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HomeMy WebLinkAboutTank Removal Site Assessment - PLN General - 5/4/2015 Mason County Department of Community Development 426 W Cedar Street RECEIVED Shelton, WA 98584 Phone (360) 427-9670 MAY 1 12015 Fax (360) 427-7798 426 W,CEDAR ST. UNDERGROUND STORAGE TANK AW"kWHOR CHECKLIST Instructions: Complete the Underground Storage Tank (UST) checklist below. Return the completed checklist and, if require, site assessment reports necessary for Department of Ecology compliance,to the Mason County Permit Assistance Center within 15 days after the UST is abandoned. Parcel Number where tank is located: 12228-13-00050 Legal description: Address: Date of A xDd=x= t 4920 E. State Hwy. 302 Removal 4-21 -15 Directions to site: Name of Property Owner: OT Trust c/o Stuart Milbrad Name & license number of Certified IFCI contractor performing abandom-nent procedures: Tom Langseth, Langseth Environmental Services, Inc. Contractor Phone: IFCI Certification#: 253 536-6961 0910875 Washington State Contractor Registration#: Bonding Agent: LANGSES077DU Westchester TANK INFORMATION ❑ Tank cleaned on site Type of property in tank: XW Tank cleaned off site Diesel Oil How was sludge disposed of? Drummed and hauled to PRS for disposal. Describe decommissioning method: 1)How was tank cleaned: Tank cut in half, scraped down, wiped with oil pad di osed 2)How was it Crushed and put in steel bin for pickup and disposal . Tank Capacity: 675 gallons Estimated age of tank: Unknown I certify that the information provided is true and correct. The U was a n accordance to current Washington State regulations and Mason County Ordi n es. remov Date: 5-6-1 5 Signature: lok May 4, 2015 ENVIRONMENTAL Stuart Milbrad 4920 E. State Hwy. 302 Belfair, WA 98528 RE: Underground Heating Oil Storage Tank Removal Project Dear Mr. Milbrad: Enclosed is the Site Assessment Report for the recently completed underground heating oil storage tank (UST) removal project at your home in Belfair, WA. As summarized in the report, visual and olfactory observations, field screenings, and the soil sample analytical results have indicated that no petroleum-contaminated soil (PCS) or groundwater, above the MTCA Method A cleanup level for unrestricted land use, were detected in any of the obtained soil and water samples. Soil samples were obtained from under the removed UST at the soil/water interface and at an approximate depth of 7' - 7Y2'. A water sample was obtained from the surface groundwater well located approximately 35' east of the tank pit area. The groundwater depth at the well was 6' below ground surface (bgs). One additional sample was obtained on the south side of the property, between the house and the beach. This sample was obtained utilizing a hand boring tool advanced to approximately 5' bgs. This sample was obtained to indicate that no PCS had migrated from the UST pit area to the beach. These observations and results would indicate that no further action regarding the former heating oil storage tank is warranted at this site. Thank you for the opportunity to work with you on this project and please give us a call if you have any questions regarding this or future projects. Sinc ly, 5 Tom Langseth Registered Site Assessor Licensed Decommissioning Supervisor Cc: Mason County Dept. of Community Development 7517 Portland Avenue, Suite A, Tacoma, WA 98404 • Phone: (253) 536-6961 • Fax: (253) 548-0201 LangsethEnviro @gmail.com .%"7-.,�An : 3 ENVIRONMENTAL SERVICES, INC. SITE ASSESSMENT REPORT 4920 E. State Hwy. 302 Parcel No. 12228-13-00050 SITE LOCATION: Milbrad Residence 4920 E. State Hwy. 302 Belfair, WA 98528 SITE CONTACT. Stuart Milbrad 4920 E. State Hwy. 302 Belfair, WA 98528 360.277.4243 milbrad _outlook.com Underground Heating Oil Storage Tank Removal Project May 4, 2015 7517 Portland Avenue, Suite A, Tacoma, WA 98404 • Phone: (253) 536-6961 • Fax: (253) 548-0201 LangsethEnviro@gmail.com SITE ASSESSMENT REPORT 4920 E. State Hwy 302 Parcel No. 12228-13-00050 SITE ADDRESS: 4920 E. State Hwy. 302 Belfair, WA 98528 SITE CONTACT. Stuart Milbrad 4920 E. State Hwy. 302 Belfair, WA 98528 360.277.4243 milbrad o- outlook.com Underground Heating Oil Storage Tank Removal Project This report was compiled by Tom Langseth, registered and licensed with the Washington State Department of Ecology to perform environmental site assessments in accordance with WAC 173-340 through the International Code Council. This site is located in Mason County outside the city limits of Belfair, Washington. Site address is 4920 E. State Hwy. 302, Belfair, WA, 98528. This site is a single-family residence owned by OT Trust c/o Stuart Milbrad, and is located in a residential area east of city center. Contact person for this project was homeowner Stuart Milbrad. Telephone number for Mr. Milbrad is 360-277-4243. The original home on the property was built in 1932. In 2009, an adjoining home was built for Mr. Milbrad's in-laws. This project entailed the removal of one (1) underground Site Assessment Report 4920 E. State Hwy 302 May 4, 2015 Page 2 storage tank (UST), used solely for the storage of home heating oil (diesel) for the original home. The exact installation date of the tank is unknown to this consultant. The UST was taken out of service in 2008 when groundwater was discovered in the tank. An aboveground storage tank (AST) was then installed for the fuel oil storage. The removal project was completed on April 21 , 2015. The heating oil tank was located northeast of the original home, in the driveway of the new residence. The tank top was exposed under approximately 10" of earth cover. The UST was pumped of all residual heating oil/water (approximately 435 gallons) at the time of this tank removal project by Certified Cleaning Services, Inc. of Tacoma, WA. The removed tank was sized at 52" x 74" with an approximate capacity of 675 gallons. The removed tank was constructed of single wall, asphalt-coated steel and had been connected to the home's heating system via two-line 3/8" copper tubing. The oil lines were drained and/or plugged or capped. All additional UST piping was removed with the tank. The removed tank showed visible signs of pinholes and/or steel-weld failures in the bottom of the tank. Field screening of the tank pit area and the excavated soil detected slight visual and olfactory indications of petroleum hydrocarbon soil contamination (PCS). The tank had been bedded and backfilled in site native soil. Soil conditions in the tank pit area of the site consisted of a silty clay type material (Unified Soil Classification System group symbol of CL with typical names such as inorganic clays of low to medium plasticity, gravelly clays, sandy clays, silty clays, lean clays) to a depth of at least 7.5' below ground surface (bgs). Groundwater was encountered during the removal project at a depth of approximately 6' bgs. The underground power and communications piping for the newer residence was located on the north side of the UST. No additional utilities were encountered in the tank pit area. Following tank removal, the heating oil pit area was excavated to an approximate size of 6' x 9' x 6' deep and one soil sample was obtained from under the removed tank at the soil/water interface depth of approximately 6'. One additional sample was obtained at a depth of 7' - 7'/2'. Subsequent to soil sampling, the tank pit area was backfilled and compacted with the excavated material, clean fill material, and brought to final grade with crushed rock. The removed tank was disposed of according to applicable federal, state, and local regulations. Two water wells are located at the original home on the site. The wells are located east of the tank pit area. The original water well at the site is a hand dug surface water well. Groundwater was observed at 6' bgs. One water sample was obtained from this well. The current well on the site is approximately 15' east of the surface groundwater well and was reportedly installed at a depth of 150' bgs. Site Assessment Report 4920 E. State Hwy 302 May 4, 2015 Page 3 To confirm that no PCS had migrated to the tidal beach lands, one hand boring was completed on the south side of the new home, between the home and the beach bulkhead. Approximately 47' south of the home and 27' west of the flag pole, a hand boring was advanced to an approximate depth of 5' bgs. It should be noted that the property slopes from Highway 302 towards the water. The hand bore location was located in a natural depression in the site. The soil encountered at the hand boring sample location depth was consistent with the soils encountered at the UST pit bottom. It is this consultant's opinion that the soil boring location represented the likeliest location of any possible PCS migration from the UST pit area. Based on the soil and water sample results, field screenings, and visual observations during this tank removal project, it is the conclusion of this consultant that no petroleum- contaminated soil or groundwater above the MTCA Method A cleanup level for unrestricted land use were detected in any of the obtained soil and water samples. Soil samples were obtained from under the removed UST at the soil/water interface (6' bgs) and below the removed UST at approximately 7' - 7Y2'. A groundwater sample was obtained from the surface groundwater well at 6' bgs. One additional soil sample was obtained on the south side of the property between the new home and the beach bulkhead. Utilizing hand boring tools, the sample was obtained at approximately 5' bgs to indicate that no PCS had migrated from the UST pit area to the beach. The MTCA Method A cleanup level for diesel in the soil is 2,000 ppm (parts per million). Diesel hydrocarbons were detected in one soil sample at a level of 94.6 ppm. All remaining soil and water samples were at the non-detect level. These observations and results would indicate that no further action regarding the former heating oil storage tank is warranted at this site. Soil sampling was conducted in accordance with Washington State Department of Ecology guidelines. The soil and water samples were collected utilizing the backhoe and/or hand tool method, utilizing clean hand tools. The samples were then placed into clean, wide mouth glass containers with Teflon lid provided by the laboratory. The samples were stored in an iced chest on the site and during transport to the lab. The samples were taken to Libby Environmental, Inc., WA 98506, for analysis. The samples were tested utilizing the NWTPH-Dx method. This analytical procedure tests for the presence of diesel petroleum hydrocarbons. Enclosed are site and sampling location maps, the tank disposal manifest, laboratory analytical data, and the chain-of-custody form. Laboratory QA/QC data, pertinent permits, and photographs taken throughout the project are included at the end of the report. Site Assessment Report 4920 E. State Hwy 302 May 4, 2015 Page 4 This report has been prepared for the exclusive use of OT Trust c/o Stuart Milbrad and his agents, in accordance with generally accepted professional practices for the nature and condition of the work completed in the same or similar localities, at the time the work was performed. The findings contained herein are relevant to the dates of the Langseth Environmental Services, Inc. UST removal project and should not be relied upon to represent conditions at later dates. No other warranty is expressed or implied. In the event that changes in the nature, usage or layout of the property or nearby properties are made, the conclusions and recommendations contained in this report may not be valid. If additional information becomes available, it should be provided to Langseth Environmental Services, Inc. so that the original conclusions and recommendations can be modified as necessary. Si erely, Tom Lan eth Registered Site Assessor Langseth Environmental Services, Inc. Cc: Mason County Dept. of Community Development SITE & SAMPLING LOCATION MAPS •• Delorme Street Atlas USAO 2015 H'. 144THStREE KP_NJ u+ /( i Allyn Z 140T1�TREET KP N 302 3 0Of 138TN-�T__ --z 5� lox J. ¢, � 51, 'q__ j. SST z F VI-OR,RD f1AMME_L.DEAL R D Victor Y :34 �� Q 2 E GRPPEVIEW.LOOP RD r - 302 z z _ w w z Z�o Z. 00 z d WC wi+ _ Y 74 < i� w w a;! me °°'�ma'+ ID R z I',To Z Z .m c 4920SR902 Im+ z m ,c m' m z 0 p o �o z U m ,�--�� ) 302 302 - o z 1897)� 0' 10 r AVENUE % COVRTKpN ZND m��FNN%F �dr/ 'Olt, �pj o Oryrripic Shore W; � Y C V O � � w Ql I C4 u m�., ) �n A 9,0 1 FLU,, F..E.DETROI7_DR= - �00 99TI—_S_T.REET KP N ,o pa Sunshlne Beach Data use subject to license. TM Scale 1:20,800 o eoo +zoo iew zaoo a000 m ©DeLorme.DeLorme Street Atlas USA®2015. Mu ne,•E+ o IN Aso MO reo www.delorme.com V=1,733.3 ft Data Zoom 13-3 ��_:� '� � t �- � � •� •�� to � , 4920 State Hwy 302 Kp N � •= earthGoOSIC km#= a v. ���� :.. ,.,E ti..._. - `�•,. f��l.. may.` ~ �`"+•L �'+.�-. .q. ���' ••, "+�t�' � � � � L}cif! rI.,; _ •-,� 6 .� � a�;y��"A,•".. 1 W.'��^l�`y+' w� , w. t �« r a .. ..�1.�: - "'lllh e h r ftv 16. iK -41 Google earth feet 100 meters 50 .;rraScan TaxSifter-Mason County Washington http://property.co.mason.wa.us/Taxsifter/AppraisalDetails.aspx?keyId.. MASON COUNTY WASHINGTON TAXSIFTER SIMPLE SEARCH SALES SEARCH REETSIFTER COUNTY HOME PAGE CONTACT DISCLAIMER Melody Peterson Mason County Assessor 411 N STH ST Shelton,WA 98584 Assessor Treasurer Appraisal MapSifter Parcel Parcel#: 12228-13-00050 Owner Name: OT TRUST DOR Code: 18-Residential-All other Addressi: C/O STUART MILBRAND Situs: 4920/4922 E STATE RT 302 BELFAIR Address2: 4920 EAST STATE RT 302 Map Number: City,State: BELFAIR WA Status: Zip: 98528-2370 Description: TR 5 OF GOUT LOT 2&TAX 129A-1&712A-1S 34/22 Comment: Land - Land Land Land Code Unit Type Units Land Shape Width Depth Improved Acres-4 Acres 2.02000000 Rectangle Improved Acres-8 Acres 2.91000000 Rectangle Improved Frnt Ft-3 Front Feet 100.00000000 Rectangle Improved Frnt Ft-3 Front Feet 273.00000000 Rectangle Improved Frnt Ft-3 Front Feet 173.00000000 Rectangle Single Family Residence - Building 1 1 1/2 Story Finished - Single-family Residence Total Area Year Built Remodel Year Quality Condition 3880 1932 3.0-Average 3.0-Average Components Building Data Code Description Units Percent 105 Frame,Siding 0 100% Architecture 206 Comp.Shingle or Built-up Rock 0 100% Bedrooms 5 309 Forced Air Furnace 0 100% Bathrooms 4 645 Double 2-Story Fireplace(#) 1 0% Total Rooms 645 Double 2-Story Fireplace(#) 1 0% Foundation Concrete 721 Carport, Flat Roof(SF) 544 0% Garage Stalls 706 Detached Garage(SF) 800 0% 601 Plumbing Fixtures(#) 10 0% 512 Dishwasher(#) 1 0% 1618 Paving,Concrete w/Base(SF) 1390 0% 1617 Paving,Asphalt w/Base(SF) 2400 0% 622 Raised Subfloor(%or SF) 0 100% 402 Automatic Floor Cover Allowance 0 100% 7 4/?/,?015 3.57 PM :erraScan TaxSifter-Mason County Washington http://property.co.mason.wa.us/Taxsifter/AppraisalDetails.aspx?keyId... Single Family Residence - Building 2 1 1/2 Story Finished - Single-family Residence Total Area Year Built Remodel Year Quality Condition 1666 2009 4.0-Good 5.0-Very Good Components Building Data Code Description Units Percent 105 Frame,Siding 0 100% Architecture 213 Metal, Formed Seams 0 100% Bedrooms 3 352 Heat Pump 0 100% Bathrooms 4 701 Attached Garage(SF) 540 0% Total Rooms 601 Plumbing Fixtures(#) 8 0% Foundation Concrete 908 Enclosed Porch(SF),Knee Walls w/Glass 25 0% Garage Stalls 1618 Paving,Concrete w/Base(SF) 522 0% 622 Raised Subfloor(%or SF) 0 100% 402 Automatic Floor Cover Allowance 0 100% Miscellaneous Improvements Misc Improvements - Detached Garage - 748 sf Improvement Year In Size D Gar-F550-Detached Garage-Fair 400 to 550 SF Area-748.00 1.O.S381.28073 TX RoifYear Search:2015 ­2 4/2/2015 3:57 PM CerraScan TaxSifter-Mason County Washington http://property.co.mason.wa.us/Taxsifter/Assessor.aspx?key1d=31929... MASON COUNTY WASHINGTON TAXSIFTER SIMPLE SEARCH SALES SEARCH REETSIFrER COUNTY HOME PAGE CONTACT DISCLAIMER Melody Peterson Mason County Assessor 411 N STH ST Shelton,WA 98584 Assessor Treasurer Appraisal MapSifter Parcel Parcel#: 12228-13-00050 Owner Name: OT TRUST DOR Code: 18-Residential-All other Addressi: C/O STUART MILBRAND Situs: 4920/4922 E STATE RT 302 BELFAIR Address2: 4920 EAST STATE RT 302 Map Number: City,State: BELFAIR WA Status: Zip: 98528-2370 Description: TR 5 OF GOVT LOT 2&TAX 129A-1&712A-IS 34/22 Comment: 2015 Market Value 2015 Taxable Value 2015 Assessment Data Land: $570,745 Land: $570,745 District: 0245-Tax District 0245 Improvements: $343,780 Improvements: $343,780 Current Use/DFL: No Permanent Crop: $0 Permanent Crop: $0 Total $914,525 Total $914,525 Total Acres: 4.93000 Ownership Owner's Name Ownership% OT TRUST 100% Sales History Sale Sales # Excise# Grantor Grantee Price Date Document Parcels 11/15/12 1998684 2 MCFEELY LIFE ESTATE, FRED $C E 09/17/08 1927831 1 200803606 STUART G MILGARD OT TRUST $C 07/03/08 1923542 1 200800000 PATRICIA L MILBRAD STUART MILBRAD(SURVIVING SPOUSE) $C 05/01/08 1919615 1 200802326 STUART MILGARD,TR OT STUART G MILGARD $C TRST 11/26/03 1799031 1 200369727 STUART MILBRAD ET AL* O.T.TRUST $C 12/31/02 1771425 1 200264962 FRED&AMELIA MCFEELY STUART G&PATRICIA MILBRAD H/W $61,80C 11/13/98 678842 1 199847183 STUART G MILBRAD ETAL O.T.TRUST;FAMLY TRUST;EVA;GREG $C MCFEELY 01/31/94 581284 1 199426180 FRED E MCFEELY LF EST STUART MILBRAD,EVE-GREGORY MCFEELY $C Historical Valuation Info Year Billed Owner Land Impr. PermCrop Value Total Exempt Taxable 2015 OT TRUST $570,745 $343,780 $0 $914,525 $0 $914,525 2014 OT TRUST $570,745 $324,625 $0 $895,370 $0 $895,37C 2013 OT TRUST $602,450 $360,695 $0 $963,145 $0 $963,14E - 7 d000I S 'A•dR PM krcIMS Viewer http://mapmason.co.mason.wa.us/website/mason/MapFrame.htm Z w S - w a C4 w: ,� 1 4/2/2015 3:51 PM �• �..` a Zia .� -�/ .�►..q.- .. �+•� �yc.` 3 .':.:� �a i �` ,may ...�•a .. te Nr Ak o e o o f } GOOSIC earth feet 100 meters 40 SITE LOCATION MAP Milbrad Residence 4920 E. State Route 362 - Belfair, WA 98528 N x house 1 i � 3 { i 5 ' 675-gal. , UST driveway -1 0 , 1 garage r pkg. � a s t . [not to scale] East State Route 302 SOIL & WATER SAMPLE LOCATION MAP Milbrad Residen e 4920 E. State Ii y 302 ' Belfair, WA 9 528 N a t } !1 Garage Garage I�_ 91 ' Carport a New Residence Original Residence not to scale Hand Boring Location Map 4920 E. State Hwy 302 N s r s it New Residence Original Residence u 47' E---271 -- Flag Pole Front Lawn Not To Scale SOIL & WAYER SAMPLE RESULTS TABLE 4920 E. State Hwy. 302 Milbrad Residence 4920 E. State Hwy 302 Belfair, WA 98528 Sample Date: 4-21-15 NWTPH-Dx (Soil) Sample # Location Diesel (mg/kg) 1 Under removed UST @ Soil/Water Interface nd 2 Under removed UST @ T - 7'/2' 94.6 4 Hand bore front yard (moist sand) @ 5' nd PQL 50 MTCA Cleanup Level 2000 NWTPH-Dx (Water) Sample # Location Diesel (ug/L) 3 Surface water well @ 6' nd PQL 200 MTCA Cleanup Level 500 Soil results reported in mg/Kg = ppm (parts per million) Water results reported in ug/L = ppb (parts per billion) "nd" = indicates not detected at the listed detection limit BOLD indicates above the MTCA cleanup level Diesel by NWTPH-Dx SOIL SAMPLE ANALYTICAL DATA Libby Environmental, Inc. Chain of Custody Record www.LibbyEnvironmental.com 4139 Libby Road NE Ph: 360-352-2110 Olympia, WA 98506 Fax: 360-352-4154 Date: Page: of Client: Project Manager: Address: Project Name: City: State: Zip: Location: City, State: Phone: Fax: Collector: Date of Collection: Client Project# Email: �RoNtrE Sample Container OGb Sample Number Depth Time Type Type J o QP �� QG �� �G Field Notes 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Relinquished by: Date/Time Received by: Date/Time Sample Receipt Remarks: Good Condition? Y N Relinquished by: Date/Time Received by: Date/Time Temp. °C Seals Intact? Y N N/A Relinquished by: Date/Time Received by: Date/Time Total Number of Containers TAT: 24HR 48HR 5-DAY "'""" 'a the ei '''A of P. Vor lal4. diet a, ythe c' cbc— 4costs vable to be by a cc Dis Whil (ellrtw nk-Oi Libby Environmental, Inc. 4139 Libby Road NE Olympia, WA 98506 Phone: (360) 352-2110 MILBRAND PROJECT FAX: (360) 352-4154 Langseth Environmental Services Email: libbyenv@aol.com Belfair, Washington Libby Project # L150422-2 Analyses of Diesel (NWTPH-Dx) in Soil Sample Date Surrogate Diesel Number Analyzed Recovery (%) (mg/kg) Method Blank 4/27/15 98 nd Under UST @ Vadose +/- 6' 4/27/15 117 nd Removed UST @ T-7.5' 4/27/15 123 94.6 Front Yard Moist Sand 5' 4/27/15 115 nd Front Yard Moist Sand 5' Dup 4/27/15 98 nd Practical Quantitation Limit 50 "nd" Indicates not detected at the listed detection limits. "int" Indicates that interference prevents determination. ACCEPTABLE RECOVERY LIMITS FOR SURROGATE (2-F Biphenyl): 65% TO 135% ANALYSES PERFORMED BY: Jamie Deyman Page 1 of 1 Libby Environmental, Inc. 4139 Libby Road NE Olympia, WA 98506 Phone: (360) 352-2110 MILBRAND PROJECT FAX: (360) 352-4154 Langseth Environmental Services Email: libbyenv@aol.com Belfair, Washington Libby Project # L150422-2 Analyses of Diesel (NWTPH-Dx) in Water Sample Date Surrogate Diesel Number Analyzed Recovery (%) (µg/1) Method Blank 4/27/15 82 nd Surface H2O Well 6' 4/27/15 85 nd Practical Quantitation Limit 200 "nd" Indicates not detected at the listed detection limits. "int" Indicates that interference prevents determination. ACCEPTABLE RECOVERY LIMITS FOR SURROGATE(2-F Biphenyl): 65%TO 135% ANALYSES PERFORMED BY: Jamie Deyman Page 1 of 1 ANCILLARY DOCUMENTATION PERMIT UST DISPOSAL MANIFEST 4/6/2015 Gmail-Ticket: 15092128 C;mail T Langseth <langsethenviro@gmail.com> Ticket: 15092128 1 message wa@occinc.com <wa@occinc.com> Mon, Apr 6, 2015 at 2:04 PM To: LANGSETHENVIRO@gmail.com ***DO NOT REPLY TO THIS EMAIL*** Ticket No: 15092128 2 FULL BUSINESS DAYS Send To: C_EMAIL Seq No: 866 Map Ref: Transmit Date: 4/06/15 Time: 2:04 PM Op: webusr Original Call Date: 4/06/15 Time: 1:54 PM Op: webusr Work to Begin Date: 4/09/15 Time: 12:00 AM State: WA County: MASON Place: BELFAIR Address: 4920 Street: STATE HWY 302 Nearest Intersecting Street: E ROCKY POINT LN Twp: 22N Rng: 1W Sect-Qtr: 28 Twp: Rng: Sect-Qtr: Type of Work: UNDERGROUND TANK REMOVAL Location of Work: MARK ENTIRE PARCEL. Remarks: Nad: Lat: Lon: Zone: Company : LANGSETH ENVIRONMENTAL SERVICE Best Time: 8AM-5PM Contact Name: GAIL LANGSETH Phone: (253)536-6961 Alt. Contact: GAIL LANGSETH Phone: (253)536-6961 Work Being Done For: STUART MILBRAD Additional Members: CHRTER02 WAVE BROADBAND (425)392-6412 MCU01 MASON COUNTY DEPT UTLNVSTE MGT (360)427-9670 MPUD301 MASON COUNTY PUD#3 (425)392-6412 QLNWA22 CTLQL-CENTURYLINK (800)283-4237 WDOTOR02 WSDOT OLYMPIC REGION-AREA 2 (360)874-3050 Please click on the following link to verify and confirm that the area covered represents the correct and complete work site area. Link To Map for C_EMAIL: http://wa_itic.occinc.com/902N-6EW-TF8-2P2 If the area covered is incomplete or inaccurate, it is your responsibility to notify the center immediately to update and correct the locate. Failure to do so could result in a delay or an incomplete utility locate. Any other utilities or notification centers not listed, you will need to contact separately. https://mail.google.com/mail/u/0/?ui=2&ik=b8190ffd07&view=pt&search=inbox&th=14c908c4cb41e6ab&siml=14c908c4cb41e6ab 112 iMpxj f V April 3, 2015 ENVIRONMENTAL SERVICES, INC.F J, To: Mason County Department of Community Development From: Langseth Environmental Services, Inc. Subject: Residential Underground Storage Tank Removal Project Site: 4920 E. State Route 302, Qelfair, WA 98528 We will be removing one 675-gallon underground heating oil storage tank from the above-referenced site. The tank will be pumped of all residual petroleum product and then removed from the ground. The tank will be transported to Langseth Environmental Services, Inc. where it will be cut in half, scraped and cleaned, and then disposed of at Schnitzer Steel facility in Tacoma. 7517 Portland Avenue, Suite A, Tacoma, WA 98404 • Phone: (253) 536-6961 • Fax. (253) 548-0201 LangsethEnviro@gmaii.com se14 ceU�'r� MASON COUNTY PERMIT NO. DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING•PLANNING•FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 t Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352 1854 PO Box 279, Shelton, WA 98584 (360)482-5269 Elma ext. 352 BUILDING PERMIT APPLICATION OWNER INFORM/ATION: CONTRACTOR INFORMATION: NAME: ()T TG1ST C� ,5�`l�(�/'T%i/. i'�G� NAME: ZZIOT,04y' C MAILING ADDRESS: D F S' f 30,Z MAILING A DRESS:���'/j CITY: STATE: _ZIP: a,P CITY: STATE: ZIP: 4,p40-1-e PHONE:,31,0,2/ ?7 40?543 CELL: PHONE: g' -69�/ CELL:.253 EMAIL:yy/i��/2'IGI��GYiI/�G't�l�:�YJi�l EMAIL : 2?114,yw&eS;JU,rt L&I REG#��'SD'7j�� EXP.,�//�/ PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER) /0?�02�--/•3— p,5 G FIRE DISTRICT LEGAL DESCRIPTION(ABBREVIATED): SITE ADDRESS //920 E. Sfg4e / �0-z CITY DIRECTIONS TO SITE ADDRESS fie=T cpaw. 6r) _/(� yy/peAp ry// furn IPP 0n10 40:3va&K,ef l ,?n>W1d, Sao F sfA/100 J2—� IS PROPERTY WITHIN 200 FT: SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES[] NO ❑ TYPE OF JOB: NEW ❑ ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER /)�'/Gf�USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) op IS USE: PRIMARY SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS DESCRIBE WORK &6WVe O`lP o S-G3�J y/! /�yJ �'DUI! PLI i� i s /JaGI�_ llf7 . SQUARE FOOTAGE: 1 ST FLOOR sq. ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq. ft. DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq. ft. GARAGE sq.ft. ATTACHED ❑ DETACHED ❑ CARPORT sq.ft. ATTACHED ❑ DETACHED ❑ MANUFACTURED HOME INFORMATION: r4 COPIES OF THE FLOOR PLAN MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the informatio rovided is accdrZte and grants employees of Mason County access to the above described property and structure(s)for review nd nspe ion.T (s' ermit/application becomes null&void if work or authorized construction is not commenced within 180 days oJ�if c nstru�tion rjs suspen e for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTI IN IV, 'OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X �' If 171-1-__? gnatu e of Applica t Date X OWNER/ REPRESENTATIV /CONTRACTOR Print Na (CIRCLE TO INDICATE DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext.352 Mason County Bldg. III 426 W. Cedar Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2015-00241 OWNER: STUART MILBRAD RECEIVED: 4/6/2015 CONTRACTOR: LICENSE: EXP: ISSUED: 4/6/2015 SITE ADDRESS: 4920 E STATE ROUTE 302 BELFAIR EXPIRES: 10/6/2015 PARCEL NUMBER: 122281300050 LEGAL DESCRIPTION: TR 5 OF GOVT LOT 2 &TAX 129A-1 &712A-1 S 34/22 PROJECT DESCRIPTION: DIRECTIONS TO SITE: REMOVE ON 675 GALLON UNDERGOUND HEATING OIL STORAGE FOLLOW ST RT 3 TO ALLYN, R ON NORTH BAY RD, TURNS INTO ST RT TANK 302 TO SITE ADDRESS ON THE RIGHT SIDE General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: Type of Constr.: Type of Use: SF Insp.Area: No. of Bathrooms: Occ. Group: Lot Size: Deck: Type of Work: ? Fire Dist.: 2 No. of Stories: Occ. Load: Building: Valuation: Building Height: Occ. Status: Basement: Manufactured Home Information Setback Information Shoreline&Planning Information Water Body: Make: Length: Ft. Front: Ft. Shoreline: Ft. Rear: Ft Slope: Ft SEPA?: . . Model: Width: Ft. Shoreline Desig.: Side 1: Ft. Year: Serial No.: Side 2: Ft. Comp. Plan Desig.: Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Building Special inspection GMM 4/6/2015 $73.00 S120150000000i Total $73.00 BLD2015-00241 Please refer to the following pages for conditions of this permit. Page 1 of 2 ERTIFIED LEANING 2103 EAST 112TH STREET ERVICES TACOMA, WA 98445-3729 (253) 536-5500 INCORPORATED FAX (253) 536-5900 SHIPPER ADDRESS EPA ID# ORIGIN PHONE U.S. D.O.T. DESCRIPTION CONTAINER QUANTITY Including Proper shipping Name, Hazard Class & I.D. Number No. Type Wt. Vol. PHYSICAL STATE (CIRCLE): SOLID LIQUID SLUDGE OTHER SPECIAL INSTRUCTIONS AND ADDITIONAL INFORMATION IN THE EVENT OF A SPILL, CONTACT EITHER THE DEPARTMENT OF ECOLOGY 1-800-258-5990 AND/OR THE NATIONAL RESPONSE CENTER, U.S. COAST GUARD 800-424-8802 FOR EMERGENCY ASSISTANCE. This is to certify that the above named materials are properly classified, described, packaged, marked, labeled and are in proper condition for transportation according to the applicable regulation of the U.S. Department of Transportation and that this material is not regulated under wac 173-303 or 40 cfr parts 261 and 761. SHIPPER SIGNATURE_ DATE TRANSPORTER: Certified Cleaning Services, Inc. PHONE: (253) 536-5500 ADDRESS: 2103 E 112th St., Tacoma, WA 98445-3729 SIGNATURE DESTINATION EPA ID# ADDRESS SIGNATURE PHONE TIME INTO SITE: TIME OUT OF SITE DATE Distribution: Return to Shipper: White copy, Transporter: Pink copy, consignee: Canary copy. Shipper: Goldenrod copy P-01WL-d�701014 ENVIRONMENTAL SERVICES, INC. DISPOSAL CERTIFICATION May 5, 2015 Stuart Milbrad 4920 E. State Hwy. 302 Belfair, WA 98528 To whom it may concern, This is to certify that Langseth Environmental Services, Inc. has received the following tank for cleaning and disposal in accordance with all federal, state, and local rules/regulations. One (1) 675-Gallon Underground Diesel Oil Storage Tank sized at 52" x 74" Date Received: April 21, 2015 Date Cleaned: April 22, 2015 Date of Disposal: April 22, 2015 Method of Disposal: Scrap Steel (Schnitzer Steel) Tank Location: 4920 E. State Hwy. 302 Belfair, WA 98528 If you have any questions or request for services, please feel free to contact this office at (253) 536-6961. Sin ely, Tom Langs Langseth Environmental Services, Inc. 7517 Portland Avenue, Suite A, Tacoma, WA 98404 • Phone: (253) 536-6961 • Fax. (253) 548-0201 LangsethEnviro@gmail.com Mason County Department of Community Development 426 W Cedar Street Shelton, WA 98584 Phone (360) 427-9670 Fax (360) 427-7798 UNDERGROUND STORAGE TANK VW &kWHFM CHECKLIST Instructions: Complete the Underground Storage Tank(UST) checklist below. Return the completed checklist and, if require, site assessment reports necessary for Department of Ecology compliance,to the Mason County Permit Assistance Center within 15 days after the UST is abandoned. Parcel Number where tank is located: 12228-13-00050 Legal description: Address: Date of Akxxkwm 4920 E. State Hwy. 302 Removal 4-21 -15 Directions to site: Name of Property Owner: OT Trust c/o Stuart Milbrad Name & license number of Certified IFCI contractor performing abandoninent procedures: Tom Langseth, Langseth Environmental Services, Inc. Contractor Phone: lFC1 Certification#: 253 536-6961 0910875 Washington State Contractor Registration#: Bonding Agent: LANGSES077DU Westchester TANK INFORMATION El Tank cleaned on site Type of property in tank: X2 Tank cleaned off site I Diesel Oil How was sludge disposed of? Drummed and hauled to PRS for disposal. Describe decommissioning method: 1)How was tank cleaned: Tank cut in half, scraped down, wiped with oil pad d ' osedC 2)How was itrushed and put in steel bin for pickup and disposa . � Tank Capacity: 675 gallons Estimated age of tank: Unknown I certify that the information provided is true and correct. The U was)0mxkx=Un accordance to current Washington State regulations and Mason County Ordi n es. remov Date: 5-6-1 5 Signature: PHOTOGRAPHS I e' L; a �Y. Milbrad residence, 4920 E. State Hwy. 302 Belfair, WA 98528. Looking south at the front side of the newer residence. ,r-It �. �:1� -#'.•� � `.' 3 .'. � r { ' ' ram.,.., _ The underground heating oil storage tank (UST)was located on the north side of the residence in a graveled driveway area. ii III The removed tank was sized at 52"x 74"with a nominal capacity of 675 gallons. Some pinholes or steel/weld failures were noted on removed tank prior to removal. Prior to tank removal, the tank was pumped and cleaned by Certified Cleaning Services of Tacoma. 4,• y s y y' .e The top of the tank was exposed under+/- 10" of earth cover. Tank had been bedded and buried in site native soil. Y j f l v � f � Tank pit bottom after removal. Slight visual or olfactory indications of petroleum-contaminated soil were detected. Laboratory analytical results of the obtained samples were not above the MTCA Method A cleanup level. a Looking north at surface water well location. Shed located east of the UST pit area in front of the original residence. i # - c* Current drinking water well is located 15' east of shed and is reportedly 150' deep. Looking north at the newer residence. The metal bar represents the location of the hand boring completed at the site. a Pit area was backfilled and compacted with the excavated soil and clean fill material. Site was brought to grade with crushed rock.