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SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 PA#: S=Sufficient REP �2T DATE: 1=lnsuffcient SITE LOCATION:�� - 7P S I INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ ❑ Description of site, including zoning information. ❑ Description of proposed development. ❑ ❑ Parcel location map. ❑ Site map showing location of all items on parcel (structures,drives,wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways,etc.) PRESENT AND PAST USES OF THE SITE SECTION ❑ Discussion of past and present uses at the site to assess potential problems. EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION ❑ Description of existing septic tank usage on site (system types, age,functioning/repair rates). ® ❑ Site septic permit history(number/types/dates of permits,age of system, permit numbers, copies in report). ❑ Discussion of on-site septic tank repair history. Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, proximity to ❑ parcel). ❑ [� General area septic permit history(number/types/dates of permits, age of system, permit numbers,copies in ❑ ❑ report). Discussion of general area septic tank repair history. ❑ Description of proposed or expected maximum (including second unit dwellings)septic tank usage on site. GROUNDWATER INFORMATION SECTION ❑ Description of the depth and gradient of groundwater in the general area. ❑ Description/discussion of any existing or potential groundwater contamination issues in the general location of the site. ❑ Description of location (address/APN),type and construction of well, and location (well head/kitchen tap)where water samples were obtained. ❑ Description of constituents being tested for in the water sample. ❑ [] Description of how sample was obtained, handled,stored, and transported to the lab.. ❑ Complete Chain of Custody document, including printed and signed name of third party sampler, condition of sample,and date and time the sample was submitted to the lab. SOIL PROFILE INFORMATION SECTION ❑ Q Site_map showing the location,with dimensions, of the soil profile pit on the parcel. Q ❑ Description of soil profile pit including depth and dimensions. ❑ Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. ❑ Discussion of soil lithology as related to future onsite septic uses. PERCOLATION TEST INFORMATION SECTION ❑ Site map showing the location,with concise and accurate dimensions,of the percolation test holes on the parcel. ❑ The minimum number of shallow and deep percolation tests were performed for each parcel. ❑ ❑ Description of the date,time and protocol used to prepare the test hole, including depth and dimensions of hole, preparation of hole, and depth of water used to presoak(minimum 12 inches). ❑ ❑ Description of the date,time and condition of the test hole after the 24 hour soak period (hole still intact, hole dry, depth to water remaining in hole, etc.). ❑ The test conformed to SJC Policy EHD 02-02 (correct depth,diameter, 2"gravel, 6"water refill, correct readings recorded). ❑ Complete (including readings)Percolation Test Form was provided with REHS verification signature. The rate was, correctly calculated using the last reading. X.� I ---�_ ter. . 'Y '- I - / Discussion of any potential problems predicted and/or the need for an engineered or alternative septic system. ❑ Discussion of percolation rates in relation to the type and size of future leach fields needed at the site. CONCLUSION SECTION QQ ❑ The report was-signed"d stamped by the appropriately registered individual. REVIEWEDY: REVIEWED DATE: ��/