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o°~ ley SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3`d Floor Stockton • CA 95202-2708 "v (209)468-3420 • Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd 9</CORN SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST E E LOCATION: 4/ �/l //,r� /,(_� ZZ]?77 PA#: ��iQ7 !/� Y I / `� , / J REPORT DATE: S = Sufficient I = Insufficient San 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 informatiorct,fl ® ❑ 1.2 Description of proposed developmer(,L�z) ® ❑ 1.3 Parcel vicinity location map. / a) ® ❑ 1.4 Site map showing location o I 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 proble�t�lt 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ® ❑ 3.1 Description of exiting on-site septic tank usage (system types, age, functioning/repair rates ej, Q ❑ 3.2 Site septic permit history(number/types/dates qft�griits, age of system, permit numbers, copies in report). ❑ 3.3 Discussion of on-site septic tank repair history _S) ® ❑ 3.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates, proximity to parceN:_,3) ® ❑ 3.5 General area septic permit(s) history (number/types/dates of permits, age of system, permit numbers, copies in report).( '>> Rij ❑ 3.6 Discus �9 general area septic tank repair history. ❑ 3.7 Descn44ion of/�roposed or expected maximum (including second unit dwellings)septic tank usage on site. l� 17-D 4.0 GROUNDWATER INFORMATION SECTION ) ❑ 4.1 Description of the depth and gradient of groundwater in the general are Pcr lmO-+ 6U^4_' Y/ ❑ 4.2 Description/discussion of any existing and/or potential groundwater coma r�nnation""iissues in the general location of the site.77 ® ❑ 4.3 Descriptio f location (address/APN),type and construction of well and location (well head/kitchen tap)where water sample(s)were obtained,,V6 7z) ❑ 4.4 Descriptioncoa5tituents being tested for in the water sample. ❑ 4.5 Description 6iow gample was obtained, handled, stored, and transported to the lab. R F-14.6 Complete Ch ofCustodydocument, including printed and signed name of third party sampler, condition of sample and date and time the sample was sub fitted to the lab. For Laboratory samplers, complete laboratory report to include the above noted information "r 4 5.0 SOIL PROFILE INFORMATION SE ION [� ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel.(kre G 1 8 ❑ 5.2 Descrip tin of soil profile pit including depth and dimensions. © ❑ 5.3 Descrip of soil as noted from test pit by appropriate professional using industry standard protocol. ❑ 5.4 Discussion o soil lithology as related to future onsite septic uses. EHD 26-02-003 Page I of 3 Soil Suitability Checklist