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*i) <br /> SAN.P1flAQUIN p� Environmental Health De artment <br /> COUNTY Greatness grows here. <br /> PERCOLATION TEST/SOIL PROFILE INSPECTION CHECKLIST <br /> SIC ordinance Code,Itie 9,Section 9-1105.2 <br /> EHD Policy For Percolation Test Procedure 98-01 <br /> Site Location: I 11(o ; Date: (� [ <br /> Test Performed by: _ Permit#: S PA#: <br /> SITE MAP <br /> Includes perc 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). Perc/soil 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 property. <br /> Notes all water wells. to Jl fa- <br /> Notes all man-made features se tic systems,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 /> Date and time of test hole preparation. <br /> Diameter and depth of test hole 4"-12"diameter and 36"-42"depth). „ wj�, <br /> Dimensions and depth of dee test hole 4"-`I T diameter and 42"-25'or minimum 10'above seasonal hi h water table . <br /> Test hole preparation(scoiring of sidewalls,removal of loose material). <br /> Bather conditions at time of testing(raining.windy,etc. %"A?n <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 by 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 /> Correct amount of water used to refill hole 13"over gravel). Documented an the recorA4on sheet. <br /> Description of type of perc test procedure used based on conditions Procedure#1&2Jr#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 be included 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 /> Descri Lion of the date,time,and protocol used to re are soil profile pit. <br /> Description of soil pmfile pit including depth and dimensions. <br /> Soil lithology described by appropriate rofessional using Industry standard protocol. <br /> COMMENTS <br /> 95 pwc rai, a iwn --rub . <br /> REHS Name:)a-rt C'- <br /> Calculations Examples: <br /> Last drop reading=.07'over 30 minutes time. Last drop reading=1.2'over 10 minutes time. <br /> .07'x 12'=.W[convert From feet to inches] 1.2'x 12"=14X{convert from feet to inches} <br /> 30 minutes z.84'=35.7 minutesfinch 10 minutes=14.4"=.69 minutesl'mch <br /> EHD42M--9-1-2018 <br /> 1868 E. Hazelton Avenue I Stockton. California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />