The URL can be used to link to this page

Home My WebLink AboutTankReconditioningFormPDFApplication for Water Tank Reconditioning Plan Approval (Revised 12/15) Page 1 of 4 Public Water Supply Section (Review 12/15) Application for Water Tank Reconditioning Plan Approval ($50 Review Fee Required) North Carolina Department of Environmental Quality Division of Water Resources Public Water Supply Section _________________________________________ Water System Name ____________________________ Water System Number Name and Location (Street Address) of Tank: ___________________________________________________________ Asheville Regional Office 2090 U.S. Highway 70 Swannanoa, NC 28778 Phone: (828) 296-4500 Fayetteville Regional Office 225 Green Street, Suite 714 Fayetteville, NC 28301 Phone: (910) 486-1541 Mooresville Regional Office 610 E. Center Ave., Ste. 301 Mooresville, NC 28115 Phone: (704) 663-1699 Raleigh Regional Office 3800 Barrett Drive 1628 Mail Service Center Raleigh, NC 27699-1628 Phone: (919) 791-4200 Washington Regional Office 943 Washington Square Mall Washington, NC 27889 Phone: (252) 946-6481 Wilmington Regional Office 127 Cardinal Drive Extension Wilmington, NC 28405-3845 Phone: (910) 796-7215 Winston-Salem Regional Office 450 Hanes Mill Road, Suite 300 Winston-Salem, NC 27105 Phone: (336) 776-9800 **Provide this notice to your Regional Office 30 days prior to commencement of work. Once 30 days have passed, Approval of Application is automatically granted unless written comments have been received from Public Water Supply. For Agency Use Only: Regional Office shall FAX this application (4 pages) to central office for tracking upon initial receipt and page 1 of 4 when ready for Final Approval: _____/_____/_____ Date form received by Regional Office _____/_____/_____ $50 Fee Acknowledged by Regional Office _____/_____/_____ Plan Approval Date _____/_____/_____ Date Engineer’s Certification with disinfection results received _____/_____/_____ Date to issue Final Approval Application for Water Tank Reconditioning Plan Approval (Revised 12/15) Page 2 of 4 Public Water Supply Section (Review 12/15) To: Division of Water Resources Department of Environmental Quality Application for Water Tank Reconditioning Plan Approval The ____________________________________________________________________________________________ (name of board, or council, authorized official and title, or owner) of ______________________________________________________________________________________________ (name of city, town, corporation, sanitary district, water company or other) in the County of _______________________________, State of North Carolina is authorized by law to act for the said _________________________________________________________________________________________ (name of city, town, corporation, sanitary district, water company or other) and to expend its funds for reconditioning of the water tank described below: Name and Location (Street Address) of Tank: ___________________________________________________________ Type of Tank: Ground / Elevated / Standpipe / Other ______________________________ (Circle One) Size of Tank (Working Volume): ____________________________________________________________________ Year Constructed: __________________________ Year of Last Reconditioning: ____________________________ Number of Tanks in System: __________ If one tank, method for maintaining system pressure during recondition: ______________________________________ ________________________________________________________________________________________________ Water System Interconnections (Public Water System Name): ________________________________________________________________________________________________ ________________________________________________________________________________________________ Description of Proposed Reconditioning: ______________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Method of Disinfection: AWWA Method #2 OR 15A NCAC 18C .1003 (circle one) Laboratory Laboratory Providing Service: _________________________________________Certification #: __________________ Microbiological Analysis - Samples to be collected by: Owner / Contractor / Other ____________________ (circle one) Tank to be taken out of service on (date): ______________________________________________________________ Tank returned to service on (projected date): ____________________________________________________________ Remarks: _______________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Application for Water Tank Reconditioning Plan Approval (Revised 12/15) Page 3 of 4 Public Water Supply Section (Review 12/15) Specification of Materials: --- (Person Executing Application-Initials _________) Tank interior and exterior surface are to be prepared in accordance with one or more of SSPC (Steel Structures Painting Manual) surface preparation methods. Painting application must be in accordance with SSPC specifications (prime, stripe, intermediate and finished coats). Interior surface coatings material must be in the Certified Listings of ANSI/NSF Standard 61 and be applied in accordance with manufacturer’s recommendations and guidelines. Paint Removal and Reapplication of Coatings: --- (Person Executing Application-Initials _________) 1. The Air Quality Division should be contacted for a ruling on the necessity of the issuance of a permit to cover the preparation of the exterior of the tanks. The following procedure should be used: a. The tank owner should notify the Regional Office, Air Quality Division, in writing of the intent to sandblast at least five (5) working days prior to the commencement of the project. b. The notification should contain, as a minimum: i The name, address, telephone number and contact person for the tank owner. ii The name, address, telephone number and contact person for the contractor. iii Dates of sandblasting or paint removal. iv Lead content, if any, of paint to be removed (analysis required). v Measures to be taken to minimize off-premises impact of particulates and lead. vi An area diagram showing the nearest residences within 1,000 feet. c. The contractor should be encouraged to utilize measures such as wet blasting, shrouding, chipping, etc. such that impacts on nearby residents and the environment are minimal. 2. The tank owner must forward a copy of this application to: Division of Public Health, Health and Hazard Control Unit, 1912 Mail Service Center, Raleigh, NC 27699-1912, phone 919/733-0668. Waste Removal: --- (Person Executing Application-Initials _________) All debris generated during the removal of the existing paints must be handled properly. If the paint is composed of RCRA metals, the contractor shall furnish the engineer with a certified test report showing Toxicity Characteristic Leaching Procedure (TCLP) results for a representative random sample taken from the debris. Should any result exceed the EPA maximum limit the owner shall have ninety days to dispose of the waste in accordance with the regulations provided by North Carolina's Division of Waste Management. The procedure for waste disposal and obtaining the Provisional Number is outlined as follows: 1. Any waste may be separated into hazardous and non-hazardous portions, e.g. the lead may be separated from the abrasive but the lead cannot be diluted to render it non-hazardous. 2. To apply for a Provisional ID Number, the contractor handling the waste will submit a typed copy to: Administrative Assistant, Division of Waste Management, 1646 Mail Service Center, Raleigh 27699-1646, North Carolina 27611-7687 or faxed to (919) 715-3605 extension 209. Assistance may be obtained from the Division of Waste Management at (919) 733-2178. 3. After the application is approved, a number will be issued over the telephone and a follow-up letter mailed to the contractor. 4. The date issued will be the effective date. 5. The number is good for ninety days and only for the waste indicated. However, time extensions may be granted for unusual, unforeseen circumstances. A written request is required. 6. A copy of the manifest signed by the transporter and disposer will be sent to the Division of Waste Management at the above address within 120 days of the effective date. $50 Review Fee: --- Check or money order payable to DEQ-Public Water Supply Section (Person Executing Application-Initials _________) Engineer’s Report & Water System Management Plan:: Not Applicable for tank reconditioning. Application for Water Tank Reconditioning Plan Approval (Revised 12/15) Page 4 of 4 Public Water Supply Section (Review 12/15) Identification of Responsible Persons: Professional Engineer (providing responsible supervision and certification) Name _________________________________________________________________________NC PE # __________ Address _________________________________________________________________________________________ Responsible person for forwarding Engineer’s Certification to Regional Office: _____________________________________________________________ Distribution Operator in Responsible Charge (distribution) _______________________________ Certificate #: ________________ Final Inspection: (name & company affiliation) __________________________________________________________ Responsible person for forwarding Disinfection & Microbiological Results To Regional Office: _________________________________________________________________________ Contractor Information: Contractor: ___________________________________Contact Person: ___________________________ Mailing Address: ___________________________________________________________________________ Phone: ________________________________ Fax: ______________________________________ Notify, as appropriate: Systems interconnected with Impacted Customers (Include neighbors adjacent to the tank site as needed) Local County Health Department Emergency Responders Final Approval: 1. Tank will not be returned to service until an Engineer’s Certification (stating that all reconditioning and disinfection has been completed in accordance with the requirements of this application and certify that the tank is ready and suitable to return to service) and disinfection results have been received by the appropriate Public Water Supply Regional Office and Final Approval has been issued by the Public Water Supply Section’s Technical Services Branch. 2. The system has an Operation and Maintenance Plan and Emergency Management Plan as required by Rule .0307 and a certified operator as required by Section .1300. __________________________________________________ _________________________ Signature of Owner, Manager, Mayor or Chairman Date ____________________________________________________________ Type or Print Name Signed Above _______________________________________ _____________________________ __________ _____________ Street or Box Number City State Zip Code (Person executing application must initial as indicated on page 3 of 4)