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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Ave Stockton, CA 95205 (209)468-3420 • Fox:(209)464-0138 • Web:www.sigov.org/ehd F0 Soil Suitability study Requirements Checklist SITE LOCATION: �`O� `ZV�C.�hCJI�U��N RECORD ID: 5 u— `Z(o b t kat REPORT DATE: S = Sufficient I = San Joaquin County Development Title Chapter 9-1105,Section 9-1105.2 Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION [� ❑ 1.1 Description of site, including zoning information. 1A ❑ 1.2 Description of proposed development. EA ❑ 1.3 Parcel vicinity location map. Q ❑ 1.4 Site map showing location of all items on parcels (i.e., structures, drives, wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds, waterways, etc.) 2.0 PRESENT AND PAST USES OF THE SITE SECTION M ❑ 2.1 Discussion of past and present uses at the site to assess potential problems. 3.0 EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION El ❑ 3.1 Description of exiting on-site septic tank usage (system types, age,functioning/repair rates). [� ❑ 3.2 Site septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). [�] ❑ 3.3 Discussion of on-site septic tank repair history. �] ❑ 3.4 Description of existing septic tank usage in the general area (system types, ages,functioning/repair rates, proximity to parcel). E ❑ 3.5 General area septic permit history(number/types/dates of permits, age of system, permit numbers, copies in report). E� ❑ 3.6 Discussion of general area septic tank repair history. [� ❑ 3.7 Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. 4.0 GROUNDWATER INFORMATION SECTION [� ❑ 4.1 Description of the depth and gradient of groundwater in the general area. ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location of the site. EHD 26-02-003 Pagel of 2 Soil Suitability Checklist 7/14/2003