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HomeMy WebLinkAboutMO-29128_48312_CA_UST-61_20220308_24-Hour Release and UST Leak Reporting FormUST-61 24-Hour Release and UST Leak Reporting Form. For Releases This form should be completed and submitted to the UST Section's regional office following a known or suspected release from an underground storage tank (UST) system. This form is required to be submitted within 24 hours of discovery of a known or in NC suspected release (DWM USE ONLY) Suspected Contamination? (Y/N) Y Facility ID Number _N/A_ Incident # Risk (H,I,L,U) Confirmed GW Contamination? (Y/N) Date Leak Discovered 3/2/20_ Received On Received By Confirmed Soil Contamination ?(Y/N) _Y Comm/Non-Commercial? _Non_ Reported by (circle one): Phone, Fax or Report Samples Taken?(Y/N) Y Reg/Non-regulated? Non_ Region Free Product? (Y/N) _N If Yes, State Greatest Thickness INCIDENT DESCRIPTION Incident Name: Puckett/Nash Assemblage Address: 10219 and 10200 Puckett Road County: Mecklenburg Regional Office (circle one): Asheville, Mooresville, Fayetteville, City/Town: Charlotte, NC Zip Code: 28216 Raleigh, Washington, Wilmington, Winston-Salem Latitude (decimal degrees): 35.214028 Longitude (decimal degrees) :-80.504156 Obtained by: GPS Briefly describe suspected or confirmed release: (including but not limited to: nature of release, date of release, amount of release, amount of free product present and recovery efforts, initial responses conducted, impacts to receptors) Topographic map GIS Address matching lmp;;rtpd soll were identified with a photo-ioni7ation dptprtc)r (Pin) during thp rpmoval of two 550-gallon out of service heating oil underground storage tanks (USTs). Suspected impacted soils were excavated as part of IAA activities. I he soils were later hauled o -si e Tor proper disposal Tollowing the installation ot a road/bridge that would allow access to the release areas. xOther Google Earth Describe location: UST Location HOW RELEASE WAS DISCOVERED (Release code) (Check one) Release Detection Equipment or Methods x Visual/Odor ❑Groundwater Contamination x During UST Closure/Removal Water in Tank ❑Surface Water Contamination Property Transfer Water Supply Well Contamination ❑Other (specify) SOURCE OF CONTAMINATION Source of Release Cause of Release Type of Release Product Type Released (Check primary source) (Check primary cause) (Check one) (Check primary product type released) X Tank Spill X Petroleum Gasoline/ Diesel/ ❑ Diesel/Veg. Oil Piping Overfill Non -Petroleum Kerosene Blend X Heating Oil ❑ Vegetable Oil 100% Dispenser Corrosion Both Other ❑ E10 — E20 Submersible Turbine Pump Physical/Mechanical Location Petroleum Damage Products ❑ E21 — E84 Delivery Problem (Check one) Install Problem Metals ❑ E85 — E99 Spill Bucket Other Facility Other Inorganics [:]Ethanol 100% Other X Unknown X Residence Other Organics ❑ E01 — E09 Unknown Other Definitions presented on reverse Definitions resented on reverse Ownership 1. Municipal 2. Military 3. Unknown 4. Private 5. Federal 6. County 7. State Operation Type 1. Public Service 2. Agricultural 3. Residential 4. Education/Relig. 5. Industrial 6. Commercial 7. Mining UST Form 61 (02/19) Page 1 of 2 IMPACT ON DRINKING WATER SUPPLIES Water Supply Wells Affected? 1. Yes 2. No 3. Unknown Number of Water Supply Wells Affected Water Supply Wells Contaminated: (Include Users Names, Addresses and Phone Numbers. Attach additional sheet if necessary) 1. 2. 3. UST SYSTEM OWNER UST Owner/Company Joe Lee, Mack Vance Puckett, and James Geoffrey Nash Point of Contact Address Same 19306 Wildcat Trail City State Zip Code Telephone Number Davidson NC 28036 336-722-0885 UST SYSTEM OPERATOR UST Operator/Company Address Unknown City State Zip Code Telephone Number LANDOWNER AT LOCATION OF UST INCIDENT Landowner Address Same City State Zip Code Telephone Number Draw Sketch of Area (showing two major road intersections) or Attach Map Person Reporting Incident Steve Libbey Company Hart & Hickman Telephone Number 704-302-4404 Title Project Manager Address 2923 South Tryon Street, Charlotte, NC Date 01/19/22 UST Form 61 (02/19) Page 2 of 2 Definitions of Sources Tank: means the tank that stores the product and is part of the underground storage tank system Piping: means the piping and connectors running from the tank or submersible turbine pump to the dispenser or other end -use equipment (Vent, vapor recovery, or fill lines are excluded.) Dispenser: includes the dispenser and the equipment used to connect the dispenser to the piping (e.g., a release from a suction pump or from components located above the shear valve) Submersible Turbine Pump (STP) Area includes the submersible turbine pump head (typically located in the tank sump), the line leak detector, and the piping that connects the submersible turbine pump to the tank Delivery Problem: identifies releases that occurred during product delivery to the tank. (Typical causes associated with this source are spills and overfills.) Other: serves as the option to use when the release source is known but does not fit into one of the preceding categories (e.g., for releases from vent lines, vapor recovery lines, and fill lines) Unknown: identifies releases for which the source has not been determined Definitions of Causes Spill: use this cause when a spill occurs (e.g., when the delivery hose is disconnected from the tank fill pipe or when the nozzle is removed from the dispenser) Overfill: use when an overfill occurs (e.g., overfills may occur from the fill pipe at the tank or when the nozzle fails to shut off at the dispenser) Physical or Mechanical Damage: use for all types of physical or mechanical damage, except corrosion (e.g., puncture of tank or piping, loose fittings, broken components, and components that have changed dimension) Corrosion: use when a metal tank, piping, or other component has a release due to corrosion (e.g., for steel, corrosion takes the form of rust) Installation Problem: use when the problem is determined to have occurred specifically because the UST system was not installed properly Other: use this option when the cause is known but does not fit into one of the preceding categories (e.g., putting regulated substances into monitoring wells) Unknown: use when the cause has not been determined —Ce f Ln Iiorttf Neekk ab • I 6M _>� I �� �. High Sc ` "• em 825 .JQpIo `IBM ��` 'r` j • �'' . tY f Vances �%�•� SITE !�Wr 141 WTERCHANGE 18 ' j/ �, �.�y\1, ��• eas, 7113 ' Tanks B IL J a ' 1a Firaft Subs ,pn Copyright013'Nati+onal Geographi :@ 2c Society, i-cubed 0 2,000 4,000 Niiiii SCALE IN FEET U.S.G.S. QUADRANGLE MAP DERITA, NORTH CAROLINA 2013 QUADRANGLE 7.5 MINUTE SERIES (TOPOGRAPHIC) Beverly, Trudy From: Beverly, Trudy Sent: Wednesday, March 9, 2022 10:21 AM To: Steve Libbey Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC Thank you. Trudy D- � E 5 Q�xk-� rH •atx ..�. N.or� Trudy Beverly, L.G. Hydrogeologist, Division of Waste Management North Carolina Department of Environmental Quality UST Section, Mooresville Regional Office 704.235.2182 (Office) Trudy. Bever] y a)ncdenr.gov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. From: Steve Libbey[mailto:slibbey@harthickman.com] Sent: Wednesday, March 9, 2022 10:14 AM To: Beverly, Trudy <trudy.beverly@ncdenr.gov> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam. Terry is our contact: Withrow Capital, Inc. 1341 East Morehead Street, Suite 201 Charlotte, North Carolina, 28226 Attn: Terry Williams tilliams@withrowcapital.com Steve From: Beverly, Trudy <trudy.beverly@ncdenr.gov> Sent: Wednesday, March 9, 2022 10:06 AM To: Steve Libbey <slibbey@harthickman.com> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC I'm going to list the UST-1 & UST-2 closures as separate sites since they are on different parcels. Looks like both parcels have been owned by Metrolina Properties, LTD Partnership/Withrow Capital, Inc. since June 10, 2020. Do you have a name and email address for the Metrolina Properties, LTD Partnership/Withrow Capital, Inc. contact? Thank you, Trudy Trudy Beverly, L.G. Hydrogeologist, Division of Waste Management 44 North Carolina Department of Environmental Quality tee, r"" '� UST Section, Mooresville Regional Office 4�' 704.235.2182 (Office) Trudy.B everlykncdenr. gov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. From: Steve Libbey[mailto:slibbev@harthickman.com] Sent: Wednesday, March 9, 2022 9:43 AM To: Beverly, Trudy <trudy.beverly@ncdenr.gov> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam. Charlotte. Revised 61 attached. Thanks From: Beverly, Trudy <trudy.beverly@ncdenr.gov> Sent: Wednesday, March 9, 2022 9:37 AM To: Steve Libbey <slibbey@harthickman.com> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC Is the city considered Charlotte or Huntersville? Trudy Trudy Beverly, L.G. Hydrogeologist, Division of Waste Management .EQ North Carolina Department of Environmental Quality r" �../ C, I$, UST Section, Mooresville Regional Office 704.235.2182 (Office) Trudy.Beverlykncdenr. , og_v Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. From: Beverly, Trudy Sent: Wednesday, March 9, 2022 9:33 AM To: Steve Libbey <slibbey@harthickman.com> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC Hey Steve, The UST-61 has Union County. It's this one in Mecklenburg? If so, please correct the UST-61 and resend. Thank you, Trudy Trudy Beverly, L.G. D- � E Hydrogeologist, Division of Waste Management North Carolina Department of Environmental Quality r" QVLACX11NA UST Section, Mooresville Regional Office awn 704.235.2182 (Office) Trudy. B everlyL& ncdenr. gov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. Office Mailing Address: 610 East Center Avenue, Suite 301 Mooresville, NC 28115 Branch's Underground Storage Tanks Website Address: hops://deq.nc.gov/about/divisions/waste-management/ust Branch's Above Ground Storage Tanks Website Address: hitps:Hdeg.nc.gov/about/divisions/waste-management/ust/ast-program INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES: httns://deo.nc. eov/about/divisions/waste-management/waste-management-rules-data/waste-management-eis-mans File Review Procedures: https://deq.nc. gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche): ho2s://deg.nc.gov/about/divisions/waste-management/laserfiche Document Submittal & UST File Names for Laserfiche Policies: htti)s:Hfiles.nc.eov/nedea/Waste%2OManauement/DWM/UST/W hatsNew/Final-Electronic-Document-Submittal-Policv.l)df https:Hfiles.nc. gov/ncdeq[Waste%2OManagement/D WMiUST/Corrective%2OAction/UST%2Ofile%20names%20for%2OLaserfiche.docx From: Steve Libbey[mailto:slibbey@harthickman.com] Sent: Tuesday, March 8, 2022 1:13 PM To: Beverly, Trudy <trudy.beverly@ncdenr.gov> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam. Thanks so much! From: Beverly, Trudy <trudy.beverly@ncdenr.gov> Sent: Tuesday, March 8, 2022 1:13 PM To: Steve Libbey <slibbey@harthickman.com> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC Hey Steve, I'll do my best to have the report reviewed within the next week. Trudy �D Trudy Beverly, L.G. Hydrogeologist, Division of Waste Management cd� -�EQ North Carolina Department of Environmental Quality FazFrrm UST Section, Mooresville Regional Office 704.235.2182 (Office) Trudy. B ev erly(a),ncdenr. gov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. Office Mailing Address: 610 East Center Avenue, Suite 301 Mooresville, NC 28115 Branch's Underground Storage Tanks Website Address: htws://deq.nc.gov/about/divisions/waste-management/ust Branch's Above Ground Storage Tanks Website Address: hops://deg.nc.gov/about/divisions/waste-management/ust/ast-program INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES: htt )s://deo.nc. eov/about/divisions/waste-management/waste-management-rules-data/waste-management-eis-mans File Review Procedures: hops://deq.nc. gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche): hitps://deq.nc.gov/about/divisions/waste-management/laserfiche Document Submittal & UST File Names for Laserfiche Policies: htti)s:Hfiles.nc.¢ov/ncdeg/Waste%2OManaizement/DWM/UST[WhatsNew/Final-Electronic-Document-Submittal-Policv.l)df htips:Hfiles.nc. gov/ncdeq/\Vaste%20Management/D WMiUST/Corrective%2OAction/UST%2Ofile%20names%20for%2OLaserfiche.docx From: Steve Libbey[mailto:slibbey@harthickman.com] Sent: Tuesday, March 8, 2022 10:56 AM To: Beverly, Trudy <trudy.beverly@ncdenr.gov> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam. Hi Trudy, I apologize for being a pest. The client just emailed me about this project. Will you have time to review this report in the next week or so? Thanks, Steve From: Beverly, Trudy <trudy.beverly@ncdenr.gov> Sent: Tuesday, March 8, 2022 6:31 AM To: Steve Libbey <slibbey@harthickman.com> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC Received. Thank you Steve. Trudy Trudy Beverly, L.G. Hydrogeologist, Division of Waste Management w, D- � E North Carolina Department of Environmental Quality PM `" CAACX11NA UST Section, Mooresville Regional Office 704.235.2182 (Office) Trudy. B everlykncdenr. gov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. Office Mailing Address: 610 East Center Avenue, Suite 301 Mooresville, NC 28115 Branch's Underground Storage Tanks Website Address: https://deq.nc.gov/about/divisions/waste-management/ust Branch's Above Ground Storage Tanks Website Address: hops://deq.nc.gov/about/divisions/waste-mana2ement/ust/ast-proeram INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES: httDs://dea.nc. eov/about/divisions/waste-manaeement/waste-management-rules-data/waste-manaeement-ais-mans File Review Procedures: https://deg.nc. gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche): https://deq.nc.gov/about/divisions/waste-manaizement/laserfiche Document Submittal & UST File Names for Laserfiche Policies: https:Hfiles.nc.eov/ncdea/W aste%2OMana2ement/DWM/UST/WhatsNew/Final-Electronic-Document-Submittal-Policy.odf hgps:Hfiles.nc. gov/ncdeq/Waste%2OManagement/D WM[U ST/Corrective%2OAction/UST%20file%20names%20for%2OLaserfiche.docx From: Steve Libbey [mailto:slibbev@harthickman.com] Sent: Monday, March 7, 2022 3:48 PM To: Beverly, Trudy <trudy.beverly@ncdenr.gov> Subject: FW: [External] Puckett/Nash Assemblage, Charlotte, NC CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam. Trudy, I apologize, please see the attached UST-61 with the correct signature date (today). Steve From: Steve Libbey Sent: Monday, March 7, 2022 3:46 PM To: Beverly, Trudy <trudy.beverly@ncdenr.gov> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC Attached, thanks! Please call me if you have any questions. Thanks, Steve Stephen Libbey, PG, Project Manager Hart &Hickman, PC 2923 S Tryon Street, Suite 100 • Charlotte, NC 28203 Direct:704-887-4606 Mobile:704-302-4404 www.harthickman.com I Im From: Beverly, Trudy <trudy.beverly@ncdenr.gov> Sent: Friday, March 4, 2022 10:59 AM To: Steve Libbey <slibbey@harthickman.com> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC Please submit a UST-61 form for the site. The information contained in the form is used for database entry. https://deg.nc.gov/about/divisions/waste-management/underground-storage-tanks-section/ust-forms Thank you and happy friday, Trudy Trudy Beverly, L.G. Hydrogeologist, Division of Waste Management North Carolina Department of Environmental Quality �i a�.m�UST Section, Mooresville Regional Office urns vawe ` 704.235.2182 (Office) Trudy.BeverlyL&ncdenr.gov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. From: Steve Libbey[mailto:slibbey@harthickman.com] Sent: Friday, March 4, 2022 10:41 AM To: Beverly, Trudy <trudy.beverly@ncdenr.gov> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam. I don't see that Ayla ever sent one. Do you need one to complete the incident/report review? Thanks, Steve From: Beverly, Trudy <trudy.beverly@ncdenr.gov> Sent: Thursday, March 3, 2022 7:36 PM To: Steve Libbey <slibbey@harthickman.com> Subject: RE: [External] Puckett/Nash Assemblage, Charlotte, NC Do you have a UST-61 form for this one? Thanks, Trudy cc���DE <A QW; fH i:ak , Trudy Beverly, L.G. Hydrogeologist, Division of Waste Management North Carolina Department of Environmental Quality UST Section, Mooresville Regional Office 704.235.2182 (Office) Trudy.13everlykncdenn gov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. Office Mailing Address: 610 East Center Avenue, Suite 301 Mooresville, NC 28115 Branch's Underground Storage Tanks Website Address: https://deq.nc.gov/about/divisions/waste-management/ust Branch's Above Ground Storage Tanks Website Address: hitps:Hdeg.nc.gov/about/divisions/waste-management/ust/ast-program INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES: httns://deo.nc. eov/about/divisions/waste-management/waste-management-rules-data/waste-management-eis-mans File Review Procedures: https://deq.nc. gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche): htt2s://deg.nc.gov/about/divisions/waste-management/laserfiche Document Submittal & UST File Names for Laserfiche Policies: httys:Hfiles.nc.eov/nedea/Waste%2OMana2ement/DWM/UST/W hatsNew/Final-Electronic-Document-Submittal-Policv.udf htt 2s:Hfiles.nc.gov/ncdeq/Waste%2OManagement/DWMiUST/Corrective%2OAction/UST%20file%20names%20for%2OLaserfiche.docx From: Steve Libbey [mailto:slibbey@harthickman.com] Sent: Thursday, March 3, 2022 4:23 PM To: Beverly, Trudy <trudy.beverly@ncdenr.gov> Subject: [External] Puckett/Nash Assemblage, Charlotte, NC CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam. Hi Trudy, please find attached an IAA report for this site. You discussed this site with Ayla in our office early last year. Recall, we weren't able to remove the impacted soil stockpiles due to site access issues (-485 cut off the original site access roads). Access was gained and the stockpiles were removed in October 2021. Please call me if you have any questions. Thanks, Steve Stephen Libbey, PG, Project Manager Hart & Hickman, PC 2923 S Tryon Street, Suite 100 • Charlotte, NC 28203 Direct: 704-887-4606 • Mobile: 704-302-4404 www.harthickman.com 10