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Home My WebLink About20150035 Ver 4_24 hour release_20170331 Wanucha, Dave From:Euliss, Amy Sent:Friday, March 31, 2017 3:31 PM To:Wanucha, Dave Cc:Seitz, Phillip K Subject:FW: UST release Attachments:24 hour release.pdf Here’s a link to the report filled out for the tank and fuel removal that was reported earlier. Amy Euliss Division 9 Environmental Officer North Carolina Department of Transportation 336 747 7802 office aeuliss@ncdot.gov 375 Silas Creek Parkway Winston Salem, NC 27127-7167 From: Seitz, Phillip K Sent: Friday, March 31, 2017 3:28 PM To: Euliss, Amy <aeuliss@ncdot.gov> Cc: Ho, Richard C <rcho@ncdot.gov>; Menius, Domisty <dmenius@ncdot.gov>; Freddie McKnight (FMcKnight@sepiengineering.com) <FMcKnight@sepiengineering.com> Subject: FW: UST release Amy, Please see the attachment for release notification. CC:Sharepoint Kelly Seitz Resident Engineer Transportation Div 9 Salisbury Resident Engineer’s Office 4770 South Main Street Salisbury NC, 28147 Email correspondence to and from this address is subject to the 1 North Carolina Public Records Law and may be disclosed to third parties. From: Troy Holzschuh \[mailto:THolzschuh@apexcos.com\] Sent: Friday, March 31, 2017 2:46 PM To: Graham, Dan Cc: Katie Lippard; Seitz, Phillip K Subject: UST release Good Afternoon Dan, I am sending you a UST 61 form for a UST pull we did yesterday. We were notified of the tank on 3-29-17, we determined it was leaking on 3-30-17. The tank was struck during road improvement activities in Rowan County. I attached a google map as well for additional reference. The 1,000 gallon capacity tank has since been removed. Thank You, Troy L. Holzschuh Troy Holzschuh Assistant Project Manager Apex Companies, LLC 10610 Metromont Parkway, Suite 206 Charlotte, NC 28269 O) 704-799-6390 x4814 Add me to your contact list! Follow Apex on and Like us on Privacy Notice: This message and any attachment(s) hereto are intended solely for the individual(s) listed in the masthead. This message may contain information that is privileged or otherwise protected from disclosure. Any review, dissemination or use of this message or its contents by persons other than the addressee(s) is strictly prohibited and may be unlawful. If you have received this message in error, please notify the sender by return e-mail and delete the message from your system. Thank you. Email correspondence to and from this sender is subject to the N.C. Public Records Law and may be disclosed to third parties. 2 L��T-�77 �4-Haur Releas�e and UST Leak Reportins Form. FQr R�:f�ases �his fcrrm stiould be completed �nd su�r�nitted to the US 1` Se�tion's regional o�tice fallr�wing a known or suspected rel�ase from an undergrvund storage tank {US"} system. This form is required ta be submitted within 24 hours af discavery of a knor�vn or in NC suspecred re�eas� (DWM U5E ONLYJ 5uspected Contamination? {Y!N} Facifity Id hlumber Incident # Ftisk (H,I,L,UJ Confirr�ed GW Contaminatian? �YrNy Date Leak C}isco�ered Received 4n F;eceived By C�nfirmed Svil Contamination ?(Y.�N} CommlNon-Cprrrmercial? Reparted t�y (circle ane): Phone, Fax or Repart S�mpl�s Taken?(YINJ FtegfNon-reg�lated? Region Free Product? (YM} If Yes, Siate Greates# T#� ickn�s5 INCIQ�hJT []ESGRIPTIC}N Ir�cideni Name. �1{/ ,.�=�, ~ _ ,. _ _��J �-� � [,;/ ' r /�'C_ Address: � �' , f � County: i�=lrc � Reg��7n�9 Qffi�ce (circle vnej: A�hewalle, voresvi e; Fayetteville, CitylTown: �ap C�de' �, � Rale.gh„ Washington, Wilmingta�, Winstfln-5a em . �71 ✓t�.� � '" , � � LBtI�U�Q [decimal dagreas): , "�. j� � � � LOfY��ItUdB tdac�mal degrees} : -- +'r _ 'r�' Q�tained by: Briefly desCribe suspected car confirmed release: {rr�cluding �ut no[ limited to: nature of re�ease, date of release, amaunt (] ��g of release. amount of free roduct reser�t ar�d recove e{forts, rrrrtial res orases corrducted. r�a acts to rece lors � ❑ Topagra�hic map : l L,rf`, - � _ � �r � . . � � --� R-t r�' 0 GIS Address matching ' ' �Other ? � f,� f"- - � . � ,- �, ,�--- � 1 ❑ Unknpwn � � l� � v� f � �:,� 1"1 ��.1 � �� `�.5 �� ' } 1 ��`s�ribe lc�cati�n: � � �1 ,,� � � �, _ . �-_, . �� 1 � fi= 1 � .' ' /- "'- � - i . ' I -r � � ..' `� ►.�t�i''� � =;F�'v t�f�`'��. H�Q ELEASE WAS D1�CDV'E'RE[� ��t��ease Gode) [Check onej D�telease Detection Equipment or Methods ❑ V�suallOd�r ❑ Groundwatef Contamination � During UST C6asurelRemaval � Water an Tank ❑ SurFace'Nater Contaminatitin �] Pro�eRy Transfer � Water 5upp9y WeIM Cantaminat�vn � t3ther {speeifyy S(7URCE {}� CONTAMINATIO�N Source v# Release Cause of R�leas€ Tvpe af Rel�ase Product Tvqe Released (Check one to indreats p�rmary {Check orre to indicafe prrmary (Check or�ej (Check or�e to indreafe primary praduct type svurcej causeJ releasedJ l� Ta�k d SpGll ❑ Petroleum ❑ Gasolinel �ieseu ❑ C]ieselNeg. ail Kerosene 81end a Piping 0 c]vehiu D Non-Petro�eum r�'' ��ating �il ❑ Vegetable t7il 100°Io � �ispenser �Cc�rrosivn �M Both [1 Other Fetroleum a �� p _ �2� ❑ Submer�ible Turbine Pump ❑ Physic�l e�r M�chanica9 Products � E21 — E84 pamage Locativn ❑ �tet�is ❑ Delivery Problem (Ch�ck anej ❑ [�#her Invrganics ❑ E85 — �99 ❑ f7ther ❑ ��stall Prohlem � Other QrganiCs ❑ Eth�nol 100°/0 0 Unknawn � ��her U FaCility ❑ Unknown ❑ Residence ❑ ��, �' Eflg l�eFrrifions presertted on reverse pefii�itions pr�senfed an re�erse ❑ Uthe� QwnershiP i N1unicipal 2 Military 3. Unknown 4. Pr�vate 5. F�deraB 6. County 7 State Cs �rat� �"' 1 Puhlic S€rv�ce 2 Agriculkural 3 Residentia� 4. Edu:;atlanlReiig. 5. Indust�ia4 6. Commercial 7. h'lining �� UST Fvrm �ii [�2l08} Page 1 of 2 IMPACT ON DRINKING WATER SUPPLIES Water 5upply Wells Affected? 1. Yes N2. o/ 3. Unknown Number of Water Supply Wells Affected Water Supply Wells Contaminaied: (Include Users Names, Addresses and Phone Numbers. Attach additional sheet if necessary) 1. 2. 3. UST Owner/Company � ,�� %/ Point of Contact G�� c�ty _ L, � �� UST Operator/Company City UST SYSTEM OWNER ress State Zip Code ,;�,L , , . ,� %,�;%i UST SYSTEM OPERATOR State ress Zip Code LANDOWNER AT LOCATION OF UST INCIDENT �1��- ! u� f phone Number elephone Number Landowner Address ��C' � � T ��>�.�'; ��.,�_�� '(,` � City State Zip Code Telephone Number ��ti �� _ �, il/� :,� � � / ,� � % - % - Draw Sketch of Area (showing two major road intersections) or Attach Map .0 _ r..J � � ;,- �,� �. ,� ,�, , ��:�, � l - yfi. Person Reporting Incident �� ' 4' Company Title _ ,�, . �_. - � Address , r ,-- � �:. � �, UST Form 61 (02/08) � =.X l_l:, � � �'�,�Y �> ��. Telephone Number Date � _t ) - � %' Page 2 of 2 Dcfinitiuns uf Suurces Tank: means die tanh that stores thc; product and is part of thc underground storagc tank system Piping: mcans the niping and connectors ninning fr�im Ihe tank or submersihle turbine pwnp to thc dispenser or other end-use equipment (Vent, vapor recovery, or fill lincs arc cxdu�led.) Dispcnser. includes the dispenscr and thc cquirment used to conncct thc dispenser to lhe pipii�g (c.g., a release from a suction pump or from componcnts IocaleJ above the shear valve) Submersible "I urbine Pump (STP) Area includes the submcrsible lurbine pump head (tyrically located in the tank sump), the line Icak detector, and the piping that connecls the submersible turbinc pumn to the lank Delivery Problem: identif ies releases th.�t occurred during proJucl delivery to thc tank. (Typical causes associaleJ with this souree are spills and uverfills.) Other: serves as the option to use when thc release source is known hut does nul lil into one of the preceding categories (e.g., lix reletises from vent I ines, vZpor recovery lines, and fill lines) Llnknown: identifies rcicases tiir which the source hxs not becn determincd Dcfinitiuns of Causes Spill: use ihis cause when a spill occurs (c.g., when the delivery hosc is disconnected from the tank Gll pipe or when the nozzlc is' removed from the disnenser) OverlilL use when an overtill occurs (e.g., overfills may occur I}om lhe fill pipe at the tanh or when the nozzle fails to shut ol�f al lhe dispenscr) Physical or Mech�nical IJamage: use for all lyres ol'physical or mechanical damage, except corrosion (e.g., puncture oftank or piping, loose liltings, broken componcnts, anJ components that havc changcd dimension) C�rrosion: usc when a metal tank, Pipin�, or otltet compunent has a release due to corrosion (e.g., for steel, corrosion takes lhe Ibrni of rust) lnstallation Problem: use when the problem is determined lo have occurred specifically because the US'1' system was nol inslalled properly (.)ther: use this option �vhen the cause is known but docs not fit inlo one oClhe preceding categories (e.g., putting regulaled subst<mces into monitoring wells) Unknown: use when the cz�usc has no[ hccn dclennined rc�cc�r�z�yr� � c� �� 'j;��,; Old Beatty Ford Rd & Bostian Rd .. -- T��T ��M:�`� � J��sf �� "- �� .i r4 �_.r - � .. - .. -. , '�y,� . :�� 1 � �1�: v �� .�� .`� r,�.._i��.'� .;ry, �` � T� _ , 1 � � n ro R r- � " „f y. � Ma *„ n,�,'� _ , � - s�-A��,rF'e`•,r; �� a� y, . ? r , r '�P�� Fs�"�� ,'` ��hh �-.q� � � :4 l � t� r �' � M �. � ✓• � � � "� � +-�. � ' I � w � - : tr ,�?'�<t? ��, �� , ., � 'A��.� �. � �� :.��'* �. � ^ F " � _ •t � •!p5 „ ,�,.�� ^ � 'y; M� r �,�}±: �}�� r �w ,. ,�i � - • �- � � �x,F.k� r' �� ".al" �t� �.�17�s wa � u�, 7 - � r ��. _ r � y�,�;� r� .� ,._�'' -�M�.1 �iR*, � t _ �f �-� W. �. �- ,� s .a- # Old Beatty Ford Rd & Bostian Rd - Google Maps � :, � '�,�-'"�'��= ,� � �� ...f��p,�� ,. y- -.. � � . • �,. i �� - r� � Imagery 02017 Google, Map data 02017 Google 200 ft https://www.googl e.com/maps/place/OId+Beatty+Ford+Rd+%26+Bosti an+Rd,+Chi na+Grove,+N C+28023/@35.5340594,-80.5907982,945m/data=!3m 1! 1 e3!4m 5!3m4! 1 sOx88540832d2322fbd:Ox30ddce2ced2e47bd!8... 1/2