WS-88711_95503_CA_IAR_20171213

CEDAR ROCK ENVIRONMENTAL, P.C.
107 Pioneer Trail, Graham, North Carolina 27253
[phone]

December 13, 2017

Ms. Carin Kromm
NCDEQ
Division of Waste Management - UST Section
450 West Hanes Mill Road, Suite 300
Winston-Salem, North Carolina 27105-7407

Reference: Initial Assessment Report for the South Oak Ridge Baptist Church Property
200 Evergreen Drive, Winston-Salem, Forsyth County
Incident Number: Pending

Cedar Rock Project Number: 238022590

Dear Ms. Kromm:

Please accept this Initial Assessment Report for a release of fuel oil from a non-commercial,
above ground storage tank (AST) located at the above referenced property. This report satisfies
the requirements specified in the Underground Storage Tank Section Guidelines for Initial
Response and Abatement, Assessment and Corrective Action for Non-UST Releases of
Petroleum, (July 1, 2012).

A single AST, used for storing home heating oil, was removed from the subject property on
November 15, 2017. On December 4, 2017, a total of 4.51 tons of impacted soil were excavated
and transported to a permitted facility for bioremediation as an initial abatement measure. The
laboratory results for five soil samples collected from the limits of the excavation showed that no
petroleum residuals remain in the unexcavated soils.

Cedar Rock recommends that the DWM should issue a Notice of No Further Action letter to the
property owner to close out the release incident.

If you have any questions or need additional information, please give me a call.

Sincerely,

Robert A. Payne, L.G.

Enclosure
cc: South Oak Ridge Baptist Church c/o Pastor Philip Beavers – Property Owner

CEDAR ROCK ENVIRONMENTAL, P.C.
107 Pioneer Trail, Graham, North Carolina 27253
[phone]

December 13, 2017

Pastor Philip Beavers
1336 Lone Hickory Road
Yadkinville, NC 27055

Reference: Initial Assessment Report

Dear Mr. Beavers:

Cedar Rock Environmental, P.C. (Cedar Rock) is pleased to submit this Initial Assessment
Report to satisfy the requirements specified in the Underground Storage Tank Section Guidelines
for Initial Response and Abatement, Assessment and Corrective Action for Non-UST Releases of
Petroleum, (July 1, 2012) for a release of fuel oil from the former above ground heating oil
system located at the 200 Evergreen Drive property in Winston-Salem, North Carolina. This
report should be maintained for your records. A copy of this report has been sent to the North
Carolina Department of Environmental Quality (DEQ), Division of Waste Management (DWM),
UST Section in Winston-Salem.

Enclosed is an invoice for this work effort. If you have any questions, please feel free to contact
me at 336-376-0394.

Sincerely,

Robert A. Payne, L.G.
President

Attachment

INITIAL ASSESSMENT
REPORT

SOUTH OAK RIDGE BAPTIST CHURCH
PROPERTY
200 EVERGREEN DRIVE
WINSTON-SALEM, FORSYTH COUNTY

Date Release Discovered: October 31, 2017
Source: One 275-gallon Home Heating Oil AST

Incident No.: Pending

Prepared by:
Cedar Rock Environmental, P.C.
107 Pioneer Trail, Graham, North Carolina

December 13, 2017

CRE Project #238022590

Title Page
INITIAL ASSESSMENT REPORT

A. Site Information
1. Project name: South Oak Ridge Baptist Church Property
2. Facility ID #: N/A (residential)
3. Site Facility address, county, and telephone no.: 200 Evergreen Drive, Winston-Salem, NC
27106, Forsyth County.
4. Latitude and longitude of release: 36.119981 °N / 80.304308 °W (from Google Earth).

B. Release Information
1. Incident number: Pending.
2. Date release discovered: October 31, 2017.
3. Estimated quantity of release: Unknown.
4. Cause of release: Corrosion of AST.
5. Source of release: One 275-gallon home heating oil AST.

C. Ownership Information
1. Name, address, and telephone number of current UST owner: South Oak Ridge Baptist
Church c/o Pastor Beavers, 1336 Lone Hickory Road, Yadkinville, NC 27055. Phone: [phone]
2. Name and address of current property owner: Same as above.

D. Consultant/contractors
1. Primary consultant: Cedar Rock Environmental, P.C.
107 Pioneer Trail, Graham, NC 27253
Robert A. Payne, L.G. [phone]

2. Soil Disposal: Zebra Environmental & Industrial Services Inc.
901 East Springfield Road
High Point, NC 27263 [phone]

3. Laboratory: Research & Analytical Laboratories, Inc.
North Carolina Certification #34
106 Short Street, Kernersville, NC 27284 [phone]

E. Report Certification

I, Robert A. Payne , a Licensed Geologist for
Cedar Rock Environmental, P.C., do certify that
the information contained in this report is correct
and accurate to the best of my knowledge. License #: 970
(Signature & Seal)

Cedar Rock Environmental, P.C. is licensed to practice geology in North Carolina. The certification
number of the corporation is C-324 .

December 13, 2017
i
TABLE OF CONTENTS

Section Page No.

1.0 SITE HISTORY AND CHARACTERIZATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2.0 INITIAL RESPONSE AND ABATEMENT ACTIVITIES . . . . . . . . . . . . . . . . . . . . . . . 1

3.0 EXCAVATION OF CONTAMINATED SOIL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
3.1 Field Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
3.2 Soils Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3.3 Discussion of Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

4.0 CONCLUSIONS AND RECOMMENDATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

5.0 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Figures

1 Site Location Map (USGS 7 ½ Minute Topographical Quadrangle Map)
2 Site Map
3 Sample Locations and Results

Table

1 AST Owner and Operator Information
2 AST System Information
3 Summary of Soil Sampling Results

Appendices

A Photographic Documentation
B Disposal Manifests
C Excavation Log
D Sampling & Decontamination Procedures
E Laboratory Reports & Chains-of-Custody

1

1.0 SITE HISTORY AND CHARACTERIZATION

The project site is a residential property located at 200 Evergreen Drive in Winston-Salem, North
Carolina (see Figure 1). A single 275-gallon above ground storage tank (AST), identified as T1,
was located as shown in Figure 2. According to the Forsyth County Tax Office records, the
house was built in 1954. Table 1 lists pertinent storage tank system ownership information.
Table 2 lists specific AST information for T1.

The subject site is surrounded by single-family homes. Municipal water is available to the
surrounding properties.

2.0 INITIAL RESPONSE AND ABATEMENT ACTIVITIES

On November 15, 2017, Cedar Rock Environmental, P.C. (Cedar Rock) removed T1 from the
crawlspace of the residence. The AST was found to be empty. Laboratory analysis of two soil
samples, CR-1 and CR-2, collected from depths of about 4.0 feet and 3.0 feet respectively below
the former location of T1 on November 15, 2017 showed that leakage from the AST had caused
significant contamination of the underlying soils.

On December 4, 2017, Cedar Rock excavated 4.51 tons of obviously contaminated soil from the
source area of the release. Soil removal continued to a maximum depth of 5.25 feet. The lateral
dimensions of the excavation pit measured about 7.5 by 4.0 feet at the pit floor. The excavated
contaminated soil was transported by Zebra Environmental & Industrial Services Inc. of High
Point, North Carolina, to a permitted disposal facility located in Sanford, North Carolina for
bioremediation. The excavation pit was filled with an excavatable flowable fill cement slurry on
December 13, 2017.

No free product was encountered during the initial abatement activities. There are no other
subsurface structures on the subject site where free product or vapors could accumulate, or that
would provide a migration pathway for the release. The possibility of an explosion or the threat
to public health and safety or to the environment from the accumulation of vapors does not exist.
Therefore, the release is not a significant fire/safety/health hazard.

The 24-Hour Notification of Discharge Reporting Form (UST-62) was submitted to the North
Carolina Department of Environmental Quality (DEQ), Division of Waste Management (DWM),
UST Section in Winston-Salem on November 22, 2017.

3.0 EXCAVATION OF CONTAMINATED SOIL

3.1 Field Activities

Soil excavation activities were performed on December 4, 2017 (see photographs in
Appendix A). As impacted soil was removed from the source area, the soils were
2

periodically inspected by a North Carolina licensed geologist for evidence of petroleum
residuals (staining and odors). Soil removal continued until a depth of 5.25 feet. The lateral
dimensions of the excavation pit measured about 7.5 by 4.0 feet at the pit floor (see Figure
3). Neither bedrock nor groundwater were encountered during excavation activities.

A total of 4.51 tons of contaminated soil were transported to a permitted disposal facility
located in Sanford, North Carolina for bioremediation. Copies of the disposal manifests for
the AST and the excavated soils are included in Appendix B.

3.2 Soils Investigation

According to the Geologic Map of North Carolina (1985), the subject site is underlain by
biotite gneiss and schist. The native soils in the source area of the release consisted of a red-
brown, sandy SILT. A copy of the excavation log is included in Appendix C.

Cedar Rock collected two soil samples, CR-1 and CR-2, from beneath T1 on November 15,
2017. Five soil samples, CR-3 through CR-7, were collected from the limits of the
excavation on December 4, 2017 to document the effectiveness of soil excavation. The
locations of the soil samples are shown in Figure 3. The soil samples were collected
according to the sampling procedures included in Appendix D.

Soil samples CR-1 and CR-2 were submitted to be analyzed for total petroleum hydrocarbons
(TPH) by EPA Method 3550 only. Samples CR-3 through CR-7 were submitted to the
laboratory to be analyzed by EPA Method 3550 and EPA Method 5035. Soil sampling
activities are summarized in Table 3.

TPH were quantified by Method 3550 at concentrations of 283 parts per million (ppm) in
CR-1 and 108 ppm in CR-2. No TPH were quantified in samples CR-3 through CR-7 by
either Method 3550 or Method 5035. Copies of the laboratory reports and chains-of-custody
for the soil samples are included in Appendix E.

3.3 Discussion of Results

Figure 3 shows a plan view of the source area, limits of the excavation, and soil sample
locations in relation to the former location of the AST.

Petroleum-impacted soils were encountered immediately beneath the former location of the
AST. Soil removal continued to a depth of 5.25 feet. The lateral dimensions of the excavation
pit measured about 7.5 by 4.0 feet at the pit floor. The excavation pit was filled with an
excavatable flowable fill cement slurry on December 13, 2017.

Five soil samples were collected from the limits of the excavation where contamination was
most likely to remain. As shown in Table 3, no petroleum hydrocarbons were quantified in
these soil samples.

3

4.0 CONCLUSIONS AND RECOMMENDATIONS
A single AST, used for storing home heating oil, was removed from the subject property on
November 15, 2017. On December 4, 2017, a total of 4.51 tons of impacted soil were excavated
and transported to a permitted facility for bioremediation as an initial abatement measure.
Laboratory analysis of soil samples collected from the limits of the excavation indicate that no
petroleum hydrocarbons remain in the unexcavated soils. Cedar Rock recommends that the
DWM should issue a “Notice of No Further Action” (NFA) letter to close out the release
incident.

5.0 REFERENCES

24-Hour Notification of Discharge Form (UST-62); submitted to the North Carolina Department
of Environmental Quality, Division of Waste Management, UST Section, Winston-Salem
Regional Office on November 22, 2017.
Underground Storage Tank Section Guidelines for Initial Response and Abatement, Assessment
and Corrective Action for Non-UST Releases of Petroleum; published by the North
Carolina Department of Environment and Natural Resources, Division of Waste
Management, UST Section, July 1, 2012.
Geologic Map of North Carolina; published by the North Carolina Department of Natural
Resources and Community Development, Division of Land Resources, 1985.

FIGURES

Topo North America™ 10
Location: 36.119981° N 80.304308° W
FIGURE 1. SITE LOCATION
Data use subject to license.
© DeLorme. Topo North America™ 10.
www.delorme.com
TN
MN (8.3°W)
0 200 400 600 800 1000
0 100 200 300 400 500
ftm
Scale 1 : 12,000
1" = 1,000.0 ft Data Zoom 14-3
PROJECT:
LOCATION:
FILENAME:
VERSION DATE:CRE PROJECT NUMBER:
INCIDENT #
CEDAR ROCK
ENVIRONMENTAL, P.C.Pending
Winston-Salem, Forsyth Co.
SITE MAP
FIGURE 2
200 Evergreen Drive
238022590
2380-2.fc7
N
12/8/17
: T1 = 275-Gallon AST

: Property Lines
South Oak Ridge Baptist Church Property
House
T1
0
1 Inch = 40 Feet
804020 Evergreen Dri
veC l a w s o n S t r e e t
JWR Building
Company Property
FNMA Property
PROJECT:
LOCATION:
FILENAME:
VERSION DATE:CRE PROJECT NUMBER:
INCIDENT #
CEDAR ROCK
ENVIRONMENTAL, P.C.Pending
Winston-Salem, Forsyth Co.
SAMPLE
LOCATIONS
AND RESULTS
FIGURE 3
200 Evergreen Drive
238022590
2380-3.fc7
N
12/8/17
: T1 = 275-Gallon AST

: Limits of Excavation
: Sample Locations (CR-x)
South Oak Ridge Baptist Church Property
0
1 Inch = 10 Feet
20105
House
1
2T1
3
4
5
6 7
SOIL SAMPLE ANALYTICAL SUMMARY
Sample ID Depth (ft). TPH 5035 (ppm) TPH 3550 (ppm)
CR-2
CR-1
CR-4
CR-7
CR-6
CR-3
CR-5
4.4
5.25
3.0
4.0
5.5
5.75
5.0
BQL
BQL
BQL
BQL
BQL
Not Requested
Not Requested
BQL
BQL
BQL
BQL
BQL
108
283

TABLES

TABLE 1
AST OWNER AND OPERATOR INFORMATION
South Oak Ridge Baptist Church Property
200 Evergreen Drive, Winston-Salem, Forsyth County
AST ID Number T1 Facility ID Number N/A (residential)
Name of Owner/Operator Dates of Ownership
South Oak Ridge Baptist Church
c/o Pastor Beavers 1/17/17 – present
Street Address
1336 Lone Hickory Road
City State Zip Telephone Number
Yadkinville NC 27055 336-466-0893

TABLE 2
AST SYSTEM INFORMATION
South Oak Ridge Baptist Church Property
200 Evergreen Drive, Winston-Salem, Forsyth County
AST ID
Number
Current/Last
Contents
Previous
Contents
Capacity
(in gallons)
Construction
Details
Tank
Dimensions
(in feet)
Description
of Assoc.
Piping/Pumps
Date Tank
Installed
Status of
AST
Was a release
associated
with the
system?
T1 (AST)

#2 Fuel Oil #2 Fuel Oil 275 Steel 3.67 x 5.0 x
2.25
(Obround)
Copper tubing

Unknown Removed
on
11/15/17.
Yes,
discovered on
10/31/17.

TABLE 3
SUMMARY OF SOIL SAMPLING RESULTS
South Oak Ridge Baptist Church Property
200 Evergreen Drive, Winston-Salem, Forsyth County

Parameter
(Analytical Method)
TPH Action Limit
(ppm)
CR-1
CR-2
CR-3
CR-4
CR-5
CR-6
CR-7
Total Petroleum Hydrocarbons (3550) 100 283 108 BQL BQL BQL BQL BQL
Total Petroleum Hydrocarbons (5035) 50 Not
Requested
Not
Requested BQL BQL BQL BQL BQL
Sample Collection Procedure Hand Grab Hand Grab Hand Grab Hand Grab Hand Grab Hand Grab Hand Grab
Sample Location Beneath AST location. Beneath AST location. North wall of pit. East wall of pit. South wall of pit. West wall of pit. Center of pit floor.
Sample Depth (ft. bls) 4.0 3.0 4.4 5.5 5.25 5.0 5.75
Date of Sample Collection 11/15/17 11/15/17 12/4/17 12/4/17 12/4/17 12/4/17 12/4/17
Incident Phase AST Removal AST Removal Initial Abatement Initial Abatement Initial Abatement Initial Abatement Initial Abatement

Results in parts per million (ppm) = mg/kg. bls = below land surface

APPENDIX A

Photographic Documentation

Photo 1. View of the AST prior to removal and excavation activities.

Photo 2. View of the former AST location prior to excavation activities.

Photo 3. View of the former AST location after removal of contaminated
soils.

Photo 4. View of the former AST location after backfilling the excavation pit
with excavatable flowable fill cement slurry.

APPENDIX B

Disposal Manifests

TANK DISPOSAL MANIFEST CRE Project # 238022590

Tank Owner/Location:
South Oak Ridge Baptist Church
200 Evergreen Drive
Winston-Salem, NC 27106

Tank Owners Authorized Representative:
Cedar Rock Environmental, P.C.
107 Pioneer Trail, Graham, NC 27253
Robert A. Payne, President
[phone]

Description of Tank(s):

Tank # Capacity (gallons) Type Previous Contents

1 (AST)

275

Steel

Heating oil

Tank Owner’s Authorized Representative Certification:
The undersigned certifies that the above listed storage tank(s) have been removed from the premises of the tank
owner.

Robert A. Payne 11/15/2017 Printed Name Signature Date

Transporter:
The undersigned certifies that the above listed storage tank(s) have been transferred to the O. K. Sales, Inc. scrap
metal facility in Burlington, North Carolina.

Robert A. Payne 11/16/2017 Printed Name Signature Date

Disposal Certification:

Robert A. Payne 11/16/2017 Printed Name Signature Date

APPENDIX C

Excavation Log

PROJECT NO.:
PROJECT:
LOC.:
COUNTY:
DATE STARTED:
DATE COMPLETED:
CONTRACTOR:
TANK # GALS.
DIA. x
LENGTH (ft.)
DEPTH TO
BOTTOM (ft.)CONTENTS
DEPTH TO BEDROCK: GROUNDWATER:
FREE PRODUCT ENCOUNTERED?SAMPLE NO.AND TYPEUSCSSYMBOLREMARKS
DEPTHIN FEETSAMPLELOCATION(wall, floor, etc.)DESCRIPTION OF MATERIAL
BACKFILL:VOL. REMOVED & DISPOSAL:
No
CEDAR ROCK ENVIRONMENTAL, P.C.
FINAL DIMENSIONS OF EXC.:
n/a
EXCAVATION LOG
Zebra Environmental, Inc
Cement slurry
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
17
16
n/a
Excavation terminated at 5.25 feet (pit center).
238022590
4.51 tons
4.00' (W) x 7.5' (L) x 5.25' (D)
12/4/17
12/4/17
South Oak Ridge Baptist Church Property
200 Evergreen Drive, Winston-Salem
Forsyth
0 - 5.25' : red-brown, sandy SILT
CR-4&5
CR-7
CR-2
CR-6
CR-3
CR-1
T1 275 3.67 x 5.0 x 2.25 #2 fuel oil AST

APPENDIX D

Sampling & Decontamination Procedures

CEDAR ROCK ENVIRONMENTAL, P.C.
SOIL SAMPLING PROCEDURES
(Collection and Handling)
Soil sampling will be performed by, or under, the direct supervision of a North Carolina licensed
geologist. Care will be taken to minimize the loss of contaminants from the sample during sample
collection, storage, and transport through disturbance of the internal structure of the soil and
exposure to heat, sunlight, and air. Decontamination and handling procedures will be used that
minimize the chance of cross-contamination of the samples during and after sample collection.
All tools used to retrieve, divide, and collect the sample portion (e.g., hand augers, split-barrel
sampler, stainless steel spoons, etc.) will be decontaminated prior to and after each use (between samples). See Decontamination Procedures.

Vinyl disposable gloves will be worn during sample collection. Gloves will be changed as necessary after handling the sampling equipment (i.e., after breaking open split-barrels) to avoid
cross-contamination. Contact between the gloved hand and the soil will be minimized by dividing
and collecting the sample portion using a stainless steel spoon or knife.
The sample portion will be collected from the core of the soil at the end of the sampling device where the deepest retrieved soil is represented (e.g., hand auger teeth). If the sample is being
retrieved using the backhoe bucket, the sample portion will be collected from the consolidated
material located directly behind one of the bucket teeth. A separate sampling implement will be used to scrape away foreign material if present and/or the soil which came into contact with the
sample retrieving device in order to expose the core of the sample portion to be collected.
Immediately upon removal from the ground, the sample will be placed in a laboratory-provided,
decontaminated container. The sample container will be precooled, if possible, to minimize loss
of volatiles. The sample portion will be disturbed as little as possible during placement into the container. The container will be filled leaving no head-space and immediately capped and sealed.
Immediately upon collection, the exterior of the sample container will be wiped free of soil, if
necessary, and placed in a ziplock bag to minimize cross-contamination. The sample will
immediately be placed in a cooler of ice for storage and transport to the analytical laboratory.
The sample will be labeled with sample identification number, project number, date and time of
collection, and analyses to be conducted. The sample will be transported as soon as practical to a
North Carolina certified laboratory under chain-of-custody.

CEDAR ROCK ENVIRONMENTAL, P.C.
EQUIPMENT DECONTAMINATION PROCEDURES

Every effort will be made to prevent cross-contamination of soil and groundwater samples before,
during, and after sample collection. It is company policy that drillers contracted by Cedar Rock decontaminate their drilling and sampling equipment with steam prior to, and after, each use and/or
each boring. The following procedures apply to the decontamination of field equipment used by
Cedar Rock employees.

Soil Sampling Equipment
Stainless steel hand augers, spoons, and knives will be cleaned prior to, and after, each use and/or
each boring. If hand auger advancement of a borehole through contaminated soil is obvious or suspected, a clean auger bucket will be used to retrieve the sample portion. A fresh pair of
disposable vinyl gloves will be worn while handling the sample container.
Sampling equipment will be decontaminated by washing with phosphate-free soapy water; rinsing
in tap water followed by an isopropyl alcohol rinse; and a final “triple” rinse with distilled water.
The equipment will then be allowed to air dry. Clean sampling spoons and knives will be stored in a fresh ziplock bag.
If available, steam may be used instead of the above procedure.

Groundwater Sampling Equipment
Use of groundwater level measuring devices will proceed from the wells known to be the least
contaminated to those known to be more contaminated. If it is not known how contaminated the wells are, measurements will be taken on the up gradient wells prior to the down gradient wells.
A fresh pair of disposable vinyl gloves will be worn at each well during water level and sample
collection.
Water level measuring and well sampling (i.e., pumps and lines) devices will be decontaminated between wells by washing the wetted portion of the device as described above.

Each well will be sampled with a new disposable or decontaminated, dedicated bailer during each sampling event. New nylon or cotton string will be used during each sampling event on each
bailer. If the bailer contains a significant quantity of silt or sand after purging the well of stagnant
water, the bailer may be flushed with distilled water. The bailer will never come into contact with
anything other than a gloved hand or the inside of the well casing. While allowing the well to
recover, the bailer will be hung inside the well at the top of the casing. The string will be coiled and placed in a ziplock bag or vinyl glove such that it does not come into contact with other objects.

Groundwater sample containers will be wiped dry and stored in individual ziplock bags.

APPENDIX E

Laboratory Reports & Chains-of-Custody