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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E Weber Avenue 3rd Floor Stockton • CA 95202-2708 <br />(209) 468-3420 • Fax: (209) 464-0138 • Web: www.co.san-joaquin.ca.us/ehd <br />SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br />SITE LOCATION: 2 20 ET VI Aile.) t1-41,11 PA #: 03- ( ) <br />REPORT DATE: 8/1../ <br />S = Sufficient <br />= Insufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br />S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br />M 1=1 1.1 Description of site, including zoning information. K---K ) 1 - 5"/ c- LY ej <br />Et III 1.2 Description of proposed development. seczoa,....of -S till- C fov riA•e---St ""j'e <br />NI El 1.3 Parcel vicinity location map. <br />Jo Li 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.) <br />2.0 PRESENT AND PAST USES OF THE SITE SECTION <br /> <br />21;fl 2.1 Discussion of past and present uses at the site to assess potential problems.it , ej 1p :- <br />(L3 Ilyet..v5 <br />3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br />8 D 3.1 Description of exiting on-site septic tank usage (system types, age, functioning/repair rates). <br />gi El 3.2 Site septic permit history (number/types/dates of 'permits, age of system, permit numbers, copies in report). <br />)2- 0 <br />i .5' eel ic -TA- Aw-i I ed i v, OS 5 -4 e("-i r i <br />3.3 Discussion <br />'h. tat <br />91ppn-site septic tank repair history. <br />-IS LI 3.4 Description ofLgsthg(stilic talgIuLseage in the general area (system types, ages, functioning/repair rates, <br />proximity to parcel). <br />-1S1 LI 3.5 General area septic permit history (number/types/dates of permits, age of system, permit numbers, copies in <br />report). <br />)K1 0 3.6 Discussion of general area septic tank repair history. <br />6 111 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br />4.0 GROUNDWATER INFORMATION SECTION <br /> <br />111 4.1 Description of the depth and gradient of groundwater in the general area. 160 (-- 1 9° 1 <br />4.2 Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br />of the site. <br /> <br />El 4.3 Description of location (address/APN), type and construction of well an location (well head/kitchen tap) where <br />water sample(s) were obtained. ,e_ fvc,r) roc) g--T /0? C0V14. <br />Er LI 4.4 Description ofonstituents being tested for in the water sample. <br /> <br />LI <br />g Dbce <br />4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br /> <br />LI 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. <br />5.0 SOIL PROFILE INFORMATION SECTION <br /> <br />n 5.1 Site map showing the location, with dimensions, of the soil profile pit on the parcel. <br /> <br />LI 5.2 Description of soil profile pit including depth and dimensions. <br />5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. <br />P— El 5.4 Discussion of soil lithology as related to future onsite septic uses. <br />ERG 26-02-003 Page 1 of 3 Soil Suitability Checklist