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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Avenue 3rd Floor Stockton•CA 95202-2708 <br /> S� $ (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: ,j-x.21 S� yy PA#: O� - Doo ayd <br /> REPORT DATE: &28/be <br /> be <br /> S = Insu icic San Joaquin Count Development Title Chapter 9-1105, Section 9-1105.2 <br /> 1 Insufficient 9 Y P <br /> S I 1.0 INTRODUCTION 8 PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information. raj /. S.5 <br /> ❑ 1.2 Description of proposed development. �;,� y .55 <br /> ❑ 1.3 Parcel vicinity location map. P�//�'a <br /> n/ ❑ 1.4 Site map showing location of all items on parcels(i.e.,structures,drives,wells,septic systems,large trees, <br /> lam-' pastures,pools,natural drainage courses,ponds,waterways, etc.) <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. /Jy -7- <br /> 3.0 <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> ❑ 3.1 Description of existing on-site septic tank usage(system types,age,functioning/repair rates). Z <br /> ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system,permit numbers,copies in report). <br /> ❑ ❑ 3.3 Discussion of on-site septic tank repair history. ,,,j 3 <br /> ❑ ❑ 3.4 Description of existing septic lank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). /j 3 <br /> ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system, permit numbers,copies in <br /> report). 9,,"'4X /D <br /> ❑ 3.6 Discussion of general area septic tank repair history.)9" <br /> ❑ ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. Py S <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> ❑ 4.1 Description of the depth and gradient of groundwater in the general area. G./„) le V_d5--jPe <br /> ❑ 4.2 Description1discussion of any existing and/or potential groundwater contaimination issues in the general location <br /> of the site, w/A <br /> 0 ❑ 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. s- <br /> ❑ 4.4 Description of constituents being tested for in the water sample. /"/'P_ <br /> ❑ ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. r/A <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. '__VA- <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. /}T'!"^--""` A <br /> ❑ 5.2 Description of soil profile pit including depth and dimensions. /Wd `7 <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..rb y <br /> EHDZQuz-003 Page I of <br /> 7/14/2003 <br />