VTNRCS 1/05

[Vermont NRCS Worksheet #4]{.underline}

Assessment of Groundwater Concerns Associated With

On-farm Petroleum Product Storage

Landowner/Producer's Name: Farm, Tract and Field No.

Farm Name: Evaluator's Name:

Site Location: Date of Evaluation:

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  **Site(s) Sketch**

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**This worksheet is adapted from the Vermont Farm\*A\*Syst worksheet
#4.**

[VT NRCS Assessment of Groundwater Concerns Associated With On-farm
Petroleum Product Storage]{.underline}

No tract with an underground storage tank (UST) (unless it's a
double-walled tank, single walled with cathodic protection, fiberglass,
or is registered with the State of VT UST program) or a UST being used
or re-used above ground shall meet Vermont NRCS Resource Management
System Quality Criteria for conservation planning. \*

  -------------- --------------- --------------- ----------------- ----------------- -----------
  **Ranking      **4**           **3**           **2**             **1**             **Score**
  Score:**                                                                           

  **LOCATION**                                                                       

  **Position of  Tank down slope Tank at grade   Tank down slope   Tank at grade or  
  tank in        more than 100   or upslope more more than 100     upslope less than 
  relation to    feet from well, than 100 feet   feet from well,   100 feet from     
  drinking water etc. in medium- from well, etc. etc.in            private well,     
  well or        or fine-        in medium- or   coarse-textured   etc. or 200 feet  
  spring**       textured soils  fine-textured   soil (sands,      from public well  
                 (silt loam,     soils (silt     sandy loam) with  in                
                 loam, clay      loam, loam,     high              coarse-textured   
                 loams, silty    clay loams,     permeability.     soil (sand, sandy 
                 clay) with low  silty clay)                       loams) with high  
                 permeability.   with low                          permeability.     
                                 permeability.                                       

  **Location     Tank located    Tank located    Tank located away Tank located next 
  relating to    away from all   away from all   from most         to driveway with  
  physical       traffic and     traffic, but is traffic, but is   frequent traffic  
  damage of the  buildings and   next to         next to building, (milk/feed truck) 
  tank**         is out of reach building and    without roof, and or is susceptible 
                 of any ice      has roof to     susceptible to    to ice damage     
                 falling off     prevent ice     ice damage from   from roof.        
                 roofs.          damage.         roof.                               
  -------------- --------------- --------------- ----------------- ----------------- -----------

\*USTs are not designed to bear the weight of fuel without the
additional structural support provided by the soil surrounding the tank.

[VT NRCS Assessment of Groundwater Concerns Associated With On-farm
Petroleum Product Storage]{.underline}

  ------------------ ---------------- ------------- -------------- -------------------- -----------
  **Ranking Score:** **4**            **3**         **2**          **1**                **Score**

                                                                                        

  **Location         Tank(s) out of   Tank(s)in the Tank(s) within Tank(s) within the   
  relating to flood  the 100 year     100 year      the 100 year   100 year floodplain, 
  damage**           floodplain       floodplain,   floodplain,    not anchored to      
                                      but are       but are        prevent flotation    
                                      anchored to   anchored to    and no impact        
                                      prevent       prevent        protection           
                                      floating.     floating. No                        
                                      Have          impact                              
                                      structures to protection.                         
                                      prevent                                           
                                      impact                                            
                                      damage.                                           

  **Design and                                                                          
  Installation**                                                                        

  **Tank Condition:  Tank is painted  Tank is       Tank is not    Tank (any color,     
  Paint/Shading**    silver or white, painted       painted, or    painted/unpainted)   
                     is not in        silver or     painted a dark in contact with      
                     contact with the white, is not color, does    ground.              
                     ground, and has  in contact    not have a                          
                     a roof for       with the      roof, but is                        
                     shade.           ground and    not in contact                      
                                      has no roof   with ground.                        
                                      or tank; is                                       
                                      painted a                                         
                                      dark color,                                       
                                      not in                                            
                                      contact with                                      
                                      ground and                                        
                                      has a roof                                        
                                      for shade                                         

  **Secondary        Tank placed      Tank placed   Tank placed on No secondary         
  containment**      within concrete, within        pad or within  containment.         
                     metal or         concrete,     dike made of                        
                     synthetic        metal or      low                                 
                     contain- ment    synthetic     permeability                        
                     structure able   containment   soils, able to                      
                     to hold 125% of  structure     hold 125% of                        
                     tank capacity    able to hold  tank capacity                       
                     and has a roof   125% of tank                                      
                     that blocks most capacity with                                     
                     precipitation.   no roof.                                          

  **Venting/relief   Tank has a       Tank has a    Tank has a     Tank without vent or 
  valve**            screened vent    screened vent vent without   pressure relief      
                     with a whistle   with a        screen or      valve.               
                     and a pressure   whistle, but  whistle, but                        
                     relief valve.    no pressure   no pressure                         
                                      relief valve. relief valve.                       
  ------------------ ---------------- ------------- -------------- -------------------- -----------

[VT NRCS Assessment of Groundwater Concerns Associated With On-farm
Petroleum Product Storage]{.underline}

**Instructions:**

**Total the rankings for the categories you completed and divide by the
number of categories you ranked:**

Rankings TOTAL Number of risk categories \* Carry the result out to one
decimal

[from all rows ranked]{.underline} divided by [(rows)
ranked]{.underline}\_\_\_\_\_\_ equals \* place.

**Example:** 16 divided by 6 = 2.66

**Use 2.7**

RESULTS:

6.  **- 4.0 = low risk**

**2.6 - 3.5 = low to moderate risk**

**1.6 - 2.5 = moderate to high risk**

**1.0 - 1.5 = high risk**

A ranking of 2.5 or greater meets the Vermont NRCS Resource Management
System Quality Criteria.

Any individual category (row) ranked with a score of 1 or 2 should be
further assessed for risk related to that category.

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**OTHER:**

Visual assessment should be made regarding hazards to surface water and
documented in field notes and the VT RMS Quality Criteria checklist
(Quality Criteria Assessment For Conservation Planning).

Conservation planners should note the proximity of the petroleum storage
to important structures and provide recommendations regarding fire
safety when appropriate. Petroleum storage should be located a minimum
of 50 feet from any structures where fire would present a significant
threat or risk to humans, animals or property.

**NOTES:**