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SAN JOAQUIN COUNTY <br /> D-�MONMENTAL HEALTH DEPARTMtNT <br /> . 600 East Main Street, Stockton •CA 95202-3029 <br /> (209)468-3420 •Fax: (209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br /> SITE LOCATION: 1 yC� � � /' <br /> �` / Y`{ IV8 U 1 REPORT DATE: �C � <br /> = Sufficient <br /> I Insufficient <br /> San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> = <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ® ❑ 1.1 Description of site, including zoning information. <br /> ®. ❑ 1.2 Desd%Vption of proposed development. <br /> ,tri JA�. <br /> ET F-11.3 Parce4icinity loc{ tlon' ap. <br /> �] ❑ 1.4 Site map showing.loca✓ tionpCof 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. <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 /> ® ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). <br /> [/q ❑ 3.3 Discussion�f on-site septic tank repair history. <br /> ❑ 3.4 Descripii8n of existing septic tank usage in the general area (system types, ages, functioning/repair rates, <br /> proximity to parcel). O-Z \ ,, � <br /> 14 ❑ 3.5 General area septic permit(s)hisfory(number/types/dates of permits, age of system, permit numbers,copies in <br /> report). f l <br /> ❑ 3.6 Discussion of general area septic tank repair history. <br /> ❑ 3.7 DescriptioAf proposeffor expected maximum(including second unit dwellings)septic tank usage on site. <br /> 4.0 GROUNDWATER INFORMATION SECTION <br /> 0 ❑ 4.1 Description of the depth and gradient of groundwater in the general area. <br /> '7— <br /> [� ❑ 4.2 Description/cli cussion of any existing and/or potential groundwater contamination issues in the general location <br /> of the site. �y <br /> ® E] 4.3 Description oAocation(address/APN),type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained. <br /> ffY <br /> ❑ 4.4 Description of cor-tlstituents being tested for in the water sample. <br /> 2 <br /> [�] ❑ 4.5 Description of how SWTI a was obtained, handled, stored, and transported to the lab. <br /> ❑ 4.6 Complete Chain of6stody d'ocJ�ilent, 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.V Z 7 ,c 0'11_" ,, <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 /> r � <br /> ® F] 5.2 DescriptiA of soil�drofileJ pLit including depth and dimensions. <br /> ® ❑ 5.3 Description of soil ology as noted from test pit by appropriate professional using industry standard protocol. <br /> �, y 3 <br /> ® F] 5.4 Discussion of soil lit ology as related to future onsite septic uses. <br /> 7G -� <br /> EHD 26-02-003 Page I of 3 Soil Suitability Checklist <br />