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SANJJ0A0UIN p <br /> Environmental Health Department <br /> I ---COUNTY-- <br /> ���+ Greatness grows her L. <br /> PERCOLATION TEST/SOIL PROFILE INSPECTION CHECKLIST <br /> SJC Ordinance Code,Title 9,Section 9-1105.2 <br /> E H 0 Pailcy for Percolation Test Procedure 98-01 <br /> Site Location: Date: 110 <br /> Test Performed by: Permit#: I 'S f-00V 74 1 PA#: <br /> SITE MAP if <br /> Includes pear 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). 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 /> systems. <br /> Notes any changes in elevation on the subject prope0y. <br /> Notes all water wells, '4r-'1 -o G44<1 f <br /> Notes all man-made features(septic s stems, drives,barns,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 /> ate and time of test hole preparation. 1 0 <br /> Diameter and depth of test hole 4"-12"diameter an 36"-42"depth). r ' <br /> Dimensions and depth of deep test hole 4"-12"diameter and 42"-25'or minimum 10'above seasonal high water table . <br /> Test hole preparation(scoring of sidewalls, removal of loose material). <br /> Bather conditions at time of testing(raining,windy,etc. L4/1 <br /> vl Soil type and condition encountered in test hole. 5 :I"t 5 <br /> Addition of 2"of course sand or fine gravel to test hole. Y -F4 a•C— 4�w� <br /> Pre-soak by addition of minimum 12"of water over gravel 24-hours before test . <br /> PERC TEST CONDITIONS, MEASUREMENTS,AND REPORTING <br /> ondition of test hole after the 24-hour re-soak amount of water re mai n i ng in the hole,any soil sloug h ing noted . <br /> Correct amount of water used to refill hole fi"over gravel). Documented on the recordation eet. <br /> • Descri lion of type of perr,test procedure used based on conditions Procedure#1,#2,o #3 <br /> Accurate recordings of drop and refill of water in same measurements. <br /> Same fixed reference point used for each reading.Description of reference point used to he inc ded 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 protocal used to prepare soil profile pit. <br /> Description of soil profile pit including depth and dimensions. <br /> Boil lithology described by appropriate rofessional using industnj standard protocol. <br /> CO�M,MwENTS+',�T pro n . 2 ►•.-l�F- a L�+�,�•n �j�, 3a <br /> U 'f ►%.t <br /> � c 4 <br /> REHS Name: <br /> Caleulatlons Examples: <br /> Last drop reading=.07'over 30 minutes time. Last drop reading 12 aver 10 minutes time. <br /> .07'x 12"=.84"(convert from feet to inches) 1.2'x 12'=14.4"(convert from feet to inches) <br /> 30 minutes+.84"=35.7 minutarAnch 10 minutes=14.4"_.69 minutesflnch <br /> EHU 4200-xx a-1-2018 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />