Underground Storage Tank Installation

Business

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Contractor

________________________________

Address

_________________________________

Address

________________________________

Telephone

_________________________________

Telephone

________________________________

City Business License ____________________________

Tank 1

Cap. ____________

Type _________

Serial Number ________________________________

Tank 2

Cap. ____________

Type _________

Serial Number ________________________________

Tank 3

Cap. ____________

Type _________

Serial Number ________________________________

Piping

Size _____________

Type _________

Check One -

Tank Supply

Dispenser Supply

Piping

Size _____________

Type _________

Check One -

Tank Supply

Dispenser Supply

Piping

Size _____________

Type _________

Check One -

Tank Supply

Dispenser Supply

1.
2.
3.

DESCRIPTION
Does the Contractor have manufacturers installation and test instructions present on
site, and have they been reviewed prior to installation and test?
Does the installation and location of UGSTs and dispensers comply with approved
stamped plans?
Tank Protection
A. Cathodic protection
Pre-Engineered
B. Listed corrosion protection materials

4.

Custom Engineered (Attach detailed specifications from Engineer)

Tank Location
A. Class I: minimum 1ft. from basements and 3ft. to property line
B: Class II or III: Minimum 1 ft from property line

5.

6.

Tank Burial Depth and Cover

A: Tanks not subject to traffic provided with 2 ft. of earth or 1 ft. of earth and 4 ft. of reinforced concrete
B: Tanks subject to traffic provided with 3ft. of earth or 18" of well-tamped earth and 6" of reinforced concrete or 18"
well tamped earth and 8" of asphaltic concrete. These shall extend 1ft. beyond outline of tank in all directions

Tank Installation
A. Is there a 12" bed of approved material provided for tanks?
B. Is the following material provided for appropriate tank? Crush stone between 1/8" & 1/4" (fiberglass tanks); Pea
Gravel between 1/8" & 3/4" (Fiberglass and Steel); Sand (Steel) ( Fiberglass only if approved by the manufacturer)
C. Distance between tanks or tanks to bank 24 ft. for fiberglass or 12" for Steel.

7.

Test Sump
A. A test sump is provided and properly installed using a 4" perforated pipe, which extends to the lowest point of the
tanks.
B. Test sump is properly identified.

8.

9.
10.

Tank Test
A. Did the primary tank pass the air test? (3-5 psi for horizontal or 2.5max psi on vertical for 30 minutes)
B. Did the secondary tank, if provided, pass the air test? (tested at the same pressure as primary tank. Air is to remain
in primary tank while the secondary tank is being tested.)
C. Was the outer skin of the tank, including all welded seams, valves, and connections soaped to determine if leaks
were present?
Liquid Level Gauge: Is the tank equipped with a device that will sound an alarm at 90% capacity or stop the
flow of product to the storage tank at 95% capacity?

Emergency Shut-off
A. Is there an emergency shut-off switch provided?
B. Is the emergency shut-off switch clearly identified and accessible?
C. Is the emergency shut-off switch no closer than 20 feet and within 100 feet of the dispenser?
D. Does Emergency Shut-off perform properly?

11.

Hoses
A. Are hoses and nozzles UL approved?
B. Are hoses less than 18 feet in length?
C. Are hoses, which dispense Class I liquids, provided with a shear valve?
D. Dispenser hoses are never within 5' of any building opening when fully extended?

YES

NO

NA

Underground Storage Tank Installation

12.

Signs - are the following signs provided as indicated and visible when pumping?
A. WARNING- It is unlawful and dangerous to dispense gasoline into unapproved containers
B. NO SMOKING
C. STOP MOTOR

13.

Piping
Piping subject to traffic
A. Is at least 6 inches of well-compacted backfill bedding provided?
B. Is piping covered with at least 18 inches of backfill and pavement?
Piping within same trench
C. Is piping spaced a minimum of 2 pipe diameters on each level?
D. If two or more levels of piping are provided, is piping separated by a minimum of 6 of well compacted fill?
E. Has Corrosion protection been provided?

14.

Line Test
A. Were all connections, valves and welded joints soaped during air test to determine leaks?
B. Hydrostatic test performed to 150% of Maximum anticipated pressure?
C. Pneumatic test performed to 110% of maximum anticipated pressure, but not less than 5psi gauge at the highest
point of system?
D. Line test performed for a minimum of 10 minutes?

15.

16.

Vent Lines- Class I Liquid

A. Are vent pipes a minimum of 12 high?
B. Are vent lines a minimum of 3 above roofline?
C. Is the inside diameter of the vent lines a minimum of 1.25?
D. Is the vent line protected from corrosion?
E. Are the vent lines protected to prevent damage from vehicles?
F. Are the vent lines equipped with approved caps?
Fill Openings
A. Are the fill openings tight fill types?
B. Are the fill openings protected from overflow?
C. Are the fill caps color code identified?
D. Are waterproof caps provided for fill openings?

17.

Dispensers
A. Are the dispensers protected against physical damage?
B. Are the dispensers UL listed?
C. Are the dispensers located a minimum of 10 feet from the property line or combustible construction?
D. Are impact valves level?
E. Are the impact valves anchored?
F. Have the clips been removed from the impact valve?
G. Has the impact valve been checked for proper operation?
H. Are dispensers visible to the attendant?
I. Is there a fire hydrant provided within 500 feet of the dispensers by vehicle access?

18.

Has approval from the City Electrical department been granted? (attachment)

Explain all No answers.

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Completion Date ___________

Contractors Signature ___________________________ Print ___________________________

Inspectors Signature ____________________________ Print __________________________
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