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<br />SAN .IOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd
<br />SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST
<br />SITE LOCATION: 1 2 b E I� a'r �i�W✓r—t �O � 1 PA #:
<br />REPORT DATE-
<br />S = Sufficient =Insufficient
<br />San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2
<br />S
<br />1
<br />1.0
<br />INTRODUCTION & PROPOSED DEVELOPMENT SECTION
<br />Description of exiting on-site septic tank usage (system types, age, functioning/repair rates).
<br />❑
<br />1.1
<br />Description of site, including zoning information.
<br />1Z
<br />❑
<br />1.2
<br />Description of proposed development.
<br />Discussion of on-site septic tank repair history.
<br />❑
<br />1.3
<br />Parcel vicinity location map.
<br />,�:[
<br />❑
<br />1.4
<br />Site map showing location of all items on parcels (i.e., structures, drives, wells, septic systems, large trees,
<br />proximity to parcel).
<br />�—
<br />❑
<br />pastures, pools, natural drainage courses, ponds, waterways, etc.)
<br />2.0 PRESENT AND PAST USES OF THE SITE SECTION
<br />❑ 2.1 Discussion of past and present uses at the site to assess potential problems.
<br />4.0 GROUNDWATER INFORMATION SECTION
<br />,,,0
<br />❑
<br />3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION
<br />Description of the depth and gradient of groundwater in the general area.
<br />❑
<br />3.1
<br />Description of exiting on-site septic tank usage (system types, age, functioning/repair rates).
<br />Description/discussion of any existing and/or potential groundwater contamination issues in the general location
<br />❑
<br />3.2
<br />Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report).
<br />of the site.
<br />❑
<br />3.3
<br />Discussion of on-site septic tank repair history.
<br />/®
<br />❑
<br />3.4
<br />Description of existing septic tank usage in the general area (system types, ages, functioning/repair rates,
<br />water sample(s) were obtained.
<br />0
<br />❑
<br />proximity to parcel).
<br />�—
<br />❑
<br />3.5
<br />General area septic permit history (number/types/dates of permits, age of system, permit numbers, copies in
<br />Description of how sample was obtained, handled, stored, and transported to the lab.
<br />❑
<br />report).
<br />-•❑
<br />❑
<br />3.6
<br />Discussion of general area septic tank repair history.
<br />,,•D
<br />❑
<br />3.7
<br />Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site.
<br />4.0 GROUNDWATER INFORMATION SECTION
<br />,,,0
<br />❑
<br />4.1
<br />Description of the depth and gradient of groundwater in the general area.
<br />E]
<br />❑
<br />4.2
<br />Description/discussion of any existing and/or potential groundwater contamination issues in the general location
<br />of the site.
<br />(❑
<br />❑
<br />4.3
<br />Description of location (address/APN), type and construction of well and location (well head/kitchen tap) where
<br />water sample(s) were obtained.
<br />0
<br />❑
<br />4.4
<br />Description of constituents being tested for in the water sample.
<br />❑
<br />4.5
<br />Description of how sample was obtained, handled, stored, and transported to the lab.
<br />❑
<br />4.6
<br />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 />EHD 26-03 Page 1 of 3 SOIL SUITABILITY STUDY CKLST
<br />4/24/12
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