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SAN J O A Q U IN Environmental Health Department <br />COU NTY <br />^` Greatness grows here. <br />PERCOLATION TEST/SOIL PROFILE INSPECTION CHECKLIST <br />51C ordinance Code, Title 9, Section 9-1105.2 <br />Elio Policy for Percolation Test Procedure 9R-01 <br />Site Location, I I .rk �A -V_An tip , Date: ��,1 2,02Z. <br />Test Performed by: �t�41—_ _ _ Permit#: I SRO(Si'S i PAM <br />SITE MAP <br />Includes perc test and soil profile locations vMth accurate measurements from a fixed reference paint (must be able to locate <br />the test hole areas in the future). Perclsoil 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 />Notes any changes in elevation on the subject property. <br />Notes all water wells. <br />Notes all man-made features stems drives, bams, outbuildings, animal pens, etc. <br />Notes all natural features meral 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" de thy. <br />Dimensions and depth of deep test hole C-12" diameter and 42"-25' or minimum 10' above seasonal high water 1 <br />Test hole re ration scori a <br />of sidewalls, removal of loose material). <br />_ Weather conditions at time of testing (raining, - ndy, etc.) <br />Soil type and condition encountered in test hole. _ <br />Addition of 2" of course sand or fine gravel to test hole. <br />Pre-soak 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 />5 Correct amount of water used to refill hole (6" over _gravel . Documented on the recordationApet. _ _ _ <br />Description of type of F <br />Accurate recordings of <br />Same fixed reference I <br />test <br />and refill of % <br />used for each <br />Math calculations checked for <br />used based on conditions <br />in same measurements. <br />ure #1, #2, <br />of reference point used to be included in the final report. <br />and end measurements of the last reading verifeg �b REHS. All above reviewed and verified by RENS. <br />SOIL PROFILE <br />p Description of the date, time, and protocol used to prepare soil profile pit. <br />Description of soil profile pit includitq depth and dimensions. <br />Soil lithology described by appropriate professional using industry standard protocol - <br />COMMENTS <br />Ines <br />coos <br />Last drop reading - .07' crier 3) minutes time. <br />.07'x 12'= .84' (oonv" from feet to inches) <br />30 minutes +.84' = 35.7 minutestinch <br />Last drop readirg =1 2over 10 minutes Erre <br />1.7 x 12' = 14.4' (convert from feet to inche } <br />10 rninides + 14.4' = .69 minulesrmch <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />