Underground Storage Tank Installation Permit

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Is your project located in
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Is your project located in
Contractor Requesting Permit 
Office Phone
Address
Fax Number
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Contact Person
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Cell Phone
Email
License Number
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Location of Tank(s) to be Installed
Name of Business/Facility
Owner Name
Phone
Address
Fax Number
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Contact Person
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Cell Phone
Email
UST Permit Information
Tank #1 Tank #2 Tank #3 Tank #4
Tank Capacity
Substance Stored
Is Tank Regulated?
Tank Constructed of?
Piping Constructed of?
The next 9 questions are about UST installation information
Have plans been submitted & approved? Click the box for Yes. Leave the box blank for No or unknown.
Have plans been submitted & approved? Click the box for Yes. Leave the box blank for No or unknown.
Distance to wall, basement or pit not less than 1 foot? Click the box for Yes. Leave the box blank for No or unknown.
Distance to wall, basement or pit not less than 1 foot? Click the box for Yes. Leave the box blank for No or unknown.
Distance to nearest property line not less than 3 feet? Click the box for Yes. Leave the box blank for No or unknown.
Distance to nearest property line not less than 3 feet? Click the box for Yes. Leave the box blank for No or unknown.
Tanks surrounded with 6” of non-corrosive inert material? Click the box for Yes. Leave the box blank for No or unknown.
Tanks surrounded with 6” of non-corrosive inert material? Click the box for Yes. Leave the box blank for No or unknown.
Vehicle Traffic - 3’ of earth cover or 18” of tamped earth and 6” of concrete or 8” of asphaltic concrete? Click the box for Yes. Leave the box blank for No or unknown.
Vehicle Traffic - 3’ of earth cover or 18” of tamped earth and 6” of concrete or 8” of asphaltic concrete? Click the box for Yes. Leave the box blank for No or unknown.
Non-Vehicle Traffic - 2’ of earth or 1’ earth and 4” of reinforced concrete? Click the box for Yes. Leave the box blank for No or unknown.
Non-Vehicle Traffic - 2’ of earth or 1’ earth and 4” of reinforced concrete? Click the box for Yes. Leave the box blank for No or unknown.
Tanks are at least 1’ apart or 2’ if fiberglass? Click the box for Yes. Leave the box blank for No or unknown.
Tanks are at least 1’ apart or 2’ if fiberglass? Click the box for Yes. Leave the box blank for No or unknown.
Are tanks secured to prevent movement? Click the box for Yes. Leave the box blank for No or unknown.
Are tanks secured to prevent movement? Click the box for Yes. Leave the box blank for No or unknown.
Tank hydrostatically tested not < 3 psi or > 5 psi for 1 hour? .Click the box for Yes. Leave the box blank for No or unknown.
Tank hydrostatically tested not < 3 psi or > 5 psi for 1 hour? .Click the box for Yes. Leave the box blank for No or unknown.
The next 5 questions are about venting requirements.
Class I - Not less than 12’ above adjacent ground level. Click the box for Yes. Leave the box blank for No or unknown.
Class I - Not less than 12’ above adjacent ground level. Click the box for Yes. Leave the box blank for No or unknown.
Class II or IIIA - Shall terminate outside of bldg and above the fill pipe opening. Click the box for Yes. Leave the box blank for No or unknown.
Class II or IIIA - Shall terminate outside of bldg and above the fill pipe opening. Click the box for Yes. Leave the box blank for No or unknown.
Vents protected against blockage from weather, dirt, etc.Click the box for Yes. Leave the box blank for No or unknown.
Vents protected against blockage from weather, dirt, etc.Click the box for Yes. Leave the box blank for No or unknown.
Not less than 5’ from building opening. Click the box for Yes. Leave the box blank for No or unknown.
Not less than 5’ from building opening. Click the box for Yes. Leave the box blank for No or unknown.
Vapors will not accumulate, enter a bldg, or travel to an unsafe location. Click the box for Yes. Leave the box blank for No or unknown.
Vapors will not accumulate, enter a bldg, or travel to an unsafe location. Click the box for Yes. Leave the box blank for No or unknown.
The next 4 questions will be about other openings 
All openings liquid tight? Click the box for Yes. Leave the box blank for No or unknown.
All openings liquid tight? Click the box for Yes. Leave the box blank for No or unknown.
Fill and discharge enter only from the top? Click the box for Yes. Leave the box blank for No or unknown.
Fill and discharge enter only from the top? Click the box for Yes. Leave the box blank for No or unknown.
Class I - Tank > 1000 gallons has a tight fill device for fill hose? Click the box for Yes. Leave the box blank for No or unknown.
Class I - Tank > 1000 gallons has a tight fill device for fill hose? Click the box for Yes. Leave the box blank for No or unknown.
Fill pipes entering top of tank terminate within 6” of the bottom of the tank? Click the box for Yes. Leave the box blank for No or unknown.
Fill pipes entering top of tank terminate within 6” of the bottom of the tank? Click the box for Yes. Leave the box blank for No or unknown.
The next 6 questions will be about piping
Tested to 150% of maximum anticipated pressure or 75 psi for 30 minutes. Click the box for Yes. Leave the box blank for No or unknown.
Tested to 150% of maximum anticipated pressure or 75 psi for 30 minutes. Click the box for Yes. Leave the box blank for No or unknown.
Correct separation between pipes within the same trench Click the box for Yes. Leave the box blank for No or unknown.
Correct separation between pipes within the same trench Click the box for Yes. Leave the box blank for No or unknown.
Vehicle Traffic trench depth: 6” of well-compacted back-fill. Click the box for Yes. Leave the box blank for No or unknown.
Vehicle Traffic trench depth: 6” of well-compacted back-fill. Click the box for Yes. Leave the box blank for No or unknown.
Vehicle traffic trench depth: covered with 18 “ of well- compacted back-fill material and pavement. Click the box for Yes. Leave the box blank for No or unknown.
Vehicle traffic trench depth: covered with 18 “ of well- compacted back-fill material and pavement. Click the box for Yes. Leave the box blank for No or unknown.
¼” per foot slope on all piping back to the tank. Click the box for Yes. Leave the box blank for No or unknown.
¼” per foot slope on all piping back to the tank. Click the box for Yes. Leave the box blank for No or unknown.
Is all piping installed according to recognized standards? Click the box for Yes. Leave the box blank for No or unknown.
Is all piping installed according to recognized standards? Click the box for Yes. Leave the box blank for No or unknown.
The next 3 questions are about overfill protection, the final question is about the product
Is the driver alerted when the tank is 90% full by restricting the flow of the liquid into the tank or triggering a high level alarm? Click the box for Yes. Leave the box blank for No or unknown.
Is the driver alerted when the tank is 90% full by restricting the flow of the liquid into the tank or triggering a high level alarm? Click the box for Yes. Leave the box blank for No or unknown.
Is the flow of liquid automatically shut-off at the 95% level? Click the box for Yes. Leave the box blank for No or unknown.
Is the flow of liquid automatically shut-off at the 95% level? Click the box for Yes. Leave the box blank for No or unknown.
Is there an over-spill prevention holding reservoir. Click the box for Yes. Leave the box blank for No or unknown.
Is there an over-spill prevention holding reservoir. Click the box for Yes. Leave the box blank for No or unknown.
Are the unloading risers color coded or marked to identify the type of product? Click the box for Yes. Leave the box blank for No or unknown.
Are the unloading risers color coded or marked to identify the type of product? Click the box for Yes. Leave the box blank for No or unknown.

Signature Required

The undersigned hereby makes application for a permit and the inspection of all work described above and hereby agrees to comply with all building regulations and other laws applicable to the use and type of work being performed.

Required Signature Block
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If applying to the City, you will be invoiced. If applying to the County, click payment method.
If applying to the City, you will be invoiced. If applying to the County, click payment method.
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