WS-29840_48942_CA_UST-61_20230406

UST-61 24-Hour Release and UST Leak Reporting Form.
For Releases
in NC
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
suspected release
(DWM USE ONLY)
Incident # ________ Risk (H,I,L,U)_______
Received On ________ Received By ________ Reported by (circle one): Phone, Fax or Report
Region _______
Suspected Contamination? (Y/N) ________
Confirmed GW Contamination? (Y/N) ______
Confirmed Soil Contamination ?(Y/N) ______ Samples Taken?(Y/N) ______
Free Product? (Y/N) _____ If Yes, State Greatest
Thickness ______________
Facility ID Number ______________
Date Leak Discovered ___________
Comm/Non-Commercial? ________ Reg/Non-regulated? _____________
INCIDENT DESCRIPTION
Incident Name:
Address: County:
City/Town: Zip Code: Regional Office (circle one): Asheville, Mooresville, Fayetteville,
Raleigh, Washington, Wilmington, Winston-Salem
Latitude (decimal degrees): Longitude (decimal degrees) : Obtained by:
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) GPS
Topographic map
GIS Address matching
Other
Unknown
Describe location:
HOW RELEASE WAS DISCOVERED (Release Code)
(Check one)
Release Detection Equipment or Methods
During UST Closure/Removal
Property Transfer
Visual/Odor
Water in Tank
Water Supply Well Contamination
Groundwater Contamination
Surface Water Contamination
Other (specify) _______________
SOURCE OF CONTAMINATION
Source of Release
(Check primary source)
Cause of Release
(Check primary cause)
Type of Release
(Check one)
Product Type Released
(Check primary product type released)
Tank
Piping
Dispenser
Submersible Turbine Pump
Delivery Problem
Spill Bucket
Other
Unknown

Definitions presented on reverse
Spill
Overfill
Corrosion
Physical/Mechanical
Damage
Install Problem
Other
Unknown

Definitions presented on reverse
Petroleum
Non-Petroleum
Both

Location
(Check one)

Facility
Residence
Other
Gasoline/ Diesel/
Kerosene
Heating Oil
Other Petroleum
Products
Metals
Other Inorganics
Other Organics
Diesel/Veg. Oil
Blend
Vegetable Oil 100%
E10 – E20
E21 – E84
E85 – E99
Ethanol 100%
E01 – E09
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
Point of Contact Address
City State Zip Code Telephone Number
UST SYSTEM OPERATOR
UST Operator/Company Address
City State Zip Code Telephone Number
LANDOWNER AT LOCATION OF UST INCIDENT
Landowner Address
City State Zip Code Telephone Number
Draw Sketch of Area (showing two major road intersections) or Attach Map
Person Reporting Incident Company Telephone Number
Title Address Date
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

4/6/23, 3:04 PM 3024 W English Rd - Google Maps
https://www.google.com/maps/place/3024+W+English+Rd,+High+Point,+NC+27262/@35.9226728,-80.0427685,14z/data=!4m6!3m5!1s0x88530bd6c9dbad6d:0x87af8dfe37a582c!8m2!3d35.9309986!4…1/1
Map data ©2023 Google 2000 ft
3024 W English Rd
CEDAR ROCK ENVIRONMENTAL, P.C.
107 Pioneer Trail
Graham, NC 27253
[phone]

March 30, 2023

Ms. Brenda Meris
795 Joyce Circle
High Point, NC 27265

Reference: Inspection of an underground storage tank (UST) located at 3024 W. English Road,
High Point, North Carolina

Cedar Rock Project # 362822590

Dear Ms. Meris:

Cedar Rock Environmental, P. C. (Cedar Rock) performed a site inspection on March 29, 2023 at the above
referenced location. The purpose of the inspection was to determine if the UST previously used for storing
heating oil had leaked causing significant contamination of the underlying soils. All residences (trailers)
have been removed from the property. It is not known when the UST was installed.

An inactive UST was observed to be located as shown in the Site Map. Note that the buildings shown on
the Site Map are no longer present (except for the one at the top right of the image). The fill pipe of the
UST was observed to be intact but partially corroded through with a hole in the sidewall of the pipe. An
attempt was made to remove the fill cap but the pipe was folding over and did not have enough integrity to
twist off the cap. No vent pipe was observed. The depth to the top of the UST is approximately 8 inches
below land surface (bls). The UST has a length of about 67 inches with a diameter of approximately 48
inches and a capacity of about 525 gallons. White flagging was installed to mark both ends of the UST (see
Photo 1). A small hole was drilled in the top of the southern end of the tank to allow access to the interior
(Photo 2). The UST was measured to contain approximately 462 gallons of fluid.

Once the orientation of the UST was determined, a soil boring was performed at the southern end of the
tank using a 3.25-inch diameter stainless steel hand auger. The boring was advanced to a depth of
approximately 4.5 feet bls, about 0.2 feet above the bottom of the UST. A strong petroleum odor and
discoloration was observed in the soils at the base of the boring suggesting significant leakage from the
UST has occurred. The soils at the base of the boring consist of a grayish brown sandy silt. The boring
was not advanced further due to an influx of fluid from the tank through a corrosion hole in the end of the
tank. The fluid level equilibrated to the level observed inside the tank. One soil sample, CR-1, was
collected from the base of the boring and can be submitted for laboratory analysis, if required.

The property is currently serviced by a municipal water supply. No water supply wells were observed
within 150 feet of the petroleum release. For this reason, the property should be classified as “Low Risk”
by the State.

Based on the results of this investigation, significant contamination of the soils surrounding the UST has
been confirmed. Current law (NCGS 143-215.85 (a) and (b)) requires that any significant release of
petroleum be immediately reported to the Guilford County Department of Public Health (336-641-3771) or
the North Carolina Department of Environmental Quality (DEQ), Division of Waste Management,
Winston-Salem Regional Office (336-776-9800). According to State law, upon reporting the release, the
current property owner where a release is discovered is identified by the State as the “Responsible Party”
Cedar Rock
ENVIRONMENTAL
Ms. Brenda Meris
March 30, 2023
Page 2

for any State required action relating to the UST leakage. Cedar Rock will submit a UST-61 form to satisfy
the State’s notification requirement for the release upon request by the property owner.

Currently, the property cannot be legally conveyed until a Notice of Residual Petroleum (NRP) is filed with
the Guilford County Register of Deeds office pursuant to NCGS 143B- 279.11 (d). The NRP will contain
applicable land use restrictions to minimize the risk of exposure to existing contamination. The land use
restrictions prohibit any disturbance of site soils within a specified radius of the estimated extent of soil
contamination and prohibit the future operation or installation of any water supply wells on the property.
Once classified as “Low Risk” and upon approval of the NRP, the DEQ will issue a “Conditional” Notice
of No Further Action (NFA) letter to formally close out the release incident. The “Conditional” provision
in the NFA letter will be removed upon receiving a certified copy of the filed NRP and the completion of
Public Notification requirements. Filing the NRP and performing Public Notification would not be required
if all soil contamination exceeding applicable standards has been removed.

The State currently will not require initial abatement or remedial action of the soils regarding the release of
heating oil from a UST on a “Low Risk” property, however, they will require removal of the tank contents
and properly cleaning the tank interior to abate the petroleum release pursuant to 15A NCAC 2L .0106(b).
Once the presence of the UST and confirmed contaminated soil is disclosed to other interested parties as
required by State law, future buyers, homeowner’s insurance providers, or lenders may also require initial
abatement and/or remedial actions relating to the UST prior to making any commitments towards the
property. In addition, there exists a potential for further environmental impact to the property from
continued leakage from the UST.

An NFA letter can be obtained in two different scenarios. Scenario One requires the removal of the UST
and all associated contaminated soil exceeding applicable standards. Scenario Two requires filing an NRP,
performing the Public Notification task and abating the petroleum release (removing tank contents and
cleaning the tank interior).

Currently, the presence of the soil contamination does not appear to pose any known health risk, however,
leaving the UST and soil contamination in place and filing the NRP might restrict future building plans
within several feet of the UST location. If there are plans to build over top of the tank, we recommend
attempting to remove the UST and associated contaminated soils. If the UST and all associated
contaminated soil is removed, the DEQ will issue an NFA letter and there will be no land use restrictions
that apply. Cedar Rock can remove the UST including 15 tons of contaminated soil for a charge of
$15,000.00 plus $1.50 per gallon of recovered fluids. Tonnage in excess of 15 tons will be an added
charge at the rate of $150.00 per ton. This would include appropriate environmental assessment, reporting,
and site restoration. All work performed would be in accordance with the recommended practices and
procedures outlined in the Guidelines for Site Checks, Tank Closure, and Initial Response and Abatement,
Change 11 (May 17, 2021), published by the North Carolina Department of Environmental Quality,
Division of Waste Management, UST Section. Note that if all contamination cannot be removed (i.e. if it
extends beyond the reach of excavating equipment) the State will still require filing an NRP and performing
Public Notification before issuing an NFA letter.

If preferred, Cedar Rock can abandon the UST for a charge of $3,800.00 plus $1.50 per gallon of
recovered fluids. The UST abandonment would consist of exposing a portion of the UST by hand
excavation, cutting a hole about two feet in diameter on the topside of the UST, removing all tank and fuel
line contents, cleaning of the tank interior, and filling the tank with an excavatable flowable fill cement
slurry. A summary report signed by a licensed geologist would be generated that would include
photographs of each step of the abandonment process, including a photograph of the interior of the UST to
show the UST was properly cleaned. Preparing and filing the NRP and performing the Public Notification
requirement will cost an additional $1,250.00. Keep in mind that since filing the NRP would be required
Ms. Brenda Meris
March 30, 2023
Page 3

with this approach, there would be land use restrictions put in place that would restrict building a confined
airspace (crawlspace) over top of the area surrounding the UST.

Attached is an invoice for the site inspection. We appreciate the opportunity to be of service to you. If you
have any questions regarding the content of this report, please call me at 336-684-3836.

Sincerely,

Josiah D. Payne, N.C. Licensed Geologist #2825

Attachment
Ms. Brenda Meris
March 30, 2023
Page 4

Site Map. Aerial view of the UST location. Tank size not to scale – for reference only.

Photo 1. View of the UST location. Both ends of the UST are marked with white flags.
Note the concrete pad of the former building (top right). Measurements of the tank’s
location seen in the Site Map are taken off the corner of this concrete pad.
Approximate location of UST 3.5 ft
6 ft

Ms. Brenda Meris
March 30, 2023
Page 5

Photo 2. View of the south end of the UST where soil boring was performed. Note the
fluid in the borehole and the small hole that was drilled in the top of the tank to allow
access to the tank’s interior.