WQCS00110_5 day Report_20201221

TX Result Report P 1
12/21/2020 14:05
Serial No. AWY011014899
TC: 170389
Addressee
�99195714718
Start Time Time
Prints
Result
Note
12-21 14:o 00:00:56
000/004
LNo An
8829
hmrs mur 'A. YUL:Y011ln UHu mriggOinal Sire Setting. FME:Frame Erase TX,
Note DPG:Page Separation TX, IX:Mixed ri anal TX, CALL:Manual TX. CSRC:CSRC,
FWD:Forward, PC:PC-FAX, BND:DoUble-Sided Binding Direction. SP:Special Original,
FCODE:F-code, RTX•Re-TX, RLY:Relay, MBX:Confidential, BUL:BUlletan, SIP:SIP Fax,
IPADR:IP Address Fax, I-FAX:Internet Fax
Result TTEL:CRXm+roMaTEL, NE: OOtheer Stop Communication,
Cont: Continuey, NoFAns: Power
Answer.
Refuse: Receipt RefUSed, BUSY:FBleyErrOYUlpMpeCOdeFErrorLOM[R7FIRMeNiRespon5e9ErrOrer.
ROUR:ReCeiving Rage aver. FI
DSN:DSN Response Error. PRINT:Compulsorgy Memory Document Print,
DEL:Compulsory Memory Document Delete, SEND:CompulSorg Memory Document Send.
TOWN OF CLAYTON
"SERVICE" OPERATIONS CENTER
'ENVIRONMENT"
ELECTRIC SERVICE •
PUBLIC WORKS
[phone]
[phone]
VEHICLE MAINTENANCE
WATER RECLAMATION
[phone]
[phone]
FAX TRANSMITTAL SHEET
DATE: December 21, 2020
TO: DWR - Raleigh Regional Office
FAX NO.: 919-571-4718
FROM: Travis Jessup & James Blalock Town of Clayton
TOTAL NUMBER OF PAGES (INCLUDING COVER): 4
Please see the attached documents in ref. to an Incident on 12/18/2020.
Should you have any problems receiving this Fax, please call the Operations Center at
[phone], or our fax number is [phone].
653 Highway 42 West -P.O. Box 879 • Clayton, Nonh Carolina 27520 - [phone] •Fan (9191 553-1541

State of North Carolina
Department of Environmental Quality
-DWR Division of Water Resources
IV IV
Collection System Sanitary Sewer Overflow Reporting Form
Division of Wafer 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: WQCS 00110 (WQCS# if active, otherwise use WQCSD#)
Facility: Town Of Clayton Incident #: 202003509 Owner: Town Of Clayton
Region: Raleigh City: Clayton County: Johnston
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.): 442 E Main ST
Manhole #: 1759
Latitude (degrees/minute/second): 35.64906 Longitude (degrees/minute/second):-78.45482
Incident Started Dt: 12-18-2020 Time: 6:12 AM Incident End Dt: 12-18-2020 Time: 7:20 AM
(mm-dd-yyyy) (hh:mm) AM/PM (mm-dd-yyyy) (hh:mm) AM/PM
Estimated volume of the SSO: 50 gallons Estimated Duration (round to nearest hour): 1 hour(s)
Describe how the volume was determined: Site visit and stained area
Weather conditions during the SSO event: clear
Did the SSO reach surface waters? ® Yes ❑ No ❑ Unknown
Volume reaching surface waters: 20 gallons Surface water name: Little 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 ll)
24-hour verbal notification (name of person contacted): Cheng Zhang
®DWR ❑Emergency Management Date (mm-dd-yyy): 12-08-2020Time: (hh:mm AM/PM): 1:26 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

Grease (Documentation such as cleaning inspection enforcement actions past overflow reports educational
material and distribution date etc. should be available upon request.)
When was the last time this specific line (or wet well) was cleaned? 4-20-20
Do you have an enforceable grease ordinance that requires new or retrofit of
grease traps/interceptors? ® Yes ❑ No ❑ NA ❑ NE
Have there been recent inspection and/or enforcement actions taken on near-
by restaurants or other nonresidential grease contributors? ® Yes ❑ No ❑NA ❑ NE
Explain: Visited the restaurant, Mannings, inspected their grease trap on 4-22-20 and it was cleaned on 4-23-20. Also
handed out grease education notices to 3 apartments upstream and all other businesses.
Have there been other SSOs or blockages in this areas that were also caused
by grease ® Yes ❑ No ❑NA ❑ NE
When? 4-20-20
If yes, describe them: WO#35405, heavy grease build up in an old line.
Have cleaning and inspections ever been done at this location? 0 Yes ❑ No ❑NA ❑ NE
Explain. yiS +hle. Line- Waz, i rr,.>j7tfr_1l-Cd on 12. 1+ 202o <::j,l �yi r1 Q Vy_XDnt"j V - mobl' L
Spats InSpc_cti on and ,no ISSU-G otascrvLcL . vvo,0- 3199
Have educational material about grease been distributed in the past? ® Yes ❑ No ❑NA ❑ NE
When: 4-20-20, two annual mailings one on May 19, 2020 and another on December 8, 2020
and to whom: all business upstream of incident on 4-20-20 and entire collections system on May 19, 2020 and
December 8, 2020.
Explain: Notices were sent out after last incident in April, and the annual FOG education mailings in May and
December.
If the SSO occurred at a pump station, when was the wet well and pumps last checked
for grease accumulation: n/a
Were the floats clean?
Comments:
❑ Yes ❑ No ®NA ❑ NE
Form CS-SSO Page 4

System Visitation
ORC ❑Yes
Backup
Name: Travis Jessup
Certification Number: 1005848
Date visited: 12/18/2020
Time visited: 1:00 PM
How was the SSO remediated (i./e. Stopped and cleaned up)?
ARM
Site was washed down, Vactor was used to reclaim standing water and lime applied to affected area
As a representative for the responsible party, I certify that the information contained in this report is true and accurate to the
best of my knowledge.
Person submitting claim: Travis Jessup
Signatur
�— Title:
Telephone Number: 919-427-1290
Date: 12/18/2020
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