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SAN J OAQ U I N Environmental Health Department <br /> . COUNTY <br /> Greatness grows her: <br /> PERCOLATION TEST/SOIL PROFILE INSPECTION CHECKLIST <br /> SIC Ora inance Code,Title 9,Section 9-1105.2 <br /> EHO Pol,,:y dor Percolation Test Procedure 98-01 <br /> Date -120 <br /> Y � _ <br /> Site Location: 32 S �tsmun Q <br /> Test Performed b TAMN4 (� rY-a C,em Permit#: 5�?(70]�t4E _ PA#: <br /> SITE MAP <br /> Includes perc test and soil profile locations with accurate measurements from a fixed reference point(must be able to locate <br /> the test hole areas in the future). Percrsoil profile holes must meet distance setbacks as noted in the sewage standards for <br /> septic system locations. Percolation test holes and soil profile pits must be conducted in the are proposed for future septic <br /> systems. <br /> Notes any changes in elevation on the subject property. <br /> Nates all water wells, <br /> Notes all man-made features(s_ptisystems,drives,barns,outbuildings,animal pens,etc.) <br /> Notes all natural features(ephemeral drainage courses,tater e sip_nds of trees,ponds,rivers,etc.) <br /> PERC TEST PREPARATION PROTOCOL <br /> Date and time of test hole preparation. jq pulrb 9:l 5 aim <br /> Diameter and depth of test hole 4"-12"diameter and 36"-42'depth). ( M <br /> Dimensions and depth of deep test hole 4"-12'diameter and 42"•25'or minimum 10' above seasonal high water table). <br /> I//ar Test hole preparation(scoring of sidewalls,removal of loose material)- _ <br /> Weather conditions at time of testing(raining,windy, etc. ° <br /> Soil type and condition encountered in test hol am 17as ) W �f san w ail <br /> Addition of 2'of course sand or fine gravel to tes hole. <br /> Pre-soak by addition of minimum 12"of water over gravel 24-hours before test), <br /> PERC TEST CONDITIONS, MEASUREMENTS,AND REPORTING <br /> _Condition of test hole after the 24-hour pre-soak.(amount of water remaining in the hole,any soil sloug6gnoted . <br /> Correct amount of water used to refill hole 6"over gravel)-Documented on the recordation sheet. <br /> Description of type of perc test procedure used based on conditions Procedure#1,42,or#3), <br /> Accurate recordings of drop and refill of water in same measurements. <br /> Same fixed reference point used for each reading,Description of reference point used tc.be included in the final report, <br /> Math calculations checked for accuracy-. <br /> Beginning and end measurements of the last reading verified by RENS.All above reviewed and verified by REHS. <br /> SOIL PROFILE - -- -- — <br /> NWI Description of the date,time,and protocol used to prepare sail profile OL <br /> tJ <br /> Description of soil profile pit including depth and dimensions. <br /> 01k Soil lithology described by appropriate professional using indus standani protocol. <br /> COMMENTS <br /> 12= oeadin �� , rQ�IW-d 2 t 3DlmIn ,� <br /> 15 Ir-eQd IgVi0'42 I �'� �7 �� �-- <br /> REHS Name- Y <br /> t,al ubtiors Exam.es <br /> Last drop reaCing=V'over 30 minuets trne. Last drop reading_1.2 over 10 mrwces t,i-te. <br /> 07'x 11=.84'(oDwert from feet to indes) 1.2 x 12'=14.4'(convert from Iger to inches) <br /> 30 rnir6le5+.84"=35-7 minutes(imh 10 mingles*14,4'=,69 m nub inch <br /> er-o•r�gl+�%� 9-r<ore — - <br /> 1868 E Hazelton Avenue I Stockton, California 95205 1 T 209 458-3420 1 F 209 464-0138 1 www.sicehd.com <br />