WQCS00222_Report_20200210

State of North Carolina
DWR - Department of Environment and Natural Resources
Division of Water Resources
Collection System Sanitary Sewer Overflow Reporting Form
Division of Water Resources Form CS-SSO
PART I:
This form shall be submitted to the appropriate DWR Regional Office within five business days of the first knowledge of the
sanitary sewer overflow (SSO).
Permit Number: WQ0019933 (WOGS# if active, otherwise use WQCSD#)
Facility: Ambassador Pump Station Incident #: Owner: Town of Lattimore
Region: Mooresville City: Lattimore County: Cleveland
Source of SSO (check applicable): ❑ Sanitary Sewer ® Pump Station / Lift Station
SPECIFIC location of the SSO (be consistent in description from past reports or documentation - i.e. Pump
Station 6, Manhole at Westall & Bragg Street, etc.): Ambassador pump station 501 N. Mill Street in Lattimore NC
Manhole #:
Latitude (degrees/minute/second): Longitude (degrees/minute/second):
Incident Started Dt: 2-6-20 Time: 11:17 am Incident End Dt: 2-6-20 Time: 12:56 pm
(mm-dd-yyyy) (hh:mm) AM/PM (mm-dd-yyyy) (hh:mm) AM/PM
Estimated volume of the SSO: 1000 gallons Estimated Duration (round to nearest hour): 1.5 hour(s)
Describe how the volume was determined: Estimated 10 gal/min
Weather conditions during the SSO event: excessive rainfall
Did the SSO reach surface waters? ® Yes ❑ No ❑ Unknown
Volume reaching surface waters: 1000 gallons Surface water name: unnamed tributary Beaver Dam Creek
Did the SSO result in a fish kill? ❑ Yes ® No ❑ Unknown
If Yes, what is the estimated number of fish killed?
SPECIFIC cause(s) of the SSO:
❑Severe Natural Conditions ❑ Grease []Roots ®Inflow & Infiltration
❑Pump Station Equipment Failure ❑ Power Outage ❑Vandalism ❑ Debris in line ❑Pipe Failure (Break)
❑Other (Please explain in Part 11)
24-hour verbal notification (name of person contacted): Michael Meillinger
®DWR ❑Emergency Management Date (mm-dd-yyy): 2-6-20 Time: (hh:mm AM/PM): 4:00 pm
Per G.S. 143-215.1 C(b), the owner or operator of any wastewater collection system shall:
In the event of a discharge of 1,000 gallons or more of untreated wastewater to the surface waters of the State, issue
a press release to all print and electronic news media that provide general coverage in the county where the
discharge occurred setting out the details of the discharge. The press release shall be issued within 24 hours after
the owner or operator has determined that the discharge has reached surface waters of the State.
In the event of a discharge of 15,000 gallons or more of untreated wastewater to the surface waters of the State,
publish a notice of the discharge in a newspaper having general circulation in the county in which the discharge
occurs and in each county downstream from the point of discharge that is significantly affected by the discharge. The
Regional Office shall determine which counties are significantly affected by the discharge and shall approve the form
and content of the notice and the newspapers in which the notice is published.
WHETHER OF NOT PART II IS COMPLETED, A SIGNATURE IS REQUIRED SEE PAGE 13
Form CS-SSO Page 1

Severe Natural Conditions (hurricane, tornado. etc.)
Describe the "severe natural condition" in detail: On 2-6-20 Cleveland County received heavy rainfall 4.75" causing
flooding through out the County and in Lattimore.
How much advance warning did you have and what actions were taken in preparation for the event? The weather forcast
had been for several days forcasting for excessive rain for 2-6-20. All wastewater pump station were inspected
in Lattimore on 2-4-20 with no issues. The Town's preparation tasks for operational readiness was completed
on 2-5-20.
Comments:
Form CS-SSO Page 4

Inflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule
❑ Yes
® No [-]NA
❑ NE
in any permit that addresses III?
Explain if Yes:
What corrective actions have been taken to reduce or eliminate I & I related overflows this
spill location
within the last year?
Has there been any flow studies to determine 1/1 problems in the
❑ Yes
® No ❑NA
❑ NE
collection system at the SSO location?
If Yes, when was the study completed and what actions did it recommend?
Has the line been smoke tested or videoed within the past year?
❑ Yes
® No [:]NA
❑ NE
If Yes, when and what actions are necessary and the status of such actions:
Are there 1/1 related projects in your Capital Improvement Plan?
❑ Yes
® No [-]NA
❑ NE
If Yes, explain:
Have there been any grant or loan applications for III reduction projects?
❑ Yes
® No [-]NA
❑ NE
If Yes, explain:
Do you suspect any major sources of inflow or cross connections
❑ Yes
® No ❑NA
❑ NE
with storm sewers?
If Yes, explain
Have all lines contacting surface waters in the SSO location and upstream ® Yes ❑ No ❑NA ❑ NE
been inspected recently?
If Yes, explain: These lines are inspected regularly.
What other corrective actions are planned to prevent future 1/1 related SSOs at this location? Smoke testing and flow testing
will be scheduled in the spring 2020 to identify any other I & I issues.
Comments: The Lattimore sewer system is 20 years old and all gravity and force main are of PVC piping. There were 2
sewer manholes on a gravity line that were submerged flowing to Ambassador pump station that caused the overflow. The
2 manholes were raised to prevent future inflow.
Form CS-SSO Page 6

System Visitation
ORC ® Yes
Backup
Name:
Michael Todd Humphries
Certification Number:
1007472
Date visited:
2-6-20
Time visited:
10:00 am thru 2:00 pm
How was the SSO remediated (i./e. Stopped and cleaned up)?
❑ Yes
The gravity sewer line to Ambassador pump Station had 2 sewer manholes submerged during the excessive
rainfall. Sewer manhole risers were installed (1) 6" and (1) 4" to stop the inflow.
As_a representative for the responsible party. I certify that the information contained in this report is true and accurate to the
hest of my knowledge.
Person submitting claim: Mike Gibert
Signature:
Telephone Number: 704-434-2357
Date: 2-10-20
Title' �w�l: e• �.tJo"-� �.f'�[c�or
Any additional information desired to be submitted should be sent to the appropriate Division Regional Office within five
business days of first knowledge of the SSO with reference to the incident number (the incident number is only generated
when electronic entry of this form is completed, if used).
Form CS-SSO Page 13