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SAN JOAQUIN COUNTY <br /> Q ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave, Stockton• CA 95202-3029 <br /> p <br /> (209)468-3420• Fax.(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> ESITELOCATION-: PAM <br /> /5 00.96"72, <br /> REPORT DATE: <br /> S = Sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 <br /> I = Insufficient <br /> S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information. <br /> ❑ 1.2 Description)of proposed development. <br /> ❑ 1.3 Parcel vicinity location map. 4-11- <br /> 1.4 <br /> `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 problems-2- <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 /> Z 7j <br /> ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers, copies in report). <br /> z , � <br /> ❑ 3.3 Discussion of on-site septic tank repair history. <br /> ❑ 3.4 Description of ex sting septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel)2 j3 <br /> ® ❑ 3.5 General area septic permit(s)history(number/types/dates of permits,age of system, permit numbers, copies in <br /> report). L�5 <br /> 4 ❑ 3.6 Discussion of general area septic tank repair history. <br /> Q ❑ 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 <br /> and gradient of groundwater in the general area. <br /> F±] F] 4.2 Description/discussioA df any existing and/or potential groundwater contamination issues in the general location <br /> of the site. 9j -) <br /> ❑ 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. y,� <br /> d❑ ❑ 4.4 Description of constituents being tested for in the water sample. <br /> h <br /> E3 ❑ 4.5 Description of how sample was obtained, handled,stored, and transported to the lab. <br /> ❑ F-1 4.6 Complete Chain of Custody doument, 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. AT <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> ® ❑ 5.1 Site map showing thelocation,with dimensions, of the soil profile pit on the parcel. <br /> ❑ ❑ 5.2 Description of soil pro Ifle 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 /> 5-6 � <br /> ❑ 5.4 Discussion of soi(lithology as related to future onsite septic uses. <br /> f —6 <br />