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�oAQ�`� c SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue P Floor Stockton -CA 95202-2708 h / (209)468-3420-Fax: (209)464-0138- Web:w,,vw.co.san-joaqum.ca.us/ehd \Z7FOit�i SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: w tel. _ '/fes /I }� ��,I PA#: I //Ci/ ~ -. REPORT DATE: S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 I = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description of site,including zoning information. ❑ 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,septic systems, large trees, �J pastures, pools, natural drainage courses,ponds,waterways,etc.) 9/� 2.0 PRESENT AND PAST USES OF THE SITE SECTION ❑ ❑ 2.1 Discussion of past and presQnt uses atthe�ije to�ssess potgn�(problems. 7r�� ur�S t (j 3.0 EXISTING AND ROPOSED SEPTIC TANK USAGE SECTION ❑ 0 3.1 Descr�ip p'on of eiisting on-site septic tank usage(system types,age,functioning/repair rates). ❑ //yri�C FTI3.2 Siteyeptic permit history(number/�Ypes/dates of permits,age of system,permit n m rs,copies in report). Alp S'�� rr.��.ys or r'-pow- �'rnr�fS /nc�ual�J �N Yr��r� ❑ ❑ 3.3 Discussign of on-site�etic repair history. e p a.GUr1t k 3.4 Description o existing septic tank usage in the general area(system types,ages,functioning/repair rates, El Elly proximity to parcel). ❑ E713.5 General area septic permit history(number/types/dates of permits,age of system,permit numbers, copies in report). Sri �4 f►r ❑ [Z 3.6 Discussion of general area septic tank repair history. ❑ ❑ 3.7 Description of proposed or expected maximum(including second unit llings) b. tank usage on site. �jj J y t /)'' 4.0 GROUNDWATEI�NFORMATION SECTION ❑ ❑ 4.1 Description of the depth and gradient of groundwater in the general area. 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location El ❑ of the site. -�tqe Iq and construction of well and location(well head/kitchen tap)where ED E-1 4.3 Description of location(address/APN),type water sample(s)were obtained. ❑ d 4.4 Description of constituents being tested for in the water sample. 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. sampler, condition of ❑ 4.6 Complete Chain of Custody document,including printed and signed name of third party sample and date and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory report to include the above noted infomtation. 5.0 SOIL PROFILE INFORMATION SECTION 6 V Q5.1 Site map showing the location,with dimensions,of the soil profile pit on the parcel. „///�y p�v 3 ❑ 5.2 Description of soil profile pit including depth and dimensions. F-1 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. Page I of 3 EHD 26-02-W3 7/1-L"2003