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SAN JOAQUIN COUNTY <br /> EPKIRONMENTAL HEALTH DEPARTMENT <br /> Ail > 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 /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: G✓I F5e2aXI1 PA#: 6) — 3y <br /> REPORT DATE: <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> 1 = Insufficient <br /> S l 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ® ❑ 1.1 Description of site, including zoning information l <br /> ® ❑ 1.2 Description of proposed development. ) � / <br /> ® ❑ 1.3 Parcel vicinity location map. c,/,� A'] <br /> [a} ❑ 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 /> ❑ 2.1 Discussion of past and present uses at the site to assess potential problemst��> <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 rateop-1) <br /> ® ❑ 3.2 Site{seeplic piittfhis r(number/types/dates of permits, age of system, permit numbers, copies in report). <br /> [x] ❑ 3.3 Discussion of on-site septic tank repair history. 4 <br /> a ❑ 3.4 Description of existinseptic ta9k usage in the general area(system types, ages,functioning/repair rates, <br /> proximity to parcel). <br /> ❑ 3.5 General area septic it(s)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 historyE )( r <br /> �. ❑ 3.7 Delscriript�n of proposed or expected maximum (including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> [ ❑ 4.1 De riptiogof the depth and gradient of groundwater in the general area. <br /> a E] 4.2 Deftri tion/discussi n of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. 3 <br /> ❑ 4.3 Description of oca ' n(address/APN), type and construction of well and location (well head/kitchen tap)where <br /> water sample(s)were obtained. <br /> ® ❑ 4.4 Description of constituents being tested for in the water sample.�t <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. /VA- <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> ® ❑ 5.1 Sitpap ghgwing the location, with dimensions, of the soil profile pit on the parcel. <br /> (f El Des ri I tion of soil profile pit including depth and dimension fz­�� <br /> [ ❑ 5.3 gescri tion of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> ❑ 5.4 1IDiscussion of soil lithology as related to future onsite septic uses.J�r Z) <br /> EHD 26-02-003 Pagel of 3 soil Suitability Checklist <br />