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Pa 'ia SAN JOAQUIN COUNTY <br /> . ENVIRONMENTAL"HEALTH DEPARTMENT <br /> 304 E Weber Avenue 3'd Floor Stockton• CA 95202-2708 <br /> (209)468-3420 •F=(209)464-0138 • Web.www.co.san-joagtun.ca.us/ehd <br /> R��rWn�T' <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> PA: <br /> SITE LOCATION: <br /> �� � �l- �C•�"ii~ / f;J �d1 / j� REPORT DATE: �c���� <br /> S = sufficient San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2: <br /> 1 '= Insufficient <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ❑ 1.1 Description of site, including zoning information. <br /> ❑ 1.2 Description of proposed development. <br /> ��p� ❑ 1.3 Parcel vicinity location map. <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 /> Zj' ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. <br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br /> s�f ❑ 3.1 Description of exiting on-site septic tank usage(system types, age,functioning/repair rates). <br /> ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report). <br /> ❑r' ❑ 3.3 Discussion of on-site septic tank repair history. <br /> 0 ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, <br /> proximity to parcel). <br /> f <br /> ❑ 3.5 General area septic permit 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 history. <br /> Er ❑ 3.7 Description of proposed or expected maximum(including second unit dwellings)septic tank usage on site. <br /> r <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> �� ,®' ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> �j Er ❑ 4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. <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. <br /> f�r ❑ 4.4 Description of constituents being tested for in the water sample. <br /> ,-csz. 1j`ff ❑ 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. <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. <br /> � -` ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> ' C [3— ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. I <br /> C ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> EHD 26-02-003 Pagel of 3 Soil Suitability Checklist <br />