WS-88169_95033_G_RRA_20230518

Incident Name: Bellemont UMC Region: Winston-Salem
Incident Number: 95033 County: Alamance
Date: 05/18/2023 Ranking Performed by: ARW
SECTION I. Risk Classification (Check all that apply)
1. High Risk
A.
B.
X
C.
D.
E.
F.
2. Intermediate Risk
A.
B.
C.
D.
E.
3. Low Risk
A.
SECTION I. Risk Classification H
RISK, RANK AND ABATEMENT RATING FORM
NORTH CAROLINA
UNDERGROUND STORAGE TANK SECTION
The levels of groundwater contamination for ethylene dibromide or benzene exceed 1,000 times
the federal drinking water standard set out in 40 CFR 141(these levels have also been termed
“gross contamination levels”).
The source area of a confirmed release is located within a designated wellhead protection area, as
defined in 42 USC 300h-7(e);
Note: a new ranking form must be completed whenever site conditions may have changed
SCORE
The levels of groundwater contamination for any contaminant (except ethylene dibromide,
benzene and the aliphatic and aromatic carbon fraction classes) exceed 50 percent of the solubility
of the contaminant at 25 degrees Celsius or 1,000 times the groundwater quality standard or
interim standard established in 15A NCAC 2L .0202, whichever is lower (these levels have been
termed “gross contamination levels”); or
A water supply well not used for drinking water is located within 250 feet of the source area of a
confirmed release;
Surface water is located within 500 feet of the source area of a confirmed release and the
maximum groundwater contaminant concentration exceeds the applicable surface water quality
standard and criteria found in 15A NCAC 2B .0200 by a factor of 10;
In the Coastal Plain Physiographic Province (as designated on a map entitled Geologic Map of
North Carolina published by the Department in 1985), the source area of a confirmed release is
located where there is recharge to an unconfined or semi-confined deeper aquifer which the
Department determines is being used or may be used as a source of drinking water;
H175D
The groundwater within 500 feet of the source area of a confirmed release has the potential for
future use in that there is no source of water supply other than the groundwater;
There exists an imminent danger to public health, public safety or the environment, as a result of
the release.
There exists a serious threat of explosion due to the accumulation of vapors in a confined space, as
a result of the release; or
A low risk classification means that the risk posed by a release does not meet any of the high or
intermediate risk criteria or, based on site-specific information received by the Department, the
release does not pose a significant risk.
An existing water supply well, including one used for non-drinking purposes, has been
contaminated by the release;
A water supply well used for drinking water is located within 1,000 feet of the source area of a
confirmed release;
UST/200 Rev. 9/04 1 of 4
SECTION II. Release Ranking (Assign points as applicable)
1. EMERGENCY HAZARD ASSESSMENT POINTS
EMERGENCY
2. EXPOSURE ASSESSMENT
Groundwater
A.
Public Supply Wells (each well can only be counted once)
1.
Private Supply Wells (each well can only be counted once)
2.
3.
Public or Private Wells Below 2L .0202 Standards (each well can only be counted once)
4.
B. Threat to Uncontaminated Drinking Water Supplies
Public Supply Wells (each well can only be counted once)
1.
40
2.
Private Supply Wells (each well can only be counted once)
3.
4.
10
5.
75
6.
Surface Water
1.
2.
Private water supply, including non-drinking well, located within 250 feet of plume
edge, wells threatened or the threat is currently unknown; award 20 points per well
Private well, not used for drinking, containing contamination in detectable
concentrations; award 75 points per well
Public or private drinking water supply contains substances that are below the 15A
NCAC 2L groundwater quality standards; award 100 points per well
Public or institutional water supply well between 500 and 1000 ft of plume edge or
threat is reasonably known; award 10 points per well
Private water supply, not including non-drinking well, located between 251 and 500
feet of the plume edge, wells threatened or the threat is currently unknown; award 10
points per well
Private domestic drinking water supply well containing substances in concentrations
exceeding 15A NCAC 2L groundwater quality standards; award 200 points per well
Public or institutional water supply well within 500 ft of plume edge, plume edge is
within radius of influence of public well, or threat currently unknown; award 40
points per well
Private water supply, not including non-drinking well, located between 501 and 1000
feet of plume edge or wells located within 1000 feet but threat to wells is reasonably
known or alternate water source is available; award 5 points per well
Free product or sheen discovered on surface waters as a result of groundwater
discharge; award 5 points
Complete entire form and assign letter E to final rating in Section III, Once Emergency is abated a new rating must be performed
Private non-drinking well, located between 251 and 1000 feet of plume edge; award 2
points per well
Violation of Class HQW,ORW,WS-l, WS-II or SA surface water quality standards as
a result of groundwater discharge; award 10 points
Public or institutional water supply well containing substances in concentrations
exceeding 15A NCAC 2L groundwater quality standards; award 600 points per well
Impacted Water Supplies
An emergency situation exists whenever the Department determines that the release poses an imminent
danger to public health, public safety, or the environment.
UST/200 Rev. 9/04 2 of 4
Soil
A Land Use
Soil to GW Residential
1.
OR
2.
0
OR
3.
Air
A. Vapor Phase Exposure
1.
2.
3. HYDROGEOLOGY AND LITHOLOGY
A.
B.
C.
4. ENVIRONMENTAL VULNERABILITY ASSESSMENT
Contamination Concentrations
A.Existing Groundwater Quality -The worst case monitor or supply well, assign only one
1.
OR
2.
OR
3.
OR
4.
Contaminant Types
A. Predominant Contamination Type
1.
2.
0
SECTION II. Release Ranking 125
Maximum soil contaminant concentration exceeds the "Industrial/Commercial"
exposure concentration or no risk-based data available; award 15 points total
Contaminant vapors detected in inhabitable building(s), but levels are below 20% of
the lower explosive limit and health concern levels; award 20 points total
Contaminant vapors detected in other confined areas (uninhabitable buildings, sewer
lines, utility vaults, etc.) but levels are below 20% of the lower explosive limit; award
5 points total
Bedrock - contamination is located in, on or within five feet of bedrock; award 20 points
Low boiling point petroleum products (gasoline, aviation fuel); award 20 points
Horizontal Contaminant Migration -Data or observations indicate that no discharge points or
aquifer discontinuities exist between the discharge, release or known extent of contamination and
the nearest down gradient drinking water supply; award 5 points total
Greater than 100 times the 2L groundwater standards; award 40 points
No Risk Data
At less than 10 times the 2L groundwater standards; award 5 points
Maximum soil contaminant concentration exceeds "Residential" but is below the
"Industrial/Commercial" exposure concentration; award 10 points total
Free Product; award 80 points
High boiling point petroleum products (fuel oil, kerosene, diesel fuel or similar
products); award 0 points
Maximum soil contaminant concentration exceeds "Soil to Groundwater" but below
"Residential" exposure concentration; award 5 points total
Vertical Contaminant Migration -Literature or well logs indicate that no confining layer is present
above bedrock or within twenty feet of land surface; award 10 points
Between 10 and l00 times the 2L groundwater standards; award 20 points
Industrial/Commercial
Choose required soil clean-up level then apply points only if soil
contamination exceeds requirement
UST/200 Rev. 9/04 3 of 4
SECTION III. Source Abatement Assignment (Award Points and Assign Letter)
A. Abated or Unabated Contaminant Source
1.
OR
2.
OR
(AST) 3.
50
OR
4.
SECTION III. Source Abatement Assignment 50 D
SECTION IV. Risk, Rank and Abatement Score
(e.g H750D)
Upon completion transfer final score to box on page 1.
DH
UST release has been abated. Contaminated soil has been removed or remediated;
Award 0 points and assign Letter R
UST remains in active use and continues to discharge into the environment; Award
100 points and assign Letter A
UST release has been abated. However, contaminated soil continues to release
product or contaminants into the environment; Award 50 points and assign Letter D
Emergency Situation, Assign Letter E (from Section II.1.)
Total: Risk, Rank and Abatement Score
(Insert risk letter from Section I, total all points from Section II and III, and insert abatement letter from Section III)
175
UST/200 Rev. 9/04 4 of 4