systems,large trees, <br /> pastures,pools, natural drainage <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> 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 /> ® [] 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers,copies in report). <br /> Z V1 3.3 Discussion of on-site septic tank repair history. s, ages,functioning/repair rates, <br /> ® ✓ 3,4 Description of existing septic tank usage in the general area(system type <br /> proximity to parcel). <br /> ®/ 3.5 General area septic permit 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 /> ✓ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> ® of the site. <br /> ®� /APN),ty <br /> pe and construction of well and location (well head/kitchen tap)where <br /> 4.3 Description of location (add <br /> water sample(s)were obtained. <br /> ®✓ 4.4 Description of constituents being tested for in the water sample. <br /> ® V 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br /> signed name of <br /> 4.6 Complete Chain of Custody osamee wasincludingprinted <br /> dthird <br /> to thelab. For Laboratorysample samplers,comp/to labo atory <br /> mpler, contion of <br /> ® sample and date and timet p <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 /> 5.2 Description of soil profile pit including depth and dimensions. <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 /> Soil Suitability Checklist <br /> p2ae t of 3 <br />