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HomeMy WebLinkAbout17127 Smokey Point Blvd_BLD434_2026 • OPERATING PERMIT APPLICATION Department of Community & Economic Development City of Arlington • 18204 59th Ave NE •Arlington, WA 98223 Phone (360) 403-3551 Part I Applicant/Building Information Applicant's Name: 7-Eleven, Inc. Applicant's Address P.O. Box 711, Dallas, TX 75221 Contact Person Amanda Grindle, Permit Coordinator Phone Number: (253) 882-4546 Email: agrindle@muircontracting.com Address of Premises for which Operating Permit is requested: ❑ Same as above ® Other 17127 Smokey Pt. Blvd., Arlington, WA 98223 Tax ParcelID# 31052800202200 Current Occupancy Class: Part II Type of Operating Permit An Operating Permit is required to conduct any activity or to use any class of building listed below. Please indicate the type(s) of Operating Permit(s) requested by checking each applicable box. (If you require assistance, or would like more information, contact the City of Arlington Building Department at 360-403-3551.) ❑ Manufacturing, storing or handling hazardous materials in quantities exceeding those listed in the Fire Code (See Appendix A.) Identify the materials and quantities and describe the manner in which the materials will be manufactured, stored or handled (attach additional sheets if necessary): Appendix A ❑ Conducting a hazardous process or activity, including, but not limited to, any commercial or industrial operation which produces combustible dust as a byproduct, fruit and crop ripening, waste handling, spray operations, and high-piled storage (see Appendix B.) Describe the process(es) or activity(ies) to be conducted (attach additional sheets if necessary): Appendix B ❑ Use of pyrotechnic devices in assembly occupancies (see Appendix C.) Describe the devices to be used and type of event (attach additional sheets if necessary): Appendix C ❑ Aboveground Storage Tank (AST) (see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary tank closure ❑ Changes in service ❑ Permanent tank closure Brief description: Appendix D ❑ Underground Storage Tank (UST) (see Appendix D) ® Removal ❑ Decommissioning ❑ Temporary tank closure ❑ Changes in service ❑ Permanent tank closure Brief description: Remove three 12,000-gal single-wall steel underground storage tanks and associated fueling system, including product, vapor, and vent piping, dispensers, monitoring equipment, etc. Appendix D ❑ Temporary Membrane Structures, including tents and canopies (see Appendix E.) Brief description of structure and use: Brief Description: Appendix E ❑ Special Event Operating Permit -An Operating Permit is required for any special event that takes place within an occupied building, or an outdoor mass gathering, which is outside the scope of the permitted use (see Appendix F.) Brief description of type of gathering proposed: Appendix F Part III Premises/Building Information 1. Date of last Inspection on Premises 2. Has a Certificate of Occupancy been issued for the premises? ❑ Yes ❑ N o Type: Temporary Date of Issuance: ❑ Permanent ❑ Temporary 3. Are there currently any open Building Permits associated with the premises? ❑ Yes 0 No If yes, please describe (attach additional sheets if necessary): 4. Additional Comments: Attached to this permit application are the following items: - Site Plans, including Demolition Plan, Restoration Plan, and Stormwater Management Plan - Copy of DOE 30 Day Notice A copy of the DOE Site Assessment Checklist will be submitted to the City following UST removal and receipt of soil sample analysis results. Please Attach Drawings or supporting documents. (PDF only) PLANS 7-Eleven Store No. 21341 Fuel System Removal.pdf; 30 DAY Notice for 21341 Arlington.pdf SIGNATURE OF APPLICANT I herby certify that the foregoing information (and all information in attached sheets, if any) is true and complete ❑X Signature of Applicant or Authorized Representatives Signature (Type you name in here) Amanda Grindle Title Date 07/25/14 Permit Coordinator for 7-Eleven Part IV To be completed by the City of Arlington Building Department Inspection Required: ❑ Yes ❑ No Inspections Performed: ❑ Yes ❑ No Inspection Date Tests or Reports required verifying compliance? ❑ Yes ❑ N o If YES, have Tests or Reports been received? ❑ Yes ❑ N o Application(s) Approved: Date Operating ❑ Yes ❑ No Permit Issued: Operating Permit Issued by: Date Operating Permit Expires: Type/Description of Operating Permit: Conditions of Operating Permit (list conditions here AND in the space provided in the Operating Permit): Additional Comments: (Attach additional pages if needed) SCOPE OF WORK PROPERTY INFORMATION G.C.=GENERAL CONTRACTOR0 OWNER SITE ADDRESS: 17127 SMOKEY PT BLVD,ARLINGTON, OT =OTHERS WA 98223 1D o.T. REMOVE 2-EXISTING DISPENSERS. SNOHOMISH COUNTY PARCEL NUMBER:31052800202200 172 N D ST NE @ c.a DEMOLISH EXISTING GASOLINE DISPENSER TOWNSHIP,RANGE,SECTION:T31 R05 S28 CANOPY SUPPORT COLUMNS,FOOTINGS AND CONCRETE PUMP ISLANDS. LEGAL DESCRIPTION OF PROJECT SITE:SECTION 28 3 c.a SAW CUT,BREAK,AND REMOVE CONCRETE TOWNSHIP 31 RANGE 05 QUARTER NW-N 165.04FT OF O SURFACE OVER UNDERGROUND STORAGE W 180.05FT AS MEAS AT R/A TO&PLW N&W LNS OF TANKS(USTs). THOF OR RD&ALSO EXOC FOR RD TH PTON LY WLY OFT @ c.a SAW-CUT,BREAK,AND REMOVE CONCRETE FDL BAAP ON S LN N 50.01 FT DIST 75FT ELY FIR AT DISPENSER ISLAND SE OF —W W--- -W———— CONCRETE DEBRIS.REMODVE OIL-WATER ER CONTACT INFORMATION —W—--—W—-- —W————W———— SEPARATOR AND CAP LINE TO SANITARY W_—— SEWER,IF APPLICABLE. PROJECT OWNER: JOSE RIGS ® c.a EXCAVATE AND STOCKPILE UST OVER BURDEN MANAGER ENVIRONMENTAL SERVICES SOIL ON 6-MIL VISQUEEN SHEETING.COVER 7-ELEVEN INC STOCKPILE WITH VISQUEEN. PO BOX 711 DALLAS,TX 75112 VENT @ c.a INERT AND REMOVE 3-EXISTING 12,000GALLON JOSE.RICS@711.COM ___ USTs.EXISTING PRODUCT,VAPOR,AND VENT CONTACT PERSON: LINE —SD —SD-----SD---- PIPING,PERFORM UST CLEANING, PAUL FAIRBARIN CB —SD-----gD—___ TRANSPORTATION,AND DISPOSAL. STANTEC CONSULTING SERVICES W (2) c.a REMOVE EXISTING PRODUCT PIPING LINES. 11130 NE 33RD PLACE SUITE 200 CB �_/ BELLEVUE,WA 98004 V ® c.a REMOVE 3-EXISTING VENT RISERS AND VENT Paul.Fairbarin@Stantec.com z LINES AND UNDERGROUND PIPING. 425-289-7343(work) O = 206-369-8383(cell) SIDEWALK cc Q9 c.a REMOVE EXISTING ELECTRICAL CONDUITS ENGINEER: CANOPY m FROM SUB-PANEL TO TANK TURBINE&FILL MARC SAUZE,P.E. LL - z x SUMPS,ANNULAR DISPENSER,AND ALL LOW STANTEC CONSULTING SERVICES (785 SF) CB - - W _ VOLTAGE SENSORS. 11130 NE 33RD PLACE SUITE 200 o' - ® BELLEVUE,WA 98004 1 c.a EXCAVATE UST BASIN IN ORDER TO REMOVE Marc.Sauze[(rDDStantec.com ANY PETROLEUM CONTAMINATED SOIL(PCS)IF 425-86auz @ eat 172(work) CB ENCOUNTERED.STOCKPILE PCS ON 425-894-2329(cell) VISQUEEN AND COVER WITH VISQUEEN UNTIL SOIL IS TRANSPORTED OFFSITE FOR DISPOSAL AT SEPARATE FACILITY. OVER EXCAVATE AREAS OF USTs AND DISPENSER ISLAND IN ORDER TO N IL IF CB I TRASH E COUN RED•REUSE SOIL AS BACKFIOVE CONTAMINATED OLL IF s TI ' DISPENSERS ' ENCLOSURE CLEAN. 3T © c.a PERFORM BACKFILL AND SURFACE RESTORATION ACTIVITIES(SEE SITE GRADING 'I 2 4 AND RESTORATION PLAN).REGRADE SO 7222 I STORMWATER FLOWS INTO EXISTING STORM \ I 7 11 DRAINS ryJM� I I VICINITY MAP Q I W 3 I CB LEGEND € Sd K,dzle B Kids 174V PI NE y0 CB om�O — EXCAVATION BOUNDARY� rO� PROPERTY BOUNDARY 172ND ST NE OTELEVEN STOREO J _ 1 3 5 6 9 - WATER LINE Lu Y #21341 -ss----- SEWER LINE Ye 3 I -SU- STORM LINE nvi Ne � Nw naa O O O 1 ---- x 169�n 5i NE 0 W I MW 4 Enxd�ool and KL_ " ' I ENT ANC I I I I I � MONITORING WELL Y PREPARED BY: w q I (4 I STORM CATCH BASIN(CB) c O I I ( �O� J UNDERGROUND STORAGE TANK(UST) 3 TANK FIELD DEMOLITION LEGEND Stantec (1,300 SF) CA ASPHALT SAWCUT 11130 NE 33RD PLACE SUITE zao �— \ \ BELLEVUE,WA 98004 m 3-12,000 GAL SINGLE PHONE:425-289-7343 FAX:425-869-1190 j CB D WALLED STEEL USTs FOR: I GENERAL NOTES A INSTALLED IN 1980 ELEVEN f/1 I 1. CONSTRUCTION ACTIVITIES WILL COMPLETED IN d I ACCORDANCE WITH CITY OF ARLININ COMPLETED PLANNING AND 3 DEVELOPMENT SERVICES REQUIREMENTS. 7-ELEVEN#21341 7-11 STORE SURFACE AREA TO BE 2. ALL HAZARDOUS MATERIALS TO BE TRANSPORTED 17127 SMOKEY PT BLVD $ I SIGN THREAT TO L PUBLIC G THE'.NEED FOR MAINTENANCE AND ARLINGTON,WA 98223 I SAWCUT REMOVED AND 3. CONTRACTOR SHALL INSTALL PROTECTIVE CHAIN LINK TITLE: q I I I E REPLACED WITH ASPHALT FENCING FAR A TO BE DEMOLISHED PER LOCAL ti SITE DEMOLITION PLAN i I I (2,520 SF) 4. CONTRACTOR SHALL ENSURE THAT ALL STORM DRAINS AND CATCH BASINS BE PROTECTED FROM UST SYSTEM REMOVAL SEDIMENTATION RUN-OF OR OFF.ANY ACCUMULATION PROTECTIONOF SED b FILTER FABRIC SHALL BE TREMOVED IMMEDIATELY WITHOUT WATER AND Ly DISPOSE OF ON-SITE OR REMOVED FOR DISPOSAL AT AN OFFSITE FACILITY. DRAWN BY: DESIGNED BY: Q 5. DO NOT ALLOW VEHICLES TO TRACK SEDIMENTATION BLG w OFFSITE. CHECKED BY: APPROVED BY: 0 6. DEMOLITION TO BE PERFORMED BY HANDWRECKING AND pF a DOZER. 7. CONTRACTOR TO PERFORM ALL WORK IN ACCORDANCE PROJECT NUMBER: SCALE: Q TO FEDERAL,STATE,AND LOCAL CODES. 185750241 AS SHOWN M 8. AMOUNT OF REPLACED IMPERVIOUS SURFACE IS DATE: FILE PATH: N N APPROXIMATELY 2,520 SQUARE FEET. JULY 2014 V:\2123\...\Design_Drawing 0 30 60 SHEET: a 1 a w J LL SCOPE OF WORK PROPERTY INFORMATION G.C.=GENERAL CONTRACTOR SITE ADDRESS: 17127 SMOKEY PT BLVD,ARLINGTON, 0 OWNER OT =OTHERS WA 98223 999 :.:liA .i�:utt MIN.4"DEPTH HOT MIX ASPHALT 1� -----SD--- SD-- 1O G.a PERFORM BACION.THE AND BACKFILL ACE MAT SNOHOMISH COUNTY PARCEL NUMBER:31052800202200 MIN.4^DEPTH 4^s CRUSHED ——S D—————SD—— RESTORATION.THE BACKFILL MATERIAL SURFACING TOP COURSE(CSTC) SHALL BE CLASS-II AGGREGATE BASE TOWNSHIP,RANGE,SECTION:T31 R05S28 MATERIAL COMPACTED TO 90%COMPACTION. IMPORT GRAVEL BORROW TO DISPLACE LEGAL DESCRIPTION OF PROJECT SITE:SECTION 28 MIN.11.25"DEPTH 8"-2(APPROX) VOLUME OF REMOVED USTs.PLACE BACK TOWNSHIP 31 RANGE 05 QUARTER NW-N 165.04FT OF COMPACTED BACKFILL CLEAN OVERBURDEN AND COMPACT IMPORT W 180.05FT AS MEAS AT R/A TO&PLW N&W LNS OF CRUSHED SURFACING TOP COURSE(CSTC) NW 1/4 EXC N 50.01 FT THOF FOR RD ALSO EXC W 50.01FT e VIA DUMP TRUCK. FILL MATERIAL DEEPER THOF FOR RD&ALSO EXC FOR RD TH PTN LY NWLY OF THAN 12 INCHES FROM SURFACE GRADE WILL FDL BAAP ON S LN N 50.01 FT DIST 75FT ELY FIR BE COMPACTED TO 90%MAXIMUM DRY DENSITY. THE UPPER 12 CONTACT INFORMATION CROSS SECTION INCHES OF BACKFILL WILL BE COMPACTED TO PROJECT OWNER: UPPER 2 FEET UST EXCAVATION JOSE RIOS SERVICES NOT TO SCALE 20 G.a BACKFILL MATERIAL WILL BE PLACED IN 17' LIFTS AND COMPACTED TO(SITY. 90%,95%8F MELEVEN PO BOX 711 INC SERVICES 172 N D ST N E MAXIMUM DRY DEN A MINIMUM DALLAS,TX 75112 4INCHES OF(CSTC)WILL PLACE AND COMPACTED. RESURFACING JOSE.RIOS711.COMG WILL BE °� COMPLETED BY PLACING 4-INCHES OF HOT CONTACT PERSON: +yam MIX ASPHALT. PAUL FAIRBARIN •.>,•,;,;•1:• ,� \".;rK,,+;. MIN.4"DEPTH HOT MIX ASPHALT © G.c. PERFORM GRADING OF BACKFILL TO MATCH STANTEC CONSULTING SERVICES CURRENT SLOPE 11130 NE 33RD PLACE SUITE200 SITE.THE SUB-GRADE BELLEVUE,WA 98004 MIN.4-DEPTH 4"41"CRUSHED THE GROUND ON WHICH THE PARKING LOT IS SURFACING TOP COURSE(CSTC) LAID)MUST BE SMOOTH,FIRM,AND EVEN. Paul.Fairbarin Stantec.com MIN.11.25"DEPTH 8-AZ COMPACTED ———W——— CHECK GRADE BEFORE ASPHALT PAVING. 425-289-7343 work) BACKFIU- —W—— W 206-369-8383(cell) _ N —W— G.c. REPAVE EXCAVATION AREAS WITH A ENGINEER: 0 4-INCH-THICK SECTION OF ASPHALT TO MARC SAUZE,P.E. LL MATCH FEAT BOTTOM. BONDS AND SEALS WILNG LIBE MADE WITH 11130 11130STANTEC CONSULTING SERVICES BOTTOM OF UST EXCAVATION EXISTING AND NEWLY PAVED SURFACES.ALL 11130 NE 33RD PLACE SUITE Z00 o BELLEVUE,WA98004 EDGES ON THE EXISTING CONCRETE OR ASPHALT MUST BE CUT AND CLEAN BEFORE Marc.Sauze Stantec.com 425-869-944 ext 172(work) 4 VENT REPAVING OPERATIONS BEGIN. 425-894-2329(cell) LINE C- --SD--- -SD-----SD— ® G.c. STORMWATER WILL FLOW TO STORM DRAIN N CROSS SECTION UST EXCAVATION CB Lu U 70�- NOTTO SCALE O p CANOPY _ _ SIDEWALK q �� •2 z x LEGEND (785 SF) -- CB - - w 9 EXCAVATION BOUNDARY J �J\ I I CB ---- PROPERTY BOUNDARY VICINITY MAP \ I I' V ----� WATER LINE 53 K,dzle 8 K,& Q 174M g NE O \ y J \ I —ss----- SEWER LINE G] it I Nwo CB I TRASH MW_4--50— STORM LINE 172ND ST NE p DISPENSERS ' ENCLOSURE 0 MONITORINGWELL STORM CATCH BASIN(CB) Y "I Q I I UNDERGROUND STORAGE TANK(UST) —$W jp91.. ' NF Nw naa : c Ia > N N J I DEMOLITION LEGEND PREPARED BY: ii W 3 I CB C ] ASPHALT SAWCUT A z i CB111 rpl O� �� 11 2 3 Stantec 6 ti I 7-ELEVEN STORE GENERAL NOTES 11130 NE 33RD PLACE SUITE 200 •o I 0/^I..L II I I Io I I I I4 J BELLEVUE,WA98004#21341 1. CONSTRUCTION ACTIVITIES WILL BE COMPLETED IN ACCORDANCE WITH CITY OF ARLINGTON PLANNING AND PHONE:425-289-7343 FAX:42 5-869-1190 N IOIO DEVELOPMENT SERVICES REQUIREMENTS.O w I ENT ANC I I I I I 2 SAFELY,,EL MINATING THE EEDFOR MAINTENANCE AND 5 ALL HZADOUSATERIALS TOE TRANSPORTED FOR: IN I Y I I I THREAT TO PUBLIC SAFETY. 3 3. CONTRACTOR SHALL INSTALL PROTECTIVE CHAIN LINK 7-ELEVEN#21341 j N O O I FENCING OF AREA TO BE DEMOLISHED PER LOCAL I I _ / REQUIREMENTS. 17127 SMOKEY FIT BLVD TANK FIELD 4. CONTRACTOR SHALL ENSURE THAT ALL STORM DRAINS ARLINGTON,WASHINGTON AND CATCH BASINS BE PROTECTED FROM SEDMENTATION RUN-OFF.ANY ACCUMULATION OF TITLE: a I 3 (1,300 SF) Cn SEDIMENT OF OR AROUND FILTER FABRIC PROTECTION SHALL BE REMOVED IMMEDIATELY WITHOUT WATER AND DISPOSE OF ON-SITE OR REMOVED FOR DISPOSAL AT AN GRADING AND RESTORATION PLAN N I 3-12,000 GAL SINGLE OFFSITE FACILITY. UST SYSTEM REMOVAL > D WALLED STEEL USTs 5 DO NOT ALLOW VEHICLES TO TRACK SEDIMENTATION CB I INSTALLED I N 1980 6. DDEEMMOLLITION TO BE PERFORMED BY HANDWRECKING AND DRAWN BY: DESIGNED BY: H I 3 U 7. CONTRACTOR TO PERFORM ALL WORK IN ACCORDANCE BLG TO FEDERAL,STATE,AND LOCAL CODES. w 7-11 STORE SURFACE AREA TO BE I I CHECKED BY: APPROVED BY: I 8. AMOUNT OF REPLACED IMPERVIOUS SURFACE IS � SIGN APPROXIMATELY 2,520 SQUARE FEET. PF I I SAWCUT REMOVED AND PROJECT NUMBER: SCALE: a A REPLACED WITH ASPHALT 185750214 AS SHOWN NI j I (2,520 SF) C11DATE: FILE PATH: Ky 3 JULY 2014 V:\2123\...\Design_Drawing SHEET: a 0 30 60 A w J U. MINIMUM 12" SCOPE OF WORK PROPERTY INFORMATION CATCH BASIN PROTECTION OVERLAP of SEAMS G o G.G.=GENERAL OWNER CONTRACTOR = SITE ADDRESS: 17127 SMOKEY PT BLVD,ARLINGTON, OT =OTHERS WA 98223 ADAPTER RETRIEVAL O GG PLACE DEVICES E.FILTER(CB) IN INSERLET TS PROTECTION SNOHOMISH COUNTY PARCEL NUMBER:31052BOO202200 STORM DRAINS ONSITE. TOWNSHIP,RANGE,SECTION:T31 R05 S28 20 G.G PERFORM DAILY SWEEPING OF SOIL FROM LEGAL DESCRIPTION OF PROJECT SITE:SECTION 28 IMPERVIOUS SURFACE TO KEEP LARGE TOWNSHIP 31 RANGE 05 QUARTER NW-N 165.04FT OF -----SD----- AMOUNTS OF SOIL GOING INTO STORMWATER W 180.05FT AS MEAS AT R/A TO&PLW N&W LNS OF VERFLOW DO DRAINS. NW1/4 EXC N 50.01 FT THOF FOR RD ALSO EXC W 50.01FT YPASS PEAK THOF FOR RD&ALSO EXC FOR RD TH PTN LY NWLY OF GEOTEXTILETORM VOUMES) -u O G.G CONSTRUCT A SILT DIKE IF NECESSARY TO FDL BAAP ON S LN N 50.01 FT DIST 75FT ELY FIR FABRIC CONTROL STORMWATER RUN-OFF. AFTER BACKFILLING,GRADING,AND REPAVING CONTACT INFORMATION ATCH - _ _ CHECK THE WATER RUN-OFF DRAINS OFF PROJECTOWNER: ASIN - - - _ _ _ _ _ _ ASPHALT PAVEMENT TOWARDS STORM DRAINS. JOSE RIOS 50 G.G EXCAVATE AND STOCKPILE UST OVERBURDEN MANAGER ENVIRONMENTAL SERVICES SEDIMENT ACCUMULATION SOIL ON 6-MIL VISQUEEN SHEETING.COVER 7-ELEVEN INC STOCKPILE WITH VISQUEEN AS PART OF BEST PO BOX 711 IN TIES. BARRIER REQUIRED )TOE OF SLOPE MANAGEMENT PRACTICES(BMPs. DALLA ,TX 75JOSE. 112 COM 1.FILTERS SHALL BE REMOVED AND CLEANED OR REFACED AFTER EACH STORM EVENT. PLASTIC SHEETING 2.CATCH BASIN INSERTS SUITABLE FOR TRAPPING PETROLEUM HYDROCARBONS AND CONTACT PERSON: SEDIMENT WHILE ALLOWING WATER TO FILTER THROUGH(SUCH AS NORTHWEST PAUL FAIRBARIN HAZMAT CATCH BASIN INSERTS)WILL BE PLACED IN AC PAECATCH BASINS STANTEC CONSULTING SERVICES ADJACENT TO AND ON THE SITE. 172ND ST NE LEGEND 1113E NE 33RD PLACE SUITE 200 BELLEVUE,WA 98004 NOTES: Paul.Fairbarin Stantec.com SCHEMATIC OF CATCH BASIN INSERT — EXCAVATION BOUNDARY 425-2 89-7343 work) 1. PLASTIC SHEETING IS USED TO PROVIDE IMMEDIATE PROTECTION TO SLOPES AND STOCKPILES. 206-369-8383(cell) NOT TO SCALE c? 2. DO NOT USE PLASTIC COVERING UPSLOPE OF AREAS SUCH AS STEEP AND/OR UNSTABLE SLOPES THAT —""— PROPERTY BOUNDARY ENGINEER: MIGHT BE ADVERSELY AFFECTED BY CONCENTRATED RUNOFF. w WATER LINE MARC SAUZE,P.E. LL STANTEC CONSULTING SERVICES 3. WHEN POSSIBLE, INSTALL AN INTERCEPTER DIKE AT THE TOP OF THE PLASTIC TO DIVERT FLOWS AWAY 11130 NE 33RD PLACE SUITE 200 I FROM THE PLASTIC. -ss----- SEWER LINE 0 -W————W—— BELLEVUE,WA98004 Marc.Sauze@Stantec.com 4. TOE-IN THE TOP OF THE SHEETING IN A 6%6"TRENCH BACKFILLED WITH COMPACTED NATIVE MATERIAL. -----s8- STORM LINE 425-869-944 eXt 172(Work) 425-894-2329(cell) 5. INSTALL A GRAVEL BERM, RIPRAP, OR OTHER SUITABLE PROTECTION AT THE TOP OF THE SLOPE IN ORDER F STORM CATCH BASIN(CB) TO DISSIPATE RUNOFF VELOCITY. m I B. ANCHOR THE PLASTIC USING SANDBAGS OR OTHER SUITABLE TETHERED ANCHOR SYSTEM SPACED ON A C ] UNDERGROUND STORAGE TANK(UST) VENT 10' GRID SPACING IN ALL DIRECTIONS. STOCKPILE N 7. OVERLAP SEAMS 1-2',TAPE, ROLL AND STAKE THE SEAMS AND THEN WEIGH DOWN THE ENTIRE LENGTH. o I LINE C- 8. BARRIER IS REQUIRED 0 TOE OF STOCK PILE. CB LV 9. REPLACE TORN SHEETS AND REPAIR OPEN SEAMS. COMPLETELY REMOVE AND REPLACE PLASTIC WHEN IT BEGINS TO DETERIORATE. SURFACE WATER FLOW DIRECTION DURING AND AFTER RESTORATION c r, 11 P Z a CANOPY _ _ SIDEWALK � ' -Z DEMOLITION LEGEND _ - VICINITY MAP ® - � Ill C ] ASPHALT SAWCUT a (785 SF) LLI S�g Kidzle BKids Q 1]aH%NF 2 GO HL z SUPerte"�.I 5 CB � 172ND ST NE p w'V'e"�n ad lFiiii 0- GENERAL NOTES w _ 1]1it PI NE Y 1. CONSTRUCTION ACTIVITIES WILL BE COMPLETED IN N I TRASH ACCORDANCE WITH CITY OF ARLINGTON PLANNING AND w�snaP 169th St NEB 'w DEVELOPMENT SERVICES REQUIREMENTS. mPI NE DISPENSERS Ta 1 Nw cnaa,e�: , Resd, 1-dK_ N ENCLOSURE 2. ALL HAZARDOUS MATERIALS TO BE TRANSPORTED SAFELY,ELIMINATING THE NEED FOR MAINTENANCE AND PREPARED BY: N 2 3 THREAT TO PUBLIC SAFETY. c 3. CONTRACTOR SHALL INSTALL PROTECTIVE CHAIN LINK 3 FENCING OF AREA TO BE DEMOLISHED PER LOCAL REQUIREMENTS. Stantec � cog 4. CONTRACTOR SHALL ENSURE THAT ALL STORM DRAINS a I , AND CATCH BASINS - PROTECTED FROM 1113E NE 33RD PLACE SUITE 200 f° 3 CB SEDIMENTATION RUN-OFF.ANY ACCUMULATION OF H I SEDIMENT OF OR AROUND FILTER FABRIC PROTECTION BELLEVUE,WA 98004 75 ///// SHALL BE REMOVED IMMEDIATELY WITHOUT WATER AND v CB I DISPOSE OF ON-SITE OR REMOVED FOR DISPOSAL AT AN PHONE:425-289-7343 FAX:425-869-1190 0 I I 10 I I �� 10 OFFSITE FACILITY. 7-ELEVEN STORE 5. DO NOT ALLOW VEHICLES TO TRACK SEDIMENTATION FOR: cOFFSITE. TET.TEVTTa l #21341 6. DEMOLITION TO BE PERFORMED BY HANDWRECKING AND I°Q I o O I DOZER. 7-ELEVEN#21341 Wil 7. CONTRACTOR TO PERFORM ALL WORK IN ACCORDANCE 17127 SMOKEY PT BLVD W w ENTRANC I TO FEDERAL,STATE,AND LOCAL CODES. Y I I I I I ARLINGTON,WASHINGTON S'' 8. AMOUNT OF REPLACED IMPERVIOUS SURFACE IS 5 O I r^ , O APPROXIMATELY 2,520 SQUARE FEET. TITLE: CC I STORM WATER MANAGEMENT PLAN N G I TANK FIELD UST SYSTEM REMOVAL W i (1,300 SF) L W Ill 3-12,000 GAL SINGLE DRAWN BY: DESIGNED BY: co I y W LAST BLG ALLED STEEL S ` w I CHECKED BY: APPROVED BY: I INSTALLED IN 1980 30 PF o_ 3 I PROJECT NUMBER: SCALE: a I 7-11 STORE , SURFACE AREA TO BE 185750214 AS SHOWN N SIGN i DATE: FILE PATH: SAWCUT REMOVED AND JULY2014 V:\2123\...\Design_Drawing REPLACED WITH ASPHALT SHEET: a W I (2,520 SF) \ 3 LL wawl� UNDERGROUND STORAGE TANK (UST) Site ID#FOR OFFICE USE ONLY 30-DAY NOTICE FSID# DEPARTMENT OF (See back of form for instructions) ECOLOGY State of Washington Please ✓the appropriate box: ❑ Intent ® Intent to Install to Close HQ (360)407-7170 / Central (509)575-2490 / Eastern (509)329-3400 /Northwest (425)649-7000 / Southwest (360)407-6300 SITE INFORMATIONIIIIIIIIIIIIIIIIIIIIIIIIII OWNER INFORMATION (this form will be returned to this address) A0782 or 5780704900010191 7-Eleven, Inc. Tag or UBI number UST Owner/Operator 7-Eleven 21341 P.O.BOX 711 Site Name Mailing Address/PO Box 17127 Smokey Point Boulevard Dallas 75221 Site Physical Address City Zip Code Arlington 98223 (214)415-0146 City Zip Code Owner/Operator Phone Number (360) 659-3353 marc.westfall@7-11.com Site Phone Number Owner/Operator Email Address TANK INFORMATION Substance Date Project is Tank ID Stored Capacity Expected to Begin Comments: REG B Unleaded 12,000 10/29/2014 Remove existing(3) 12,000-gallon single-wall steel Gasoline USTs,gasoline dispensers,and piping from the site. REG B Unleaded 12,000 10/29/2014 7-Eleven will no longer operate gasoline at this Gasoline location. SNL B Unleaded 12,000 10/29/2014 Gasoline 1)SERVICE PROVIDER INFORMATION-check the appropriate boxes PLEASE NOTE:INDIVIDUALS PERFORMING UST SERVICES MUST BE ICC CERTIFIED OR HAVE PASSED ANOTHER QUALIFYING EXAM APPROVED BY THE DEPARTMENT OF ECOLOGY. ❑ Installer ❑Decommissioner ® Site Assessor Stantec Consulting Services Inc. Paul Fairbairn Service Provider Company Name Contact Person Deitrie M.Hanson (206)369-8383 Certified Service Provider Name Contact Phone Number 8012337 paul.fairbairn@stantec.com ICC Certification# Contact Email Address 2)SERVICE PROVIDER INFORMATION (REQUIRED IF USING MORE THAN ONE PROVIDER) -check the appropriate boxes ❑ Installer ®Decommissioner ❑ Site Assessor To Be Determined(TBD) Service Provider Company Name Contact Person Certified Service Provider Name Contact Phone Number ICC Certification# Contact Email Address ECY 020-95 (Rev. Feb. 2012) AFTER COMPLETING THIS FORM, RETURN TO: Instructions DEPARTMENT OF ECOLOGY TOXICS CLEANUP PROGRAM Please Read Carefully P.O. BOX 47655 OLYMPIA,WA 98504-7655 GENERAL Under WAC 173-360-200 and 173-360-385,owners and operators are required to notify Ecology 30 days prior to beginning underground storage tank(UST)installation or decommissioning projects.Please use a separate form for each activity. Once this form is received and processed by Ecology,it is date stamped and returned to the owner listed on the form. Installation and decommissioning projects may begin 30 days after the date stamped on the form. If a project cannot meet the deadlines described below,you must submit an additional 30-Day Notice. The 30-day wait period may be waived on these additional 30-Day Notices by contacting the inspector in your region. SITE AND OWNER INFORMATION Fill in the site and owner information and be sure to provide telephone numbers and email addresses so that any problems can be resolved quickly. Include the facility compliance tag or UBI number for tank closures. TANK INFORMATION List tanks to be installed or closed, substance stored(e.g. gas,diesel,etc),tank size and date the project is expected to begin. The contact person listed on this form must confirm the exact date an installation and/or decommissioning project will begin at least three business days before proceeding.Please report tank ID number(s)for tanks to be closed and assign new Tank ID number(s)to tanks being installed. If you are installing new tanks, do not assign a Tank ID number that has previously been used at the facility.Use the Comments box to include additional information, such as when product was removed so that no more than one inch of residue remains in the system. TANK INSTALLATIONS List the installation company. The date stamped on the form indicates the beginning of a 90-day period in which an installation project must begin. Once,processed,this form also allows you to receive a one-time drop of product,for UST system testing purposes only.The fuel drop is not required to occur within this 90-day period. To dispense product and receive additional deliveries,you must complete the Business License registration and obtain your facility compliance tag from Ecology. The registration information must be submitted to the Department of Revenue within 30 days of installation to receive a Business License with the appropriate tank endorsement(s). If,at any time,your tank(s)store greater than one inch of product,you must begin using an acceptable release detection method to monitor for leaks every month. PERMANENT TANK CLOSURES List the closure and site assessor companies.Upon receiving a completed 30-day closure form,Ecology will stamp the date received on the form and return a copy to the owner. Decommissioning projects must be completed 90 days after the stamped date. No work may begin within the first 30 days unless a waiver has been obtained from Ecology. Contact your local fire marshal and planning department prior to tank closure to find out if any additional permits are required by county or other local jurisdictions. Compliance with the State Environmental Policy Act(SEPA)Rules,Chapter 197-11 WAC,may be required. A site assessment is required at the time of closure. Contamination found or suspected at the site must be reported to the appropriate Ecology regional office within 24 hours.If the contamination is confirmed,a site characterization report must be submitted to the regional office within 90 days; if contamination is not confirmed,a site assessment report must be submitted to the above address within 30 days. The following are examples of tanks that are exempt from notification requirements. ❖ Farm or residential tanks, 1,100 gallons or less,used to store motor fuel for personal or farm use only. The fuel must be used for farm purposes and cannot be for resale. ❖ Tanks used for storing heating oil that is used solely for the purpose of heating the premises. ❖ Tanks with a capacity of 110 gallons or less. ❖ Equipment or machinery tanks such as hydraulic lifts or electrical equipment tanks. ❖ Emergency overflow tanks, catch basins,or sumps. If you need this document in a format for the visually impaired,call Toxics Cleanup Program at(360)407-7170.Persons with hearing loss can call 711 for Washington Relay Service.Persons with speech disability,call(877)833-6341. ECY 020-95 (Rev. Feb. 2012) • OPERATING PERMIT APPLICATION Department of Community & Economic Development City of Arlington • 18204 59th Ave NE •Arlington, WA 98223 Phone (360) 403-3551 Part I Applicant/Building Information Applicant's Name: 7-Eleven, Inc. Applicant's Address P.O. Box 711, Dallas, TX 75221 Contact Person Amanda Grindle, Permit Coordinator Phone Number: (253) 882-4546 Email: agrindle@muircontracting.com Address of Premises for which Operating Permit is requested: ❑ Same as above ® Other 17127 Smokey Pt. Blvd., Arlington, WA 98223 Tax ParcelID# 31052800202200 Current Occupancy Class: Mercantile Part II Type of Operating Permit An Operating Permit is required to conduct any activity or to use any class of building listed below. Please indicate the type(s) of Operating Permit(s) requested by checking each applicable box. (If you require assistance, or would like more information, contact the City of Arlington Building Department at 360-403-3551.) ❑ Manufacturing, storing or handling hazardous materials in quantities exceeding those listed in the Fire Code (See Appendix A.) Identify the materials and quantities and describe the manner in which the materials will be manufactured, stored or handled (attach additional sheets if necessary): Appendix A ❑ Conducting a hazardous process or activity, including, but not limited to, any commercial or industrial operation which produces combustible dust as a byproduct, fruit and crop ripening, waste handling, spray operations, and high-piled storage (see Appendix B.) Describe the process(es) or activity(ies) to be conducted (attach additional sheets if necessary): Appendix B ❑ Use of pyrotechnic devices in assembly occupancies (see Appendix C.) Describe the devices to be used and type of event (attach additional sheets if necessary): Appendix C ❑ Aboveground Storage Tank (AST) (see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary tank closure ❑ Changes in service ❑ Permanent tank closure Brief description: Appendix D ❑ Underground Storage Tank (UST) (see Appendix D) ® Removal ❑X Decommissioning ❑ Temporary tank closure ❑ Changes in service 0 Permanent tank closure Brief description: Remove three 12,000-gal single-wall steel underground storage tanks and associated fueling system, including product, vapor, and vent piping, dispensers, monitoring equipment, etc. Appendix D ❑ Temporary Membrane Structures, including tents and canopies (see Appendix E.) Brief description of structure and use: Brief Description: Appendix E ❑ Special Event Operating Permit -An Operating Permit is required for any special event that takes place within an occupied building, or an outdoor mass gathering, which is outside the scope of the permitted use (see Appendix F.) Brief description of type of gathering proposed: Appendix F Part III Premises/Building Information 1. Date of last Inspection on Premises 2. Has a Certificate of Occupancy been issued for the premises? ❑ Yes ❑ N o Type: Temporary Date of Issuance: ❑ Permanent ❑ Temporary 3. Are there currently any open Building Permits associated with the premises? ❑ Yes 0 No If yes, please describe (attach additional sheets if necessary): 4. Additional Comments: Attached to this permit application are the following items: - Site Plans, including Demolition Plan, Restoration Plan, and Stormwater Management Plan - Copy of DOE 30 Day Notice A copy of the DOE Site Assessment Checklist will be submitted to the City following UST removal and receipt of soil sample analysis results. Please Attach Drawings or supporting documents. (PDF only) SIGNATURE OF APPLICANT I herby certify that the foregoing information (and all information in attached sheets, if any) is true and complete 0 Signature of Applicant or Authorized Representatives Signature (Type you name in here) Amanda Grindle Title Date 07/25/14 Permit Coordinator for 7-Eleven Part IV To be completed by the City of Arlington Building Department Inspection Required: ❑ Yes ❑X No Inspections Performed: ❑ Yes ❑ No Inspection Date Tests or Reports required verifying compliance? ❑❑ Yes ❑ No If YES, have Tests or Reports been received? ❑ Yes ❑ N o Application(s) Approved: Date Operating 07/30/14 ❑X Yes ❑ No Permit Issued: Operating Permit Issued by: Date Operating Christopher Young Permit Expires: Type/Description of UST Removal. DOE lead agency Operating Permit: Conditions of Operating Permit (list conditions here AND in the space provided in the Operating Permit): Copies of Site Assessment and Close Out Package upon completion of tank decommissioning Additional Comments: (Attach additional pages if needed) Permit#: 434 Permit Date: 07/28/14 Permit Type: FUEL TANK Project Name: 7-Eleven tank removal Applicant Name: 7-Eleven, Inc. Applicant Address: P.O. Box 711 Applicant, City, State, Zip: Dallas,WA 75221 Contact: Amanda Grindle Phone: 253-882-4546 Email: agrindle@muircontracting.com Scope of Work: Tank Removal Valuation: 0.00 Square Feet: 0 Number of Stories: 0 Construction Type: Occupancy Group: ID Code: Permit Issued: 07/30/2014 Permit Expires: Permit Form Type: Civic Plus Number: Status: COMPLETE Assigned To: Launa Black Property Parcel# Address Legal Description Owner Name Owner Phone Zoning 31052800202200 17127 SMOKEY POINT SOUTHLAND 541 Groceries(With BLVD CORP THE or Without Meat) Plan Reviews Date Review Type Description Assigned To Review Status 07/28/2014 Misc O.P.is approved z.Christopher Young Uploaded Files Date File Name 07/30/2014 Approved Operating Permit.pdf 07/28/2014 17127 Operating Permit Anplication resnonse.pdf 07/28/2014 17127-30 DAY Notice for 21341 Arlington.pdf 07/28/2014 17127 PLANS 7-Eleven Store No.21341 Fuel System Removal.pdf