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<br /> .. o\ SAN JOAQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> t-= 304 E Weber Avenue 3rd Floor Stockton•CA 95202-2708
<br /> CCC a > (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquin.ca.uslehd
<br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST
<br /> SITE LOCATION S�/Z S I/4 ��� / PA#: b b - 3 L o
<br /> REPORT DATE: Z 0 77-
<br /> s = Imfficient
<br /> sufficient
<br /> I = InsucieSan Joaquin County Development Title Chapter 9-1105,Section 9-1105.2
<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 /> ❑ 1.3 Parcel vicinity location map. Ap?-„a, —
<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.) 147�r \e
<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.
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<br /> 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION
<br /> ® ❑ 3.1 Description of existing on-site septic lank 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)pV �
<br /> ® ❑ 3.3 Discussion of on-site septic tank repair history.
<br /> n F-13.4 Description of existing septic tank usage in the general area(system types,ages,functioning/repair rates,
<br /> Jam" proximity to parcel). ;if / -
<br /> © ❑ 3.5 General area septic permit history(number/types/dates of permits,age of system, permit numbers,copies In
<br /> report). /I 1, per,,,-i v
<br /> ® ❑ 3.6 Discussion of general area septic tank repair history. O� L
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<br /> ❑ 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 and gradient of groundwater in the general area. rp Z /00
<br /> FZ ❑ 4.2 DescriptioNdiscussion of any existing and/or potential groundwater contaimination issues in the general location
<br /> of the site. P1 z ,
<br /> © ❑ 4.3 Description of location(address/APN),type and construction of well and location(well head/kitchen tap)where
<br /> Fv_1 water sample(s)were obtained. (9`j. Z
<br /> Ycl-I ❑ 4.4 Description of constituents being tested for in the water sample. rp s
<br /> ❑ 4.5 Description of how sample was obtained,handled,stored,and transported to the lab. As
<br /> ❑ 4.6 Complete Chain of Custody document,including printed and,signed name of third party sampler,condition of
<br /> sample and data and time the sample was submitted to the lab. For Laboratory samplers,complete laboratory
<br /> report to include the above noted information.
<br /> /01-
<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-
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<br /> arcel.
<br /> t� ❑ 5.2 Description of soil profile pit including depth and dimensions. �� 3
<br /> ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol,�_e
<br /> ❑ 5.4 Discussion of soil lilhology as related to future onsite septic uses.
<br /> 7 fir✓.rne.+/, /,s.y=
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