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pnurN ' <br /> SAKJOAQUIN Environmental Health Department <br /> N j <br /> COUNT Y <br /> ` a4. �� Greatness grows here . <br /> PERCOLATION TEST/SOIL PROFILE INSPECTION CHECKLIST <br /> SJC Ordinance Code, Title 9, Section 9-1105.2 <br /> EH Policy for Percolation Test Procedure 98-01 <br /> Site Location : 1 Date : 10 a <br /> Test Performed by , Permit#. 5 Q og / 31 S 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 . <br /> Diameter and depth of test hole 4"- 12" diameter and 36"42" depth . Vj di&4rw 4A, q 2 " <br /> Dimensions and depth of deep test hole 4"-12" diameter and 42"-25' or minimum 10' above seasonal high water table). <br /> tr Test hole preparation (scoring of sidewalls , removal of loose material). <br /> Weather conditions at time of testing (raining , windy, etc. S V-c <br /> Soil type and condition encountered in test hole . , _ L C o-PTRC Soil <br /> Addition 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 20our re-soak amount of water remaining in the hole, any soil sloughing noted) . r <br /> siss� Correct amount of water used to refill hole 6" over gravel) . Documented on the recordation sheet. <br /> Lss00000 Description of type of perc test procedure used based on conditions Procedure #1 (#2) or #3 . <br /> ccurate recordings of drop and refill of water in same measurements. <br /> ame 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 /> Beginning 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 /> Descrilion of soil profile pit including depth and dimensions. <br /> Soil lithology described by appropriate professional using industry standard protocol . <br /> COMMENTS p �6) rj sk & r, / tt <br /> Se o 1 , a N . <br /> v� <br /> REHS Name: I <br /> Calculations Examples: <br /> Last drop reading = .07' over 30 minutes time. Last drop reading = 1 .2' over 10 minutes time. <br /> .OT x 12" = ,W (convert from feet to inches) 1 .2' x 12" = 14.4' (convert from feet to inches) <br /> 30 minutes + 14" = 35.7 minutes/inch 10 minutes = 14.4" = ,69 minutesrinch <br /> END 4200-m 8-1 -2016 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 F 209 464-0138 1 www. sjcehd . com <br />