WQ0029346_SSO Incident No. 202100033_20210104

DWR
Division of Water Resources
Incident Report
Report Number : 202100033
Incident Type : Bypass
Category Incident
Incident Started : 01/02/2021
Country : Watauga
City: Ferguson
Farm #:
Responsible Party :
Owner : Blue Ridge Mountain Club Property
Permit : WQ0029346
Facility : Blue Ridge Mountain Club WWTP
First Name : James
Middle Name : R
Last Name : Pitts
Address : PO Box 1727
City/State/Zip : Blowing Rock NC 28605
Phone :
On -Site Contact :
First/Mid/Last Name : Robert
Company Name :
Phone :
Pager/Mobile Phone :
P Barr
Reported By :
First/Mid/Last Name : Danny
Company Name :
Address :
City/State/Zip :
Phone :
Page/Mobile Phone :
D Holman
Material Category: Estimated Qty: UOM: Chemical Name Reportable Qty.lbs. Reportable Qty.kgs.
Latitude :
Longtitude :
DD:MM:SS Decimal
Position Method :
Position Accuracy :
Position Datum :
Location of Incident : Pump Station #27 on collection system. (SSO entry as Bypass per Ron Boone)
Address :
City/State/Zip : Ferguson
Report Created 1/4/21 10:17 am Page 1

Cause/Observation : Directions :
Action Taken :
Incident Questions :
Comments :
Mechanical electrical issue resulted in pump station #27 overflow.
Approx. 2000 gal. reported as overflowing. Lime reportedly placed
over spill area.
Did the Material reach the surface Water? Unknown Conveyance :
Surface Water Name ?
Did the Spill result in a Fish Kill? Unknown Estimated Number of fish?
(Above Ground or Under Ground)
If the Spill was from a storage tank indicate type •
Containment? Unknown
Cleanup Complete? Unknown
Water Supply Wells within 1500ft : Unknown Groundwater Impacted :Unknown
Pump Station
Eauipment Failure
Event Type Event Date Due Date Comment
Referred to Regional Office - Primary Contact
Report Entered 2021/01/04 10:15:24
Report Received 2021/01/02 7:30:00
SSO 24-hr Reported start 2021/01/02 5:30:00
Report Created 1/4/21 10:17 am Page 2

Standard Agencies Notified :
Agency Name Phone First Name M.I. Last Name Contact Date
Other Agencies Notified :
Agency Name Phone First Name M.I. Last Name Contact Date
DWQ Information :
Phone:
Report Taken By:
Patrick
Report Entered By: Regional Contact:
Mitchell Patrick Mitchell Patrick Mitchell
Date/Time: 2021 /01 /02 07:30:OOPM 2021 /01 /04 10:15:24AM
Referred Via:
Did DWQ request an additional written report?
If yes, What additional information is needed?
Report Created 1/4/21 10:17 am Page 3