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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton-CA 95202-3029 (20%468-3420 •Fux:(209)464-0138 ■ Web:www.co.san-joaquin.ca.us/ehd SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST SITE LOCATION: 1 �tj w. �a `j5 3 77 PA#: .1 Ir CLIP rA[,r,�/ REPORT DATE: { S = smfflcict I = InsutFici� San Joaquin County Development Title Chapter 8-1105,section 9-1105.2 S 1 1.0 INTRODUCTION $ PROPOSED DEVELOPMENT SECTION © ❑ 1.1 Description of site,including zoning information. ® ❑ 1.2 Description of proposed development. 1 ❑ 1.3 Parcel ,��nrity location map. E ❑ 1.4 Site mdp 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. i 3.0 EX13TI O AND PROPOSED SEPTIC TANK USAGE SECTION 9 ❑ 3.1 Description of exiting on-site septic tank usage(system types,age,functioning/repair rates). ❑ 3.2 Site septic permit history(number/types/dates of permits,age of system, permit numbers,copies in report). z im ❑ 3.3 Discussion of on-site septic tank repair history. 0 ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, proximity to parcel). ® E] 3.5 General area septic permit(s)history(numberttypes/dates of permits,age of system, permit numbers, copies in report). Z ® ❑ 3.6 Discussion of general area septic tank repair history. ❑ 3.7 Descriptio proposed or expected maximum(including second unit dwellings)septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION ® 4.1 Description of thr�depth and gradient of groundwater in the general area. [e� 4.2 Description/discu'ssion of any existing and/or potential groundwater contamination issues in the general location of the site. 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where 47 water sample(s)were obtained. 4.4 Description of constituents being test in the water sample. 4.5 Description of how sample was obtained, ndled, stored,and transported to the lab. 4.6 Complete Chain of Custody document.4 luding printed and signed name of third party sampler,condition of sample and date and time the sample was submittep the lab. For Laboratory samplers,complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION ❑ 5.1 Site rRap showing the location,with dimensions, of the soil profile pit on the parcel. ❑ 5.2 Des crition of soil profile pit including depth and dimensions. ❑ 5.3 Description 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. EHD 26.02-003 10 Page 1 of 3 sou Suitability Chmkhst yli