WA-26553_31751_G_RRA_20230816

NCDEQ UNDERGROUND STORAGE TANK SECTION
RISK, RANK, AND ABATEMENT RATING FORM
Incident Name:Pearson Residence Region:
8/16/2023 Ranked By:
Note: a new ranking form must be completed whenever site conditions may have changed, or at least once every 5 years
SECTION I. Initial Risk Classification (Check all that apply)
1. High Risk
All UST and Non-UST Petroleum Releases NRP for soil and gw needed
A.
B.
C.
D.
Commercial UST, Noncommercial Motor Fuel UST, and Non-UST Petroleum Releases Only
F.
G.
Noncommercial UST Releases Only (including Noncommercial Farm or Residential Motor Fuel USTs)
H.
I.
J.
2. Intermediate Risk (Commercial UST and Non-UST Releases Only)
A.
B.
C.
D.
E.
3. Low Risk
A.x
WaRO
Chowan
ALW
The levels of groundwater contamination associated with a confirmed release 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”).
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.
L 80 D
An existing water supply well, including one used for non-drinking purposes, has been contaminated by any UST release
or any non-UST petroleum release;
Low
is no source of water supply other than the groundwater;
confirmed release;
no wells within 150 feet
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
responsible party for the release; or
contaminant concentration exceeds the applicable surface water quality standard and criteria found in 15A NCAC 2B
.0200 by a factor of 10;
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;
UST/200 Rev 2017-05_P Pg 1 of 4
Incident #
SECTION II. Risk Classification (Assign points as applicable)
1. EMERGENCY HAZARD ASSESSMENT E - FLAG
Complete form with letter "E" assigned to final rating. Once Emergency is abated, a new rating must be prepared.
2. EXPOSURE ASSESSMENT
Groundwater
A. Impacted Water Supplies
Public Supply Wells (each well can only be counted once)
x 600 =
Private Supply Wells (each well can only be counted once)
x 200 =
x 75 =
Public or Private Wells below 2L .0202 Standards (each well can only be counted once)
x 100 =
B. Threat to Uncontaminated Drinking Water Supplies
Public Supply Wells (each well can only be counted once)
x 40 =
x 10 =
Private Supply Wells (each well can only be counted once)
x 20 =
x 10 =
x 5 =
C. Proximity of Wells to Permitted USTs (PIB Information Check - No Points)
*
*
Surface Water
UST or non-UST plume edge, or 100 feet of other noncommercial UST plume edge; plume edge is
UST plume edge; or threat is reasonably known. 10 pts ea.
edge and wells threatened or threat is currently unknown. 20 pts ea.
motor fuel UST or non-UST plume edge and wells are threatened or threat is currently unknown. 10
motor fuel UST or non-UST plume edge; or wells located within 1000 ft but threat to wells is
Check after
notifying PIB:
1. Violation of Class HQW, ORW, WS-I, WS-II, or SA surface water quality standards as a result of groundwater
discharge. 10 pts total.
2. Free product or sheen discovered on surface waters as a result of groundwater discharge. 5 pts total.
31751
CO
U
N
T
(Flag if true, leave blank if no emergency is apparent.)
x
PO
I
N
T
S
TO
T
A
L
NCAC 2L groundwater quality standards. 600 pts ea.
15A NCAC 2L groundwater quality standards. 200 pts ea.
75 pts ea.
groundwater quality standards. 100 pts ea.
UST/200 Rev 2017-05_P Pg 2 of 4
Incident #
Section II.2: Surface Water (cont.)
A. Land Use (Choose soil cleanup level. Apply points only if soil contamination exceeds requirement.)
5 :
10 :10
15 :
B. Proximity of Protected Waters to Permitted USTs (PIB Information Check - No Points)
*
Air Quality
A. Vapor Phase Exposure
3. HYDROGEOLOGY and LITHOLOGY
A. Bedrock
B. Vertical Contaminant Migration
C. Horizontal Contaminant Migration
4. ENVIRONMENTAL VULNERABILITY ASSESSMENT
A. Existing Groundwater Quality - Worst-Case Monitor or Supply Well (assign only one)
B. Predominant Contamination Type
5. CONTAMINANT SOURCE ABATEMENT (from Section III)
A. Rank Contributions from Section III: Source Abatement Assignment (automated)
100 :
50 :50
SECTION II. Release Ranking
31751
4. Free product is present. 80 pts total.
OR
1. Low boiling-point petroleum productes (gasoline, aviation fuel). 20 pts total.
2. High boiling-point petroleum products (fuel oil, kerosene, diesel fuel, etc). 0 pts.
OR
OR
OR
OR
PO
I
N
T
S
:
80
2. Abatement letter "D" assigned due to a contaminated soil source remaining. 50 pts total.
concentration. 5 pts total.
exposure concentration. 10 pts total.
no risk-based data is available. 15 pts total.
limit and health concern levels. 20 pts total.
but levels are below 20% of the lower explosive limit. 5 pts total.
surface. 10 pts total.
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. 5 pts total.
TO
T
A
L
WS-II or SA is located within 500' of a permitted UST.
Check after
notifying PIB:
No Risk Data Soil to GW Residential Ind/Comm
UST/200 Rev 2017-05_P Pg 3 of 4
Incident #
(Assign Letter)
1. Abated or Unabated Contaminant Source
A. Emergency Situation
D
OR
D. Contaminant Sources Abated
80 D
SECTION IV. Risk, Rank, and Abatement Score
Total: Risk, Rank, and Abatement Score
(Use Risk letter from Section I, total of all Rank points from Section II, and Abatement letter from Section III. Transfer final score to Page 1)
UST Systems remain in operation and continue to discharge into the environment.
Assign Letter "A". (+100 points added to Rank.)
The UST release has been abated; however, contaminated soil continues to release product or contaminants
into the environment. Assign Letter "D". (+50 points added to Rank in Section II.5.)
The UST release has been abated and contaminated soil has been removed or remediated.
Assign Letter "R". (No points added to Rank in Section II.5.)
An Emergency condition must be immediately abated. Assign letter "E" (and see Section II.1).
L 80 D
UST/200 Rev 2017-05_P Pg 4 of 4