WS-2725_6272_CA_TCR_20210107_byNCDOT

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UST Closure Report and Site Investigation Report for Permanent Closure or
Change-in-Service of UST

A. Site Information
1. Site Identification
Date of Report: January 7, 2021 Site Risk: H75 (from previous incident)
Facility I.D.: 00-0-0000003351 UST Incident Number (if known): 6272
Site Name: Jeff Tutterow Residence (Former Greyhound Bus Lines)
Street Address: 716 Yadkinville Road
City/Town: Mocksville Zip Code: 27028 County: Davie
Description of Geographical Data Point (e.g., diesel fill port): UST 7 and 8 Tank Pit
Location Method (GPS, topographical map, other): Google Earth
Latitude (decimal degrees): 35.902075° N Longitude (decimal degrees): 80.572840° W
2. Information about Contacts Associated with the Leaking UST System
(Addresses must include street, city, state, zip code and mailing address, if different)
UST/AST Owner/Operator: Not Known Email: N/A
Address: N/A Tel: N/A
Property Owner: Paul Tony Forrest Email: Not Known
Address: 113 Junction Road, Mocksville, NC 27028 Tel: Not Known
Property Occupant: None (Facility Demolished) Email: N/A
Address: N/A Tel: N/A
Consultant/Contractor: Zebra Environmental Email: N/A
Address: 901 E Springfield Road, High Point, NC 27263 Tel: [phone]
Analytical Laboratory: REDLab, LLC State Certification No: UVF Method
Address: 5598 Marvin K Moss Lane, Wilmington, NC 28409 Tel: [phone]
3. Information about the Release
Date Discovered: 12/08/21
Estimated Quantity of Release: Not Known
Cause of Release: Corrosion
Source of Release (e.g., Dispenser/Piping/UST): UST
Sizes and Contents of Tanks or Other Containment
from which the Release Occurred: Two 600 Gallon USTs and one 3,850-gallon UST

4. Certification
I, Keith C. Seramur, a Licensed Geologist for Seramur & Associates, PC, do certify that the information
contained in this report is correct and accurate to the best of my knowledge. Seramur & Associates, PC is licensed to
practice geology in North Carolina. The certification number of the company or corporation is C310.
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B. Executive SummaryThree abandoned USTs were discovered at this site during a Preliminary Site Assessment completed by Seramur & Associates in August 2018. Contaminated soil was documented in the vicinity of two of these USTs during this
assessment.
Seramur & Associates was contracted to oversee the UST closure on December 8, 2021. Zebra Environmental was
contracted to perform the excavation work, pump residual liquids from the tanks and remove the tanks from the site. Following the removal of the USTs from the two excavations, four soil samples were collected for laboratory analysis. The laboratory analytical results show that petroleum constituent concentrations are not at or above the NCDEQ Action Levels.
On December 9, 2021 Seramur & Associates personnel oversaw the abandonment of five groundwater monitoring wells previously installed at the site. The well abandonment was completed by Geonetics Corporation.
Seramur & Associates does not recommend any further assessment work in relation to the UST system removed from
the property during this phase of work.
C.Table of ContentsA. Site Information….……………………………………………...……..…..... 1
B. Executive Summary………………………...…………………………..…… 2
C. Table of Contents………………………...…………………………..……… 2
D. Site History and Characterization………………………...…………...…… 3
E. Closure Procedure………………………...…………………………..……... 4
F. Site Investigation………………………...…………………………..……….. 6
G. Conclusions and Recommendations….…...…………………………..……. 7
H. Figures………………………...…………………………..………………….. 8
I. Tables………………………...…………………………..…………………...14
Appendix A – Notification of Intent: UST Permanent Closure of UST (UST-3 Form)
Appendix B – Site Investigation Report for Permanent Closure of UST (UST-2 Form)
Appendix C – Standard Operating Procedures
Appendix D – Copy of Laboratory Analytical Records and Chain-of-Custody Records
Appendix E – Well Abandonment Records
Appendix F – Disposal Manifests
Appendix G – Photographs of Closure Activities
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D.Site History and CharacterizationPresent information relevant to site history and characterization, using the following outline:
1.Provide information for UST owners/operators and other responsible parties.
List the names, addresses, telephone numbers, and dates of ownership/operation of all previous UST owners,
UST operators, and other responsible parties.
See Table B-2 in Section I for information regarding UST owners/operators.
2.Provide UST information (inclusive of all USTs, currently and historically in place at facility).
See Table B-1 in Section I for information regarding all known USTs at the facility.
3.Provide information about petroleum AST systems, petroleum spills, and other non-UST petroleum releases
(inclusive of all ASTs, currently and historically in place at site and all spills at site).:
No ASTs are known to have been in use on the property. Petroleum spills and non-UST petroleum releases
are not documented to have occurred on the property.
4.Provide a comprehensive description of the release, including date discovered, cause and source (including
tank identification number and contents), and the relationship of historical UST releases, non-UST releases,
and off-site releases (indicate incident number) to contamination from current release.
The three USTs closed by removal during this phase of work were apparently orphaned USTs that were
discovered during a geophysical survey for an NCDOT Preliminary Site Assessment completed in August of
2018. The date that these tanks were installed and abandoned is not known. Six other USTs are known to
have been removed from the site in 1990 but only five of these are documented in the NCDEQ UST Database.
A release was documented from that UST system. Five of these tanks (1-5) were gasoline USTs and one (6)
was a kerosene UST (Figure 3). The tanks removed during this closure event were given identification
numbers of 7, 8 and 9. The contents of these USTs is unknown, although the largest of these USTs (9) had
a weathered gasoline odor.
Soil contamination was detected in the vicinity of USTs 7 and 8 during the Preliminary Site Assessment. The
analytical results for the samples collected under USTs 7, 8 and 9 did not detect petroleum constituents above
the NCDEQ Action Levels. The soil contamination detected during the Preliminary Site Assessment is likely
related to the former product lines or dispensers for these USTs.
5.Provide a brief description of site characteristics (including status of facility (active or inactive), land use of
site and surrounding area, water supply, topography, vegetation, surface water, wells, buildings, surface
cover, soil type, depth to and nature of bedrock, depth to groundwater, direction of groundwater flow, etc.)
The former gas station has been demolished. A residential structure remains on the west side of the parcel.
The surrounding property is used for residential and commercial/industrial use. The property and surrounding
properties appear to utilize a public water supply. The site is level and is covered with asphalt, concrete and
thick grass. No surface water is present on or near the property. The soil at the property is a sandy silt. Depth
to bedrock is not known. Bedrock in the area is mapped as metagranodiorite and related metagranitoids
(Goldsmith, Richard, Milton, D.J., and Horton, J.W., Jr., 1988, Geologic map of the Charlotte 1 degree x 2
degrees quadrangle, North Carolina and South Carolina, U.S. Geological Survey, Miscellaneous
Investigations Series Map I-1251-E, 1:250,000.) Depth to groundwater was measured to be about 27-28 feet
BGS at the time the monitoring wells were abandoned. Groundwater flow has been documented to flow to
the southeast.
6.Summarize initial abatement actions, assessment activities, and corrective actions performed to date and list
all reports previously submitted.
On December 8, 2021, three petroleum USTs were permanently closed by removal. These three tanks were
removed by Zebra Environmental of High Point, NC. Contaminated soil was not encountered in either of the
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two UST excavations. Petroleum constituents were not detected at concentrations above the NCDEQ Action Levels in the four soil samples collected below the three USTs (Figures 4 and 5 and Table B-3). The extent of the excavation and locations of soil samples are shown on Figures 4 and 5.
A Preliminary Site Assessment Report was submitted to NCDOT on September 12, 2018 and updated on October 26, 2018. It was recommended in this report that the USTs within NCDOT’s roadwork footprint be
removed, any contaminated soil encountered be removed and sent to a remediation facility, and the monitoring wells on the property from the existing release incident be properly abandoned.
E.Closure Procedure1.Describe preparations for closure including steps taken to notify authorities, permits obtained, and stepstaken to clean and purge the tanks.
Prior to closure of the UST system, a UST-3 form was submitted to NCDEQ. The Davie County Fire Marshallwas notified and scheduled to be onsite during closure activities. A UST removal permit was obtained from
the Davie County Inspections Department.
Soil was excavated from above and around the USTs. The tanks were pressure washed and vacuumed out byZebra Environmental. The Davie County Fire Marshall, Mr. Cameron Webb, was onsite to verify that thetanks were sufficiently cleaned and that the lower explosive limit (LEL%) was at 0%. The tanks were thenremoved from their excavations.
2.Describe the closure procedure (For guidance, see the Guidelines, Section 5.0.), referencing site andsampling location maps and cross-sections presented in Section H of this report. Clearly state how theselection of sample types and locations was influenced by the nature of the stored substance, any initial alarmor cause for suspicion, the type of backfill, the depth to groundwater, and other factors appropriate foridentifying the presence and source of a release. Describe the condition of the UST system (pitting, holes,
etc.) where it could be observed. If it was necessary to install and sample monitoring well(s), explain.
Seramur & Associates mobilized to the site to close the three USTs on December 8, 2021. Soil was excavatedfrom the sides, and both ends of each UST. Zebra Environmental only excavated as much soil as wasnecessary to remove the USTs from the ground. The USTs were then removed from their excavations usingchains and a backhoe. The two smaller USTs showed signs of pitting and holes. It appeared that holes hadbeen previously ripped into the tops of these two tanks as well. Zebra Environmental transported the USTsto their facility in High Point, NC for scrapping and disposal.
The soil samples collected from the tank excavations were collected using the backhoe bucket. Soil sampleswere collected from below each UST (Figures 3, 4 and 5). All soil samples were collected while wearing anew pair of disposable Nitrile gloves. A total of four soil samples were collected, placed in containers
provided by the lab, labeled, and placed on ice. A chain-of-custody was initiated, and the samples wereshipped via FedEx to REDLab, LLC in Wilmington, NC. REDLab analyzed the samples for TPH-GRO and
TPH-DRO using the UVF Method. The selection of sample types and locations was not influenced by thenature of the stored substance. Following collection of the soil samples, the excavations were backfilled usingthe clean soil removed from around the USTs and clean backfill brought in from offsite. As NCDOT’sroadway plans indicate that a travel lane will be located in the vicinity of the larger, single UST, ZebraEnvironmental compacted the soil in approximate 12-inch lifts using a sheepsfoot roller.
The soil samples were screened in the field with a calibrated Photoionization Detector to look for evidenceof a release. Petroleum vapors were not detected in these samples. It did does not appear that there was a
release from these tanks. Contaminated soil was detected in the vicinity of the two smaller USTs during aPreliminary Site Assessment completed for NCDOT in 2018. The contaminated soil found in the vicinity of
these USTs is likely from the related product lines or dispensers previously removed from the site.
Five monitoring wells located within NCDOT’s proposed Right-of-Way, Control-of-Access, and Easementswere abandoned by Geonetics Corporation on December 9, 2021. The well abandonment records are includedin Appendix E.
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3.Note the amount of residual material pumped from the tank and describe the storage, sampling and disposalof the residual material and the disposal of the tank, pumps and piping (Refer to appendices with disposalmanifests and certificate of tank disposal in Section J.).
Zebra Environmental pumped 475 gallons of water/fuel mixture from the three USTs on December 8, 2021
prior to their closure. Most of the liquid pumped from the USTs was the water used to clean the tanks.
Zebra Environmental transported the three USTs to their facility in High Point, NC for scrapping anddisposal.
4.Document any soil excavation activities.•Describe excavation procedures noting the condition of the soil encountered and the dimensions of theexcavation in relation to the tanks, piping, and/or pumps;
Soil removed from around the USTs appeared to be “clean” backfill. Petroleum odors were not detected
in the soil removed from the excavations.
The excavation around USTs 7 and 8 was about 14’ x 11.5’. Soil was excavated to a depth of about 3feet and the tanks were pulled from the excavation (Figures 4 and 5). No piping was present.
The excavation around UST 9 was about 10’ x 15’. Soil was excavated to a depth of 4.5 feet and the tank
was pulled from the excavation (Figures 4 and 5). Piping was present over the tank, but not beyond.There was a large concrete slab above the tank.
•Note the depth from the land surface to the top and to the base of the tank and to the piping;
USTs 7 and 8 were buried about 1 foot below the ground surface and extended to a depth of about 4.7feet below the ground surface. No piping was present around these two tanks. UST 9 was buried about
1.5 feet below the ground surface primarily under asphalt and concrete. A portion of a product line wasobserved on top of the tank. The tank extended to a depth of about 7.1 feet below the ground surface.
•Note the volume of soil excavated;
The volume of soil excavated from around USTs 7 and 8 was about 450 ft3 and the volume of soilexcavated from around UST 9 was about 650 ft3 (Figures 4 and 5).
•Describe the soil type(s) encountered;
Soil encountered during the closure activities was primarily a sandy silt.
•Describe the type and source of backfill used;
Clean backfill was brought in from offsite by Zebra Environmental.
•Note if groundwater, NAPL, or bedrock was encountered during the excavation process
Groundwater, NAPL and/or bedrock were not encountered during the excavation process.
•Describe the method of temporary storage, sampling, and treatment/disposal of soil.
After asphalt and concrete was removed from above the USTs and surrounding area, the soil excavatedfrom around the USTs was temporarily piled on the side of the excavation. Following removal of theUSTs, this soil was used to backfill the tank excavation along with clean soil brought in from offsite.
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The soil removed from around the USTs was screened prior to being used as backfill to confirm that petroleum vapors were not present in the soil was used as backfill.
F.Site Investigation1.Describe field screening, including:
•Physical characteristics of the soil samples, as observed during collection;
Soil excavated during the UST closure appeared to be clean backfill. No petroleum odors or vapors werepresent in the soil excavated from around the three USTs. The soil was primarily a brown, sandy silt.
•Field instrumentation used to screen soils;
Soil was screened in the field with a calibrated Ion Science PhoCheck Tiger LT Photoionization Detector(PID).
•Field instrument calibration procedures; and
The PID is calibrated using an Isobutylene (100 ppm) Air Balance Calibration Gas.
•Screening results (Refer to table provided in Section I.).
The soil samples were screened in the field. Volatile organic vapors were not detected in the four soilsamples. These results are included in Table B-3.
2.Document soil sampling information (Refer to tables and appendices provided in Sections I and J.),including:
•Lithological descriptions from logs for borings, excavations;
Intact soil from under the USTs was a brown sandy silt.
•Type of samples (from excavation, borehole, direct push boring, stockpiled soil, etc.);
The four soil samples collected during the UST closure were collected from underneath the three USTs.
•Sample collection procedures (grab, split spoon, hand auger, etc.);Soil samples were collected in the backhoe bucket and while wearing a new pair of nitrile gloves.
•Location of soil samples;
One sample was collected from under each of the 600-gallon USTs and two samples were collected
underneath the larger UST (Figures 4 and 5).
•Sample identification;
Soil samples were identified numerically in the order they were collected (S-1, S-2, S-3 and S-4).
•Depth of soil samples (feet below land surface);
Soil samples S-1 and S-2 were collected at a depth of about 4.75 feet below the ground surface. Soil
samples S-3 and S-4 were collected at a depth of about 7.15 feet below the ground surface (Figure 5).
•Time/date collected; and
Refer to the Chain-of-Custody Record in Appendix D for sample collection information.
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•Method(s) of soil sample analysis.
The four soil samples were analyzed by REDLab, LLC in Wilmington, NC using the UVF Method.
3.Document groundwater and surface water sampling information (Refer to tables and appendices providedin Sections I and J.):
Groundwater and/or surface water sampling was not conducted during this UST closure.
4.Document quality-control measure information (Refer to tables and appendices provided in Sections I andJ.), including:
•Sample handling procedures including sample preservation techniques and sample transportprocedures;
All soil samples are collected while wearing a new pair of disposable Nitrile gloves to avoid cross-contamination. Samples are collected and placed in jars provided by the lab. The sample jars provided
by REDLab are 40 ml jars filled with approximately 20 ml of methanol. New Terra-Core samplers wereused to collect the proper volume of soil. REDLab requires about 10 grams of soil in each sample jar.
The jars are labeled and placed on ice in a cooler. A Chain-of-Custody record is initiated at our office,and the samples are shipped in the cooler with ice via FedEx to REDLab, LLC in Wilmington, NC for
TPH-GRO and TPH-DRO analysis using the UVF Method.
•Time and date samples were submitted to lab; and
The samples were dropped off at a FedEx pickup location at 14:30 on December 9, 2021 and receivedby the lab at 13:30 on December 10, 2021.
•Collection of samples for quality control purposes (e.g., duplicates, field blanks, trip blanks).
Trip blank samples and/or duplicate samples were not collected during this assessment.
5.Describe soil investigation results:
TPH GRO were not detected in any of the soil samples at concentrations above the quantification limits. TPHDRO were not detected in soil samples S-1, S-3 and S-4 at concentrations above the quantification limits.
TPH DRO was detected at low concentrations soil sample S-2. In sample S-2, the DRO concentration was1.4 ppm.
Conclusions and Recommendation
1.Present conclusions, referencing maps, tables, and appendices in Sections H-J, as follows:
•Indicate that soil contaminant levels are below the action level;
Petroleum constituents were not detected at or above the NCDEQ Action Levels of 50 ppm for GROand 100 ppm for DRO in any of the soil samples collected below the three USTs (Figures 4 and 5 andTable B-3).
•Indicate that NAPL is not present;
NAPL was not present in either of the excavations.
•Indicate if groundwater or bedrock was encountered during investigation and, if so, at what depth below
land surface;
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Groundwater and/or bedrock were not encountered in either of the two UST excavations. Groundwater was measured at a depth of about 27-28 feet prior to the abandonment of the groundwater monitoring wells.
•Indicate if groundwater assessment was necessary due to the proximity of the UST system togroundwater or bedrock (or to the presence of a slab or tank for which removal was determined to beeconomically or technologically unfeasible), thereby preventing the reliable determination of a releaseby soil assessment alone;
A groundwater assessment was not necessary for this assessment. Five monitoring wells were abandoned
due to their location within NCDOT’s proposed roadwork footprint.
2.If soil contaminant levels in the system closure soil samples were below the applicable TPH action limits,and, where sampled, groundwater contamination was not found to exceed the applicable 2L standards and
NAPL was not encountered in the excavation(s), monitoring well(s), or on nearby surface water bodies,then no further action should be requested.
Petroleum constituents were not detected above the NCDEQ Action Levels in any of the UST closure soil
samples. No further assessment work is recommended for this tank closure.
G.Figures
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Figure 1
Site Location Map
Source: U.S.G.S.
The National Map
Seramur & Associates, PC
Boone, NC N0800400
Feet
Site Location
State Project: U-6002
Davie County, NC
Parcel #001
Facility I.D. #: 00-0-03351
Paul Tony Forrest Property
716 Wilkesboro Street
Mocksville, NC
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Figure 2
Site Plan
State Project: U-6002
Davie County, NC Seramur & Associates, PC
Boone, NC
Parcel #001
Facility I.D. #: 00-03351
Paul Tony Forrest Property
716 Wilkesboro Street
Mocksville, NC
0 30 60
Feet N
DocuSign Envelope ID: 4EF46B34-9ECA-4739-A470-E540896903BC
State Project: U-6002
Davie County, NC
Seramur & Associates, PC
Boone, NC
Parcel #001
Facility I.D. #: 00-03351
Paul Tony Forrest Property
716 Wilkesboro Street
Mocksville, NC
20100
Feet N
MW-2
MW-3 MW-4
MW-1
VEW-1
- Monitoring Well Locations
- Approximate Cross-Section
Locations
Figure 3
UST Site Plan
E
PUEPUE-Y1- STA. 12+00
7
8
9
12
3
4
5
6
USTs Removed
from recent
assessment
Approximate
Location of
Former
UST System
B
B`
A
A`
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State Project: U-6002
Davie County, NC
Seramur & Associates, PC
Boone, NC
Parcel #001
Facility I.D. #: 00-03351
Paul Tony Forrest Property
716 Wilkesboro Street
Mocksville, NC
20100
Feet N
MW-2
MW-3 MW-4
MW-1
VEW-1
S-1
BDL
BDL
- Soil Sample Locations
- Monitoring Well Locations
- Approximate Extent
of Excavations
E
PUEPUE-Y1- STA. 12+00
Figure 4
Site Plan with
Excavation and Soil
Sample Locations
S-2
BDL
1.4
S-3
BDL
BDL
S-4
BDL
BDL
BDL - Below Detectable Limit
BDL
1.4
- Concentrations of Petroleum
Constituents Reported as Gasoline
Range Organics (upper) and
Diesel Range Organics (lower)
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State Project: U-6002
Davie County, NC
Seramur & Associates, PC
Boone, NC
Parcel #001
Facility I.D.#: 00-03351
Paul T. Forrest Property
716 Wilkesboro Street
Mocksville, NC
Figure 5
Cross-Sections
A-A` and B-B`
0
5
10
0
5
10
5
8 7 Feet
Feet
2.50
Feet
52.50
Feet
9
8
West
B
East
B`
North
A
South
A`
S-1
BDL
BDL
S-2
BDL
1.4
S-2
BDL
1.4 S-4
BDL
BDL
BDL - Below Detectable Limit
BDL
1.4
- Concentrations of Petroleum
Constituents Reported as Gasoline
Range Organics (upper) and
Diesel Range Organics (lower)- Soil Sample Locations
- Approximate Extent
of Excavations
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H.Tables
Table B-1: Site History – UST/AST System and Other Release Information
Revision Date: 12/16/2021 Incident Number and Name: 6272 - Greyhound Bus Lines
UST ID Number Current / Most-Recent
Contents
Previous Contents Capacity (in gallons) Construction Details Tank Dimensions Description of Piping
and Pumps
Date Tank
Installed
Status of UST
Release associated
with this
UST System?
1 Gasoline Gasoline 3,000 Single-Wall Steel Not Known Steel 1956 Removed (6/15/1990) Yes
2 Gasoline Gasoline 3,000 Single-Wall Steel Not Known Steel 1956 Removed (6/15/1990) Yes
3 Gasoline Gasoline 3,000 Single-Wall Steel Not Known Steel 1956 Removed (6/15/1990) Yes
4 Gasoline Gasoline 3,000 Single-Wall
Steel
Not Known Steel 1968 Removed
(6/15/1990)
Yes
5 Gasoline Gasoline 2,000 Single-Wall Steel Not Known Steel 1959 Removed (6/15/1990) Yes
6 Kerosene Kerosene 550 Single-Wall
Steel
Not Known Not Known Not
Known
Removed
(6/15/1990)
Not Known
7 Not Known Not Known 600 Single-Wall
Steel
3.6’ x 7.8’ Not Known Not
Known
Removed
(12/8/2021)
Yes
8 Not Known Not Known 600 Single-Wall
Steel
3.6’ x 7.8’ Not Known Not
Known
Removed
(12/8/2021)
Yes
9 Not Known Not Known 3,850 Single-Wall Steel 5.6’ x 10.9’ Steel Not Known Removed (12/8/2021) No
N/A #2 Fuel Oil #2 Fuel Oil Not Known Not Known Not Known Not Known Not
Known
Not in Use Not Known
Incident Number Material Released Date of Release Description of Release
6272 Gasoline 3/19/90 (Discovered) Release discovered following removal of UST system.
N/A Not Known 12/8/21 (Discovered) Insignificant amount of petroleum constituents detected in soil samples
collected from under USTs following closure.
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Table B-2: Site History - UST/AST Owner/Operator and Other Responsible Party Information
Revision Date: 12/16/2021 Incident Number and Name: 6272 - Greyhound Bus Lines
UST ID Number 7, 8, 9 Facility ID Number 00-0-0000003351
Owner/Operator Name (and Contact) Dates of Operation (mm/dd/yy to mm/dd/yy)
Not Known Not Known
Street Address
716 Yadkinville Road
City State Zip Telephone Number
Mocksville NC 27028 None (Facility Demolished)
UST ID Number 1, 2, 3, 4, 5, 6 Facility ID Number 00-0-0000003351
Owner/Operator Name (and Contact) Dates of Operation (mm/dd/yy to mm/dd/yy)
Lois Tutterow (no contact) 1956 – 06/15/1990
Street Address
716 Yadkinville Road
City State Zip Telephone Number
Mocksville NC 27028 None (Facility Demolished)
Other Incidents Onsite or Commingled/In Close Proximity
Incident Number 6272 Date Incident Occurred 03/19/1990
Name of Responsible Party Date Incident Reported 03/19/1990
Jeff Tutterow Date Incident Closed (i/a) Not Closed
Table B-3: Summary of Soil Sampling Results Revision Date: 12/15/21
Property Name: Paul Tony Forrest Property Parcel ID#: 001
Analytical Method (e.g., VOC by EPA 8260)  UVF UVF UVF PID
Contaminant of Concern  GRO (mg/kg) DRO (mg/kg) TPH (mg/kg) VOC (ppm) Sample ID
Date Collected (mm/dd/yy)
Source Area Sample Depth (ft. BGS)
Incident Phase
S-1 12/08/21 UST 7 4.75 PSA <0.36 <0.36 0.488397 0.0
S-2 12/08/21 UST 8 4.75 PSA <0.69 1.4 1.4 0.0
S-3 12/08/21 UST 9 7.15 PSA <0.38 <0.38 <0.38 0.0
S-4 12/08/21 UST 9 7.15 PSA <0.76 <0.76 <0.76 0.0
NC DEQ Action Level (mg/kg) 50 100 -- --
ft. BGS = feet below ground surface
mg/kg = milligrams per kilogram
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I.Appendices
Appendix A Notification of Intent: UST Permanent Closure or Change-in-Service (UST-3 Form)
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Appendix B
Site Investigation Report for Permanent Closure or Change-in-Service of UST (UST-2 Form)
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Appendix C Standard Operating Procedures
A safety meeting was conducted prior to commencing the tank excavation work. Zebra Environmental completed the
cleaning and removal of the UST system. Soil samples from the excavation were collected out of the backhoe bucket
which were extracted from the soil below each UST. One soil sample is collected for every ten feet of tank. A new
pair of Nitrile gloves was worn while collecting each sample. The depth and horizontal locations of the soil samples
were identified by measuring with a fiberglass tape, estimating right angles and referencing site features or using a
total station. Soil samples collected for laboratory analysis were placed in laboratory sample jars, labeled and chilled
immediately following collection. Chain-of-Custody records were initiated, and samples were packaged and sent to
REDLab, LLC in Wilmington, North Carolina.
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Appendix D
Copy of Laboratory Analytical Records and Chain-of-Custody Records
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Hydrocarbon Analysis Results
Client:SERAMUR Samples taken Wednesday, December 8, 2021
Address:165 KNOLL DR Samples extracted Wednesday, December 8, 2021
BOONE, NC 28607 Samples analysed Friday, December 10, 2021
Contact:KEITH SERAMUR, JOEY ANDERSON Operator HARRY WOOTEN
Project:NCDOT U-6002
4 U04049
Matrix Sample ID Dilution
used
BTEX
(C6 - C9)
GRO
(C5 - C10)
DRO
(C10 - C35)
TPH
(C5 - C35)
Total
Aromatics
(C10-C35)
16 EPA
PAHs BaP HC Fingerprint Match
% light % mid %
heavy
s S-1 14.3 <0.71 <0.36 <0.36 0.4884 0.3 <0.11 <0.014 75.4 17 7.7 V.Deg.PHC 74.7%,(FCM)
s S-2 27.6 <0.69 <0.69 1.4 1.4 0.81 <0.22 <0.028 0 82.3 17.7 Deg Fuel 79.2%,(FCM)
s S-3 15.0 <0.38 <0.38 <0.38 <0.38 <0.08 <0.12 <0.015 0 0 0 Residual HC
s S-4 30.5 <0.76 <0.76 <0.76 <0.76 <0.15 <0.24 <0.03 0 0 0 PHC not detected,(BO)
Initial Calibrator QC check OK Final FCM QC Check OK 100.3 %
Results generated by a QED HC-1 analyser. Concentration values in mg/kg for soil samples and mg/L for water samples. Soil values are not corrected for moisture or stone content
Fingerprints provide a tentative hydrocarbon identification. The abbreviations are:- FCM = Results calculated using Fundamental Calibration Mode : % = confidence for sample fingerprint match to library
(SBS) or (LBS) = Site Specific or Library Background Subtraction applied to result : (PFM) = Poor Fingerprint Match : (T) = Turbid : (P) = Particulate present
Ratios
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QED Hydrocarbon FingerprintsProject:NCDOT U-6002 Friday, December 10, 2021
700
S-1 : V.Deg.PHC 74.7%,(FCM)
1745
S-2 : Deg Fuel 79.2%,(FCM)
700
S-3 : Residual HC
700
S-4 : PHC not detected,(BO)
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Appendix E Well Abandonment Records
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2
Figure
DIAGRAM IS FOR GENERAL LOCATION ONLY, AND IS NOT INTENDED FOR CONSTRUCTION PURPOSES 7327-G West Friendly Ave
Greensboro, NC
SITE PLANProject Manager:
Drawn by:
Checked by:
Approved by:
MIM Project No.
File Name:
Date:
Scale:
75159688
ALF
APR 2015CLC
CLC
1”~ 35’
Tutterow
Tutterow (Incident #6272)
716 Yadkinville Road
Mocksville, Davie County, North Carolina
denotes approximate site boundary
denotes groundwater monitoring well.
MW-3
MW-2
MW-1
VEW-1
MW-4
FORMER
DISPENSER
ISLANDS
T1
T2
T3
T4
T5
FORMER
BUILDING
LOCATION
APPARENT
HEATING OIL UST
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Table 1
Monitoring Well Construction Information and Historical Groundwater Elevations
Tutterow
Mocksville, North Carolina
Terracon Project No. 75159688
NCDENR Incident No. 6272
Well ID Date Installed
(m/dd/yyyy)
Screen Interval
(ft. BGS)
Depth of Well
(ft. BGS)
Top of Casing
Elevation (ft.)
Date Water Level
Measured
(m/dd/yyyy)
Depth to Water
from Top of
Casing (ft.)
Free Product
Thickness (ft.)
Groundwater
Elevation (ft.) *Comments
4/18/2011 32.13 ND 69.15
7/14/2011 32.23 ND 69.05
10/24/2011 32.74 ND 68.54
4/10/2015 31.52 ND 69.76
4/18/2011 32.59 ND 69.49
7/14/2011 32.63 ND 69.45
10/24/2011 33.24 ND 68.84
4/10/2015 31.94 ND 70.14
4/18/2011 30.97 ND 69.03
7/14/2011 31.02 ND 68.98
10/24/2011 31.62 ND 68.38
4/10/2015 NS NS NS
4/18/2011 31.74 ND 68.53
7/14/2011 31.8 ND 68.47
10/24/2011 32.38 ND 67.89
4/13/2015 31.28 ND 68.99
4/18/2011 31.58 ND 69.22
7/14/2011 31.69 ND 69.11
10/24/2011 32.14 ND 68.66
4/10/2015 30.93 ND 69.87
Notes:
* = If free product is present in a well, groundwater elevation is calculated by: [Top of Casing Elevation - Depth to Water] + [free product thickness x 0.8581]
Assumed data of 100 feet at top-of-casing (TOC) is well MW-3.
101.28
102.08
100
100.8VEW-1 2/15/2002
10-40 40
10-40 40
10-35 35
45-50 50
MW-1 11/20/2003
MW-2 2/15/2002
MW-3 2/15/2002
MW-4 2/15/2002 10-35 35 100.27
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Appendix F
Disposal Manifests
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Appendix G
Photographs of Closure Activities
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