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[� ❑ 4.3 Description of location (address/APN),type and construction of well and location (well head/kitchen tap) <br /> where water sample(s)were obtained. <br /> F' ❑ 4.4 Description of constituents being tested for in the water sample. <br /> [� ❑ 4.5 Description of how sample was obtained, handled, stored, and transported to the lab. <br /> Q( ❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, <br /> condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers, <br /> complete laboratory report to include the above noted information. <br /> 5.0 SOIL PROFILE INFORMATION SECTION <br /> M ❑ 5.1 Site map showing the location, with dimensions, of the soil profile pit on the parcel. <br /> 0 ❑ 5.2 Description of soil profile pit including depth and dimensions. <br /> [, ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard <br /> protocol. <br /> [] ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. <br /> S 1 6.0 PERCOLATION TEST INFORMATION SECTION <br /> ❑ 6.1 Site map showing the location,with concise and accurate dimensions of the percolation test holes on the <br /> parcel. <br /> ❑ 6.2 The minimum number of shallow and deep percolation tests was performed for each parcel. <br /> [ I ❑ 6.3 Description of the date,time and protocol used to prepare the test hole, including depth and dimensions <br /> of hole, preparation of hole, and depth of water used to presoak(minimum 12 inches). <br /> E ❑ 6.4 Description of the date,time and condition of the test hole after the 24-hour soak period (hole still <br /> intact, hole dry, depth to water remaining in hole, etc.) <br /> [?f ❑ 6.5 The test conformed to SJC Policy EHD 02-02 (correct depth, diameter, 2" gravel, 6" water refill, correct <br /> readings recorded). <br /> [// ❑ 6.6 Complete Percolation Test Form (including readings) was provided with REHS verification signature. The <br /> rate was correctly calculated using the last reading. <br /> EZ// ❑ 6.7 Discussion of any potential problems predicted and/or the need for an engineered or alternative septic <br /> system. <br /> ❑ 6.8 Discussion of percolation rates in relation to the type, size and location of future leach fields needed at <br /> 7.0 CONCLUSION SECTION <br /> [� ❑ 7.1 The r"powassi ned and stamped by the appropriately registered individual <br /> Reviewed By Reviewed Date: <br /> EHD 26-02-003 Page 2 of 2 Soil Suitability Checklist <br /> 7/14/2003 <br />