NC0021849_SSO Report_20191115

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Collection System Sanitary Sewer Overflow Reporting Form
Division of Water Resources Fonn 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
sanitarysewer overflow (SSO).
Permit Number: WQCS00209/NC0021894 (WQCS# if active, otherwise use WQCSD#)
Facility: Town of Hertford WWTP Incident#: 201901768 Owner: Town of Hertford
Region: Washington City: Hertford County: Perquimans
Source of SSO (check applicable): C9 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.): WWTP Influent
Manhole#:
Latitude(degrees/minute/second): Longitude(degrees/mttute/second):
Incident Started Dt: 1 ]1912019 Time: UNK IncidentEnd Dt: I U10/2019 Time: 09:00AM
(mm-dd-yyyy) (hh:mm)AM/PM (mm-dd-yyyy) (hh:mm)AM/PM
Estim ated vol ume of the SSO: 70000gallons Estimated Duration (round to nearesthour): 16 hour(s)
Describe howthe volume was determined: Influent flow
Weather conditions during the SSO event: Clear and cold
Did the SSO reach surface waters? ❑ Yes ❑ No ER Unknown
Volume reaching surface waters: UNK gallons Surface water name: Unnamed tributary and swamp toPerquimans
River
Did the SSO result in a fish kill? ❑ Yes ® No ❑ Unknown
If Yes, what is the estimated numberof 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 II)
24-hour verbal notification (name of person contacted): Randy Sipe
®DWR ❑ Emergency Management Date (mm-dd-yyy):11113/19 Time: (hh:mm AM/PM): 09:00 AM
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 wastewaterto the surface waters of the Slate, 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 pointof discharge thatis significantly affected by the discharge. The
Regional Office shall determine which counties are signif icantly 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 I

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Collection System Sanitary Sewer Ov ertlow Reporting Fonn
Division of Water Resources Form CS-SSO
Form CS-SSO Page 2

In order to submita claim forjustification of an SSO, you mustuse Par[ II of form CS-SSOwith additional documentation as
necessary. DWR staff will review the justification claim and determine if enforcementaction is appropriate.
PART Ili:
ANSWER THE FOLLOWING QUESTIONS FOR EACH RELATED CAUSE CHECKED IN PART 1 OF THIS FORM AND
INCLUDE THE APPROPRIATE DOCUMENTATION AS REQUIRED OR DESIRED
COMPLETE ONLY THOSE SECTONS PERTAINING TO THE CAUSE OF THE SSO AS CHECKED IN PART I
(In the check boxes below, NA = Not Applicable and NE = Not Evaluated)
A HARDCOPY OF THIS FORM SHOULD BE SUBMITTED TO THE APPROPRIATE DWR REGIONAL OFFICE UNLESS
IS HAS BEEN SUBMITTED ELECTRONICALLY THROUGH THE ONLINE REPORTING SYSTEM
Form CS-SSO Page 3

Severe Natural Conditions (hurricane tornado etc.)
Describe the "severe natural condition" in detail:
How much advance warning did you have and what actions were taken in preparation for the event?
Comments:
Form CS-SSO Page 4

Grease (Documentation such as cleaning. inspection. enforcement actions, past overflow reports. educational
material and distribution date. etc. should be available upon reguest.)
When was the last time this specific line (or wet well) was cleaned?
Do you have an enforceable grease ordinance thatrequires new orretrofitof
grease trapsPnterceptors? ❑ Yes ❑ No ❑ NA ❑ NE
Havethere been recent inspection and/or enforcementactions taken on near-
by restaurants or othernonresidentlal grease contributors? ❑ Yes ❑ No ❑ NA ❑ NE
Explain:
Have there been other SSOs or blockages in this areas that were also caused
by grease ❑ Yes ❑ No El NA ❑ NE
When?
If yes, describe them:
Have cleaning and inspections ever been done at this location? ❑ Yes ❑ No ❑NA ❑ NE
Explain.
Have educational material aboutgrease been distributed in the past? ❑ Yes ❑ No ❑ NA ❑ NE
When:
and to whom:
Explain:
If the SSO occurred at a pump station, when was the wet well and pumps last checked
forgrease accumulation:
Were the floats dean? ❑ Yes ❑ No ❑NA ❑ NE
Comments:
Form CS-SSO Page 5

Roots
Do you have an active root control program on the line / area in question? ❑ Yes ❑ No ❑ NA ❑ NE
Describe:
Have cleaning and inspections ever been increased at this location because
of roots? ❑ Yes ❑ No ❑ NA ❑ NE
Explain:
What corrective actions have been accomplished atthe SSO location (and
surrounding system if associated with the SSO)?
What corrective actions are planned atthe SSO location to reduce root intrusion?
Has the line been smoke tested or Adeoed within the past year? ❑ Yes ❑ No ❑NA ❑ NE
If Yes, when?
Comments:
Form CS-SSO Page 6

Inflow and Infiltration
Are you underan SOC (Special Order by Consent) or do you have a schedule
❑ Yes ER No ❑ NA
❑ NE
in any permit that addresses VI?
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 14 problems in the
❑ Yes ❑ No ❑ NA
❑ NE
collection system at the SSO location?
If Yes, when was the study completed and whatactions 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 a ctions:
Are there UI related projectsin your Capital Improvement Plan?
❑ Yes ❑ No ❑NA
❑ NE
If Yes, explain:
Have there been any grantor loan applications for 1/1 reduction projects?
❑ Yes ❑ No ❑ NA
❑ NE
If Yes, explain:
Do you suspect any major sources of inflow or cross connections
❑ Yes ❑ No El 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:
What other corrective actions are planned to preventfuture VI related SSOs at this location?
Comments:
Form CS-SSO Page 7

Pumo Station Equipment Failure (Documentation of testing records etc should be provided upon request)
What kind of notification/alarm systems are present?
Auto-dialeritelemetry(one-way communication) ❑ Yes
Audible ❑ Yes
Visual ❑ Yes
SCADA (two-way com munication) ® Yes
Emergency ContactSignage ❑ Yes
Other ❑ Yes
If Yes, explain:
Describethe equipment thatfailed: intluentbarscreen
What kind of situations trigger an alarm condition atthis station (i.e. pump failure, power failure, high water, etc.)?
Were notification/alarm systems operable? ❑ Yes ® No ❑NA ❑ NE
In no, explain: SCADA system down
If a pump failed. when was the last maintenance and/or inspection performed?
What specifically was checked/maintained?
If a valve failed, when was it last exercised?
Were all pum ps set to alternate?
❑ Yes ❑ No ❑NA ❑ NE
Did any pump show above normal run times prior to and during the SSO event? ❑ Yes ❑ No ❑ NA ❑ NE
Were adequate spare parts on hand to flxthe equipment
❑ Yes
❑ No
❑NA
❑ NE
Was a spare or portable pump immediately available?
❑ Yes
❑ No
❑NA
❑ NE
If afloat problem, when were the floats last tested? How?
If an auto-dialeror SCADA, when was the system last tested? How? UNK. SCADA Out of commision since early this
year
Comments:
FormCS-SSO Page 8

Power outage (Documentation of testing records tec should be provided of alternative power source upon
reguest. )
What is your alternate power or pumping source? Generator
Did it function properly? ® Yes ❑ No ❑ NA ❑ NE
Describe?
When was the alternate power or pumping source lasttested underload?
If caused by a weatherevent, how much advance warning did you have and what actionswere taken to prepare forthe
event?
Comments:
Form CS-SSO Page 9

Vandalism
Provide police reportnumber:
Was the site secured?
If Yes, how?
Have there been previous problems with vandalism atthe SSO location?
If Yes, explain:
What security measures have been put in place to preventsimilar
occurrences in the future?
Comments:
❑ Yes ❑ No
❑ Yes ❑No
❑ NA
❑ NA
❑ NE
❑ NE
Form CS-SSO Page 10

Debris in line (Rocks. sticks. rags and other items not allowed in the collection system, etc.)
What type of debris has been found in the line?
Suspected cause or source of debris:
Are manholes in the area secure and intact? ❑ Yes ❑ No [I NA ❑ NE
When was the area last checked/cleaned?
Have cleaning and inspections ever been increased at this location ❑ Yes ❑ No ❑NA ❑ NE
dueto previous problems with debris?
Explain:
Are appropriate educational materials being developed and distributed ❑ Yes ❑ No ❑NA ❑ NE
to prevent.futuresimilar occurrences?
Comments:
Form CS-SSO Page I I

Other (Pictures and police reportas applicable must be available upon reauesta
Describe:
Were adequate equipmentand resources available to fixthe problem?
If Yes, explain: Equipment and manpower available to fix once discovered
If the problem could not be immediately repaired, whatactions
were taken to lessen the impact of the SSO?
Comments:
® Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA
❑ NE
❑ NE
Form CS-SSO Page 12

Pine Failure (Break)
Pipe size (inches)
What is the pipe material
What is the approximate age of the line/pipe (years old)
Is this a gravity line?
Is this a force main line?
Is the line a "High Priority" line?
Last inspection date and findings
If a force main then,
Was the break on the force main vertical?
Was the break on the force main horizontal?
Was the leak at the joint due to gasket failure ?
Was the leak at the joint due to split bell?
❑ Yes ❑ No ❑NA ❑ NE
❑ Yes ❑ No ❑NA ❑ NE
❑ Yes ❑ No ❑NA ❑ NE
❑ Yes ❑ No
❑NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑NA
❑ NE
❑ Yes ❑ No
❑NA
❑ NE
When was the last inspection or test of the nearestair-release valve to determine if operable?
When was the last maintenance of the air release performed?
If gravity sewer then,
Does the line receive flowfrom a force main immediately upstream ❑ Yes ❑ No ❑NA ❑ NE
of the failed section of pipe?
If yes, what measures are taken to control the hydrogen sulfide production?
When was the line last inspected or videoed?
If line collapsed, what is the condition of the line up and down stream of the failure?
What type of repairwas made?
If temporary, when is the permanentrepairplanned?
Have there been other failures of thisline in the past five years? ❑ Yes ❑ No ❑NA ❑ NE
If so, then describe
Form CS-SSO Page 13

System Visitation
ORC ❑ Yes
Backup ® Yes
Name: Harold Sanchez
Certification Number:
Date visited: 1 1/10/2019
Time visited: 0830
How was the SSO remediated (i./e. Stopped and cleaned up)?
Equipment removed and bypassed
Asa representative forthe responsible party. 1 certify that the information contained in this report is true and accurate to the
best of my knowledge.
Person subm itting claim: tsar^!l Date: 1 1 ! 1-5 f 0
Signature: 'itJ o�, e Ct Title:
Telephone Number:
Any additional information desired to be submitted should be sent to the appropriate Division Regional Off i ce within five
business days of first knowledge of the SSO with reference to the incident number (the incident number is only generated
when electronicentry of this form is completed, if used).
Form CS-SSO Page 14