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"cisSAN JOAQUIN Environmental Health Department <br /> � COUNTY <br /> \�lFOR�c O grows rows here. <br /> j <br /> PERCOLATION TEST/SOIL PROFILE INSPECTION CHECKLIST <br /> SJC Ordinance Code,Title 9,Section 9-1105.2 <br /> EHD Policy for Percolation Test Procedure 98-01 <br /> Site Location: I gq ® $ , Date: Z 20 ZD <br /> Test Performed b Permit#: 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). Perc/soil 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 area proposed for future septic <br /> systems. <br /> Notes any changes in elevation on the subject property. <br /> Notes all water wells. <br /> Notes all man-made features(septic sstems,drives, bams,outbuildings,animal pens,etc. <br /> Notes all natural features(ephemeral drainage courses, large stands of trees, ponds, rivers, etc. <br /> PERC TEST PREPARATION PROTOCOL <br /> Date and time of test hole preparation. 2 tz_Z 0 to -, v� <br /> Diameter and depth of test hole 12"diameter and 36"-42"depth). 3.'-1 t= <br /> Dimensions and depth of deep test hole 4"-12"diameter and 42"-25'or minimum 10'above seasonal high water table). <br /> est hole preparation(scoring of sidewalls, removal of loose material). <br /> 611 <br /> Weather conditions at time of testing (raining,windy,e Sa Yin k <br /> Soil type and condition encountered in test hole. c S;if k cliq <br /> ddition of 2"of course sand or fine gravel to test 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 re-soak amount of water remaining in the hole,any soil sloughing noted). <br /> 1/ Correct amount of water used to refill hole 6"over gravel). Documented on the r dation sheet. <br /> Descriptio of type of perc test procedure used based on conditions Procedure#1,(# or#3 . <br /> Accurate recordings of drop and refill of water in same measurements. <br /> me fixed reference point used for each reading. Description of reference point used to be included in the final report. <br /> Math calculations checked for accuracy. <br /> Beoinnina and end measurements of the last reading verified by REHS.All above reviewed and verified by REHS. <br /> SOIL PROFILE <br /> Description of the date,time,and protocol used to prepare soil profile pit. <br /> Des cri tion of soil profile pit including depth and dimensions. <br /> Soil lithology described by appropriate rofessional using industry standard protocol. <br /> COMMEN SP? M—C9,- ) �"G .� � <br /> REHS Name: , >-�D- A <br /> calculations Examples: <br /> Last drop reading=.07'over 30 minutes time. Last drop reading=1.2'over 10 minutes time. <br /> .07'x 12"=.84"(convert from feet to inches) 1.2'x 12"=14.4"(convert from feet to inches) <br /> 30 minutes=.84"=35.7 minutesrnch 10 minutes_14.4"=.69 minutes/inch <br /> EHD 4200-xx 8-1-2018 <br /> 1868 E. Hazelton Avenue I Stockton, Califomia 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />