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.;, SAN JOAQUIN COUNTY <br /> L. ✓IRONMENTAL HEALTH DEPAR1. SENT <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 C <br /> SITE LOCATION: - <br /> 7 <br /> 7 3 PA#: /uU <br /> REPORT DATE: <br /> S = sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br /> 1 = Insufficient <br /> S I 1.0 INTRODUCTION & PROPOS D DEVELOPMENT SECTION <br /> [(� ❑ 1.1 Description of site, inciuding zoni i formation. <br /> ❑ 1.2 Description of proposed development: <br /> ® ❑ 1.3 Parcel vicinity location map. t z k <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.) V� -, <br /> 2.0 PRESENT AND PAST USES OF THE SITE SECTION G <br /> ❑- ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. '21 <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 /> [1- ❑ 3.3 Discuion of on-site septic tank repair history. N3 <br /> ® ❑ 3.4 Description of existing septic tank usage in the general area(system types, ages,functioning/repair rates, <br /> proximity to parcel).(,,� 3 <br /> ® ?• ❑ 3.5 General area septic permit(s)history(number/types/dates of permits, age of system, permit number copies in <br /> report). 1 0— <br /> ❑ 3.6 Discussion of general area septic tank repair history. < = <br /> 21 ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings)septic tank usage on site. <br /> fe 3 <br /> 4.0 GROUNDWATER INFORMATION SECTION s� <br /> ® ❑ 4.1 Description of the depth and gradient of groundwater in the general area. f i <br /> IM ❑ 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 6T location(address/APN),type and construction of well and location(well head/kitchen tap)where <br /> water sample(s)were obtained. �& `4 <br /> ® ❑ 4.4 Description of constituents being tested for in the water sample. <br /> ® ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the labt <br /> [D ❑ 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. )Y(Y_� <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. r��-- <br /> ® ❑ 5.2 Description of soil profile pit including depth and dimensions. [ S " <br /> ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br /> ❑ ❑ 5.4 Discus on of soil lithology as related to future onsite septic uses. <br /> n <br /> EHD 26-02-003 1 Pagel of 3 Soil Suitability Checklist <br /> —e1-1 <br />