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SAN JOAQUIN COUNTY ? ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. Hazelton Ave, Stockton • CA 95202-3029 \c 209 468-3420 • Fax: 209 464-0138 • Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: PA#: ' 1� —ppp 3 7 C� 31 c4 S ` �� 33 l ru cy `l 53 v�I REPORT DATE: 17 Z I S = Sufficient San I = Insufficient Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ ❑ 1.1 Description of site, including zoning information. l [ ❑ 1.2 Descrioto of� oosed development. K E] 1.3 Parcell�cinity location map. [� ❑ 1.4 Site map showing location of all items on parcels (i.e., structures, drives,wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 11 3.0 EXIS I G AND PROPOSED SEPTIC TANK USAGE SECTION ❑ 3.1 Description of exiting on-site septic tank usage (system types, age,functioning/repair rates). ® ❑ 3.2 Site septic��rmit h1st6k enumber/types/dates of permits,age of system, permit numbers, copies in report). 6 z ❑ 3.3 Discussion of on-site septic tank repair history. Z ® ❑ 3.4 Description of sting septic tank usage in the general area(system types, ages,functioning/repair rates, proximity to parcel). i ® ❑ 3.5 General area septic permit(s) history(number/types/dates of permits, age of system, permit numbers, copies in report). Pb �2 ® ❑ 3.6 Discussion of general area septic tank repair history. 2 ❑ 3.7 Description off�ro ose/d'or expected maximum (including second unit dwellings) septic tank usage on site. 4.0 GROUNDWATEK INFORMATION SECTION ® ❑ 4.1 Description of-t e depth and gradient of groundwater in the general area. ® ❑ 4.2 Description/di�culsion of any existing and/or potential groundwater contamination issues in the general location of the site. I �] ❑ 4.3 Description of location (address/APN),type and construction of well and location (well head/kitchen tap)where water sample(s)were obtained. �] ❑ 4.4 Description of constituents being tested for in the water sample. ® ❑ 4.5 Description of hcw�ample was obtained, handled, stored, and transported to the lab. ® ❑ 4.6 Complete Chari of Custody document, including printed and signed name of third party sampler, condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION 4 ❑ 5.1 Site map s'h`pwiing the location,with dimensions, of the soil profile pit on the parcel. ® ❑ 5.2 Description of soil profile pit including depth and dimensions. 2 ® ❑ 5.3 Descridfi99 on 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.