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® ❑ 4.3 Description of location (address/APN),type and construction of well and location (well head/kitchen tap)where water sample(s)were obtained. • 1997 Replacement well, 170 foot total depth, 100 foot grout seal • 1997 destruction of 60 foot well • Obtained from domestic well ® El 4.4 Description of constituents being tested for in the water sample. • Nitrate (2.6 PPM)and DBCP (Non-detect) ® ❑ 4.5 Description of how sample was obtained, handled, stored,and transported to the lab. ® ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers, complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION ® ❑ 5.1 Site map showing the location,with dimensions, of the soil profile pit on the parcel. 5.2 Description of soil profile pit including depth and dimensions. ® El Shallow soil boring • 4 inch diameter, 3.46 feet deep • Silty clay with sand 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. • 0-15 Inches Clay loam ® ❑ a 15-72 inches clay loam/sandy clay loam • Severe percolates slowly • Source: USDA web soil survey ® El 5.4 Discussion of soil lithology as related to future onsite septic uses. • Limited potential for percolation S = Sufficient I = Insufficient S I 6.0 PERCOLATION TEST INFORMATION SECTION ® ❑ 6.1 Site map showing the location,with concise and accurate dimensions of the percolation test holes on the parcel. ® ❑ 6.2 The minimum number of shallow and deep percolation tests was performed for each parcel. ® ❑ 6.3 Description of the date,time and protocol used to prepare the test hole, including depth and dimensions of hole, preparation of hole, and depth of water used to presoak(minimum 12 inches). • 12 inches H2O used for presoak • Dry after 24 hour period ® ❑ 6.4 Description of the date,time and condition of the test hole after the 24-hour soak period (hole still intact, hole dry, depth to water remaining in hole, etc.) • Intact and dry ® ❑ 6.5 The test conformed to SJC Policy EHD 02-02(correct depth, diameter, 2"gravel, 6"water refill, correct readings recorded). ® ❑ 6.6 Complete Percolation Test Form (including readings)was provided with REHS verification signature. The rate was correctly calculated using the last reading. • One hour test performed, measurements every 10 minutes 6.7 Discussion of any potential problems predicted and/or the need for an engineered or alternative septic system. ® ❑ • Percolation rate of 20.8 Minutes per Inch • Standard septic system • 8 foot separation to ground water ® E] 6.8 Discussion of percolation rates in relation to the type, size and location of future leach fields needed at the site. • Leach lines or filter bed recommended 7.0 CONCLUSION SECTION ® ❑ 7.1 The report was signed and stamped by the appropriately registered individual Reviewed By: Aaron Gooderham Reviewed Date: EHD 26-02-003 Page 2 of 3 Soil Suitability Checklist