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FM REVIEW u, Harnett :Meal o u r �cnc, sc.Nos Dope., t Cho RO.s ci N Ro T. MA r ow E wwrrLarnatt.arg Plan Review, Inspection and Permit Fees Application Number 10- 50025025 $150.00 Explosive Mat. (90 Days) $ 75.00 1 1 Explosive Mat. (72 Hrs) $ 25.00 n Fireworks Public Display $ 35.00 n Final Inspection $ 35.00 +2.00 per device Fire Alarm Testing $ 35.00 + 2.00 per nozzle ❑ Fixed Fire Suppression $ 25.00 1 Insecticide Fog/Fumigation $ 50.00 n Pipe Test/UST /AGST $ 50.00 n Plans up to 5000 ft $100.00 n Plans 5001 ft to 10,000 ft $150.00 Plans 10,001 ft to 25,000 ft $250.00 1 Plans 25,001 ft and over $ 35.00 + 2.00 per Head Sprinkler Certification Test $ 35.00 n Standpipe Testing $ 25.00 n Special Assembly $ 25.00 n Temporary Kiosks/Displays $ 25.00 ❑ Tents, Canopies, Air Supported $ 50.00 n Tank Installation (charge for each tank) $ 50.00 ® Tank Removal (charge for each tank) $ 200.00 Total Total device /heads Michael L. Marti /I 8 -13 -10 Code Enforceme • cial Date 1 1 0-500 2502 S I „41 1d1 0m ', ph I , ddia 0 4ti Ills i , F i, °, , h ,I 1� - , 4A� 4 ei,f 1 vai r, t 1 Marshal /Emergency Management, 1 '� rrl r I '� � K �41 +I , , _� „� a• Fire Mars 1: I�)�!Ig cH.re; ih m ' r y: III ; 4 1 1 I I I 1.1.1 1/41:17:M : 0 7 � 7 R cAt-1' y !IiVI l u. N k1G c ' � .. n -.., Ai k Icd "� n� IM. °4 ,,Ai 1n,r, {i b. �R_ f a l l u.r {N �Ef ,c i t [: Mailing: P. 0. Box 370 Lillington, NC 27546 IAi 910 - 893 -7580 Physical: 200 North 13th Street, Suite 19 910- 893 -5025 Erwin, NC 28339 PERMIT APPLICATION FOR INSTALLATION, REMOVAL OR ABANDONMENT OF UNDERGROUND OR ABOVE GROUND STORAGE TANK(S) Application is hereby made by the undersigned for a permit: G Sit to Install: r/ Storage Tank(s) Underground ✓Above Ground Lic Remove: ,1 Storage Tank(s) Underground / Above Ground Abandon: / Storage Tank(s) Underground Above Ground Business Name: CAa / en /e J57/D ( Texi-co) Address: 9/0/ US f/wy Vo / /44/X City: ru Qu/4 y ✓ i f State / Zip: 0 75 Contractor's Name: ,-JO 1- c.7ietti f u.,-p r T;90, ea.-e- ,t,y Address: 5 5 B /,ac/&t>,a-f1^ ,Sv City: . 2A - 1 9 --- , 15 k State: NC- Zip: 276o/0 -A permit shall be obtained for the above listed procedure prior to beginning work. All fees shall be paid at the time of the permit being issued. -All tank work shall comply with all local, state, federal laws and NFPA and API standard practices. - Notify the Emergency Services Office prior to installation, removal or in place abandonment of tank(s). -For removal or abandonment in place, all liquids shall be removed from the tank(s) and disposed of properly. -A representative from this office shall be on site at the time of the installation or removal of the tank(s). -Tank contractors shall complete and submit the attached AGST /UGST Removal or Abandonment Checklist to this office after completion of the job. I understand and consent to the above - stipulated conditions upon which this permit is ranted. Failure to obtain permit and comply with regulations may re ha (e to the ppenalties provided bylaw. o OI - // g/ y -'/ - o.- / '7 p plicant. Date: Phone #: / — 8'0 —10 _/'----'------------ • • ' Date: Granted Denied (( Receipt #: Amount: Cash:_ Check #: Rec By: Y1kmwE. (3) co lc 3 L A(t) Il.ge ,,.ic`rrLA, 0) c tic yaL. 4. (v) SKcsal 1 tl .ill U ST -3t Notice tent' °iUST ntl PermaneCIosure, ort Ser`vice'� , a i J ID r in Return completed form to: STATE USE ONLY The DWM Regional Office located in the area where the facility is located. Send a copy to the Central Office in Raleigh so that I_D, « the status of the tank may be changed to "PERMANENTLY CLOSED" and your lank fee account can be closed out. SEE MAP ON THE BACK OF THIS FORM FOR THE CENTRAL AND REGIONAL OFFICE ADDRESSES. Date Received tfi ;j„ 1 1„18,01NSTRUCTIONS (READ THIS�FIRST)i ��lr4 tai I Complete and return at least thirty (30) days prior to closure or change -in- service activities. If a Professional Engineer (P.E.) or a Licensed Geologist (L.G.) provides supervision for closure or change -in- service site assessment activities and signs and seals all closure reports then at least a five (5) working days notice is acceptable. Completed UST closure or change -in- service site assessment reports, along with a copy of the UST -2 form, should be submitted to the appropriate Division of Waste Management (DWM) Regional Office within thirty (30) days following closure activities. The UST -2 form should also be submitted to the Central Office in Raleigh so that the status of the tanks may be changed to permanently closed and your tank fee account can be closed out. UST closure and change -in- service site assessments must be completed in accordance with the latest version of the Guidelines for Tank Closure. The Guidelines for Tank Closure can be obtained at www.wastenotnc.org. You must make sure that USTs removed from your property are disposed of properly. When choosing a closure contractor, ask where the tank(s) will be taken for disposal. Usually, USTs are cleaned and cut up for scrap metal. This is dangerous work and must be performed by a qualified company. Tanks disposed of illegally in fields or other dumpsites can leak petroleum products and sludge into the environment. If your tanks are disposed of improperly, you could be held responsible for the cleanup of any environmental damage that occurs. I: OWNERSHIPIOF'TANKsv : . '1 - , IIP'LOCATION Owner Name (Corporation, Individual, Public Agency, or Other Entity) Facility Name or Company PICK N MOVE, LLC CHALYBEATE STORE Street Address Facility ID # (If known) 2114 ROLAND GLEN ROAD 0- 034289 City County Street Address CARY WAKE 9101 US HWY 401 NORTH State Zip Code City County Zip Code NC 27519 FUQUAY VARINA HARNETT 27526 Phone Number Phone Number (919) 387 -8082 CONTACT0PERSONNELOIN.4J' II1II1Gf "III' Name: Company Name: Job Title: Phone Number: CHRIS LEWIS SOUTHERN PUMP & TANK COMPANY PRIME CONTRACTOR 832 -6634 IV. TANK.REMOVAL;'CLOSURE'IN PLACE, CHANGE=INISERVICE Std 1. Contact local fire marshal. 5. Provide a sketch locating piping, tanks and a P.E. or L.G., with all closure site 2. Plan entire closure event. soil sampling locations. assessment reports bearing the signature 6. Submit a closure report in the format of and seal of the P.E. or L.G. If a release has 3. Conduct Site Soil Assessment. UST -12 (including the form UST -2) within not occurred, the supervision, signature or 4. If removing tanks or closing in place, refer to thirty (30) days following the site seal of a P.E. or L.G. is not required. API Publication 2015 Cleaning Petroleum investigation. 8. Keep closure records for three (3) years. Storage Tanks and 1604 Removal and 7. If a release from the tanks has occurred, the Disposal of Used Underground Petroleum Storage Tanks. site assessment portion of the tank closure must be conducted under the supervision of Contractor Name: Contractor Company Name: QUINT O'COCK EAGLE SWS Address: State: Zip Code: Phone No: 165 BLUE BELL ROAD, GREENSBORO NC 27406 (336) 553 -1853 Primary Consultant Name: Primary Consultant Company Name: Consultant Phone No: HENRY NEMARGUT HENRY NEMARGUT ENGINEERING SERVICES (910) 762 -5475 e. l ! I iGVL 'ilIANKSISCHEDULEDIF.OR,CLOSURE OR.CHANGE :IN- SERVICE ' Proposed Activity Closure Change -In- Service Tank ID No. Size In Gallons Last Contents Removal Abandonment in Place New Contents Stored 1 10000 Gasoline, Gas Mix ® ❑ 2 10000 Gasoline, Gas Mix ® ❑ 3 10000 Dielsel, Dielsel Mix ® ❑ 4 1000 Kerosene ® ❑ • ❑ ❑ Prior written approval to abandon a tank in place must be received from a DWM Regional Office. .VII:. OWNER.OR OWNER 'S'AUTHORIZED'REPRESENTATIVE ' I' " ' I understand that I can be held responsible for environmental damage resulting from the improper disposal of my USTs. Print name and official HENRY NEMARGUT /CONSULTING ENGINEER title: Signature Date Signed SCHEDULED REMOVAL DATE Notify your DWM Regional Office 8/24/2010 48 hours before this date if scheduled removal date changes UST -3 Rev 10/2006 Harnett County Office of the Fire Marshal P.O. Box 370 Lillington, N.C. 27546 (910)493 -7580 Permit Certificate Business Name: CHALYBEATE STORE Address: 9101 N US 401 Fuquay Varina, NC 27526 OFFC 919- 552 -0193 Phone: The following permit has been issued: Permit No. 0000021 Type: 036 Under Ground Tank Removal Issued Date: 08113/2010 Effective Date: 08/24/2010 Expiration Date: 08/2512010 This permit certificate has been issued for [ 4nstruction / [ ] operational purposes located at the above business location. This permit has been issued and will be enforced in accordance with section 105 of the N.C. State Fire Prevention Code. Please contact our office for any further questions regarding this permit. Inspector: Michael (30) L Martin Date Reno ✓b 11 10000 Gm/ Galt .7.) mom Gal 2') 10000 ad � 6.r y-) (004 6.1 Arrmrr -t_ 08/13/2010 Page 1 �. N H arnett , .. , K ' COUNTY � F Mf Eme9ancY!°nn°° +baPertrn° ^t 40 a . 5OR :I EA R A ` F ' v+w'aliarnatt.otg August 13, 2010 Chris Lewis Southern Pump and Tank Company 1501 South Bloodworth Street Raleigh, NC 27610 Chalybeate Store 9101 US 401 North Fuquay Varina, NC 27526 Application Number 10- 50025025 Mr. Lewis, Thank you for submitting the plans for the 4 tank removals. The plans have been carefully reviewed by a qualified code enforcement official to examine for full compliance with the North Carolina Fire Prevention Code and all other fire protection regulatory documents. These items are outlined and described below. Scheduled Date of Removal: August 24, 2010 • 3404.2.14 Removal and Disposal of Tanks o Flammable and combustible liquids shall be removed from the tank and connecting piping o Piping at tank openings which is not to be used further shall be disconnected o Piping shall be removed from the ground o Tank openings shall be capped or plugged, leaving a .125 inch to .25 inch diameter opening for pressure equalization o Tanks shall be purged of vapor and inserted prior to removal o All exterior above grade fill and vent piping shall be permanently removed. n Harnett ' 0 U H T Y A 4 0) Emergency Services Department NOM, £hPC�:3NA WN,•,hrnettca • On site inspections o A safe workplace shall be maintained throughout the prescribed activities o After all liquids and residues have been removed from the tank, confirmation shall be made that the atmosphere in the tank is safe and shall be conducted on a periodic schedule. o Access to the tank shall be made by careful excavation to the top of the tank o The tank shall be removed from the excavated site and shall be secured against movement o Any corrosion holes shall be plugged o The tank shall be labeled with its former contents, preset vapor state, vapor - freeing method, and a warning against reuse o The tank shall be removed from the site /county promptly on the same day General Notes Contact our office to witness the purging and removal of the tank and the test associated with the tank. A Fire Marshal must be onsite to perform these test. Tanks shall not be pulled unless a Fire Marshal is on site Thank you again for submitting the plans for the 4 tank removals. Please review the plans and adhere to any notes and alterations that were made in addition to the original drawings. These remarks are for the plans that were submitted and its original intent. These remarks do not apply if the original intent changes or what was submitted on the above date changes. If you have any questions, please do not hesitate to call this office. Again, thank you and we look forward to working with you during the construction period! Sincerely, ..„„ M' - ael L. Martin Deputy Fire Marshal k .Harnett ® t � M Eman9cncY Sarwont DopertmaM C O U N T Y wwwharmuttorg -0- KURT LAROUNA ale Plan Review, Inspection and Permit Fees Application Number 10- 50025025 $150.00 1j Explosive Mat. (90 Days) $ 75.00 _ Explosive Mat. (72 Hrs) $ 25.00 n Fireworks Public Display $ 35.00 n Final Inspection $ 35.00 +2.00 per device in Fire Alarm Testing $ 35.00 + 2.00 per nozzle in Fixed Fire Suppression $ 25.00 1 1 Insecticide Fog/Fumigation $ 50.00 ® Pipe Test/UST /AGST $ 50.00 n Plans up to 5000 ft $100.00 Li Plans 5001 ft to 10,000 ft $150.00 n Plans 10,001 ft to 25,000 ft $250.00 n Plans 25,001 ft and over $ 35.00 + 2.00 per Head n Sprinkler Certification Test $ 35.00 n Standpipe Testing $ 25.00 in Special Assembly $ 25.00 ❑ Temporary Kiosks/Displays $ 25.00 n Tents, Canopies, Air Supported $ 50.00 Tank Installation (charge for each tank) $ 50.00 n Tank Removal (charge for each tank) $ 150.00 Total Total device/heads Michael L. M i 8 -13 -10 Code Enforcemen ficial Date 1 1 0 25o2- , r 'r'Y4' }ti t i i � +l tit Fire Merstial %Emergency Management p + . g ,8 1 ,' r y � 1;. 1 1 � , ~ , t. ; - s � r i; , ; , '$a % r ,, „ .'_. i r v.; t !" r 4§ a.,. ;i . .'.. IL !r el : :' ■ 1 " ' 1 rct, ` � ir ;yC�p i' ;;;,;l, ! Mailing: P. 0. Box 370 Lillington, NC 27546 n 910-893-7580 i I Physical: 200 North 13th Street, Suite 19 i , a u 910-893-5025 Erwin, NC 28339 PERMIT APPLICATION FOR INSTALLATION, REMOVAL OR ABANDONMENT OF UNDERGROUND OR ABOVE GROUND STORAGE TANK(S) Application is hereby made by the undersigned for a permit: QtcAl4E Install: V Storage Tank(s) Underground ✓ Above Ground "- r' Remove: Storage Tank(s) Underground / Above Ground Abandon: _ Storage Tank(s) Underground _ Above Ground Business Name: CAa /ye) 4e ,57 (JD( Texs -c'o) Address: 9i6% 1-15 flwy `'o/ /ALA City: Ft Qu fi y t4 State N C-- Zip: - -7 5; 1 (0 Contractor's Name: ,S© Lc/la,. A44- ( /,mA ed2nrvil Address: 6Th / 5 8 /DJi..i-fti 54 City: 41e. r' k State: NC- Zip: 2? (o (O - permit shall be obtained for the above listed procedure prior to beginning work. All fees shall be paid at the time of the permit being issued. -All tank work shall comply with all local, state, federal laws and NFPA and API standard practices. - Notify the Emergency Services Office prior to installation, removal or in place abandonment of tank(s). -For removal or abandonment in place, all liquids shall be removed from the tank(s) and disposed of properly. -A representative from this office shall be on site at the time of the installation or removal of the tank(s). -Tank contractors shall complete and submit the attached AGST /UGST Removal or Abandonment Checklist to this office after completion of the job. I understand and consent to the above - stipulated conditions upon which this permit is ranted. Failure to obtain permit and comply with regulations may re a lia le to the penalties provided by law. pplicant. Date: Phone #: iV E -- '.`��. - = Date: Granted Denied Pep nest Receipt #: \ Amount: Cash:_ Check #: Rec By: 9 1k'004E (3loKc)eLL AA( lk3eu.. nNSritLL 6 ) l tic c at._ A. (1) Blc'j•tL ray H arnett C O U N T Y Emergency SWOON Department ' � RORiit •LAROiiNA wwveltarmtt.eag August 13, 2010 Chris Lewis Southern Pump and Tank Company 1501 S. Bloodworth Street Raleigh, NC 27610 Chalybeate Store 9101 US 401 South Fuquay Varina, NC 27526 Application Number 10- 50025025 Mr. Lewis, Thank you for submitting the plans for the tank installtion. The plans have been carefully reviewed by a qualified code enforcement official to examine for full compliance with the North Carolina Fire Prevention Code and all other fire protection regulatory documents. There are some items that were found during the plan review process that need to be addressed before a final inspection of the new facility can be given. These items are outlined and described below. The installation of the above ground tanks shall be installed in accordance with N.0 Fire Code and NFPA 30. • 3404.2.3.1 Smoking and open flame. o Signs shall be posted in storage areas prohibiting open flames and smoking. Signs shall comply with Section 3403.5. • 3404.2.9.6.5 Vehicle impact protection. o Where protected above - ground tanks, piping, electrical conduit or dispensers are subject to vehicular impact, they shall be protected therefrom, either by having the impact protection incorporated into the system design in compliance with the impact test protocol of UL 2085, or by meeting the provisions of Section 312, or where necessary, a combination of both. Where guard posts or other approved barriers are provided, they shall be independent of each above - ground tank. r -= 'Harnett ;a ' , C 0 u N r Y (FM), Em ni ergency Sar Daparamant maRi3 tARO.iN� wwwLarn•tt.mg 4� • 2.4.2.3 Testing of the inner space and the outer space o Underground secondary containment tanks and horizontal aboveground secondary containment tanks shall have the primary(inner) tank tested for tightness either hydrostatically or with air pressure at not less than 3 psig and not more than 5 psig. The interstitial space of such tanks shall be tested either hydrostatically or with air pressure at 3 to 5 psig, by vacuum at 5.3 inHg, or in accordance with the tank's listing or manufacturer's instructions. The pressure or vacuum shall be held for not less than one hour or for the duration specified in the listing procedures for the tank. Care shall be taken to ensure the interstitial space is not overpressured or subjected to excessive vacuum. • 3403.6.3 Testing of piping o Unless tested in accordance with the applicable section of ASME B31.9, piping, before being covered, enclosed, or placed in use, shall be hydrostatically tested to 150 percent of the maximum anticipated pressure of the system, or pneumatically tested to 110 percent of the maximum anticipated pressure of the system, but not less than 5 pounds per square gauge (psig) (34.47 kPa) at the highest point of the system. This test shall be maintained for a sufficient time period to complete visual inspection of joints and connections. For a minimum of 10 minutes, there shall be no leakage or permanent distortion. Care shall be exercised to ensure that these pressures are not applied to vented storage tanks. Such storage tanks shall be tested independently from the piping. General Notes Contact our office to witness the setting of the tank and the test associated with the tank and piping attached to tank. A Fire Inspector must be onsite to perform these tests. Manufactures Specification Sheets shall be provided to our office prior to performing any test on the tank. Plans indicate the installation of (1) 12000 gallon and (1) 8000 gallon tanks. Harnett (I3) Emergency lemon, DnpeMwnt letmoz —alit Wove LAROANA 1' w harnan,org Thank you again for submitting the plans for tank installation. Please review the plans and adhere to any notes and alterations that were made in addition to the original drawings. These remarks are for the plans that were submitted and its original intent. These remarks do not apply if the original intent changes or what was submitted on the above date changes. If you have any questions, please do not hesitate to call this office. Again, thank you and we look forward to working with you during the construction period! Sincerely, Mich. e L. Martin Deputy Fire Marshal Harnett County Office of the Fire Marshal P.O. Box 370 Lillington, N.C. 27546 (910)- 893 -7580 Permit Certificate Business Name: CHALYBEATE STORE Address: 9101 N US 401 Fuquay Varina, NC 27526 OFFC 919 - 552 -0193 Phone: The following permit has been Issued: Permit No. 0000024 Type: 039 Under Ground Tank Installation Issued Date: 08/13/2010 Effective Date: 08/13/2010 Expiration Date: 02/13/2011 This permit certificate has been issued for [ construction / [ ] operational purposes located at the above business location. This permit has been issued and will be enforced in accordance with section 105 of the N.C. State Fire Prevention Code. Please contact our office for any further questions regarding this permit. S Inspe r: Michael (30) L Martin Date !, /a,oao G/ .2) 8 eoe lay/ 08/13/2010 Page 1 Harnett County Office of the Fire Marshal P.O. Box 370 Llllington, N.C. 27546 (910)493 -7580 Permit Certificate Business Name: CHALYBEATE STORE Address: 9101 N US 401 Fuquay Varina, NC 27526 OFFC 919 -552 -0193 Phone: The following permit has been issued: Permit No. 0000025 Type: 037 Pipe Inspection Issued Date: 08/13/2010 Effective Date: 08/13/2010 Expiration Date: 02/13/2011 This permit certificate has been issued for [construction / [ ] operational purposes located at the above business location. This permit has been issued and will be enforced in accordance with section 105 of the N.C. State Fire Prevention Code. Please contact our office for any further questions regarding this permit. Inspector: Michael (30) L Martin Date 08/13/2010 Page 1