WQCS00171_Public Notice_20200117

Job No.: 025413 Total Time: 0101'10" Page: 005
Complete
Document: doc02541320191125135555
Stanly County Utilities
1000 North First Street suite 12
Albemarle, North Carolina_ 28001
Phone [phone]b86 Fax [phone] l
To: DWQ Spill Reporting From Detria. Tumer
Fax No. - [phone] Pages sent; 4
No. Date/Time Destination
001 11/25/19 13:5697046636040-3636
Times Type Result Resolution/ECM
0'01'10" FAX OK 200x100 Normal/On
1

o
Stanlyies
1000 North First Street Suite 12
Albemarle, North Carolina 28001
Phone [phone] Fax [phone]
To: DWQ Spill Reporting
Fax No.: [phone]
Phone No.: [phone]
Re: Spill - Bypass Report
From: Detria Turner
Pages sent: 4
Date: Monday, November 25, 2019
cc to: File
This fax is: 0 Urgent 0 For review
0 Requesting your comment 0 Requesting your reply 0 For Your reference
Comments: WQCS00171
AIRPORT #1 LIFT STATION
11-25-2019 Spill By-Pass/Upset Report

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 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: WQCS00171 (WQCS# if active, otherwise use WQCSD#)
Facility: AIRPORT #1 PUMP STATION Incident #: Owner: STANLY COUNTY UTILITIES
Region: MOORESVILLE City: ALBEMARLE County: STANLY
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.): AIRPORT RD #1 PUMP STATION
Manhole #: 2
Latitude (degrees/minute/second): 35.350143 Longitude (degrees/minute/second):-80.200058
Incident Started Dt: 11-19-2019 Time: 09:00 AM Incident End Dt: 11-19-2019 Time: 09:15 AM
(mm-dd-yyyy) (hh:mm) AM/PM (mm-dd-yyyy) (hh:mm) AM/PM
Estimated volume of the SSO: 2,500 gallons Estimated Duration (round to nearest hour): 0.25 hour(s)
Describe how the volume was determined: EST FLOW OUT OF WET WELLS & AMOUNT SEEN ON GROUND
Weather conditions during the SSO event: RAINING
Did the SSO reach surface waters? ® Yes ❑ No ❑ Unknown
Volume reaching surface waters: 1,200 gallons Surface water name: LITTLE MOUNTAIN 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
®Pump Station Equipment Failure ❑ Power Outage ❑Vandalism
❑Other (Please explain in Part II)
❑Inflow & Infiltration
❑ Debris in line ❑Pipe Failure (Break)
24-hour verbal notification (name of person contacted): ORI TUVIA - MOORESVILLE
®DWR ❑Emergency Management Date (mm-dd-yyy): 11-19-2019 Time: (hh:mm AM/PM): 9:15 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 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

In order to submit a claim for justification of an SSO, you must use Part II of form CS-SSO with additional documentation as
necessary. DWR staff will review the justification claim and determine if enforcement action is appropriate.
PART II:
ANSWER THE FOLLOWING QUESTIONS FOR EACH RELATED CAUSE CHECKED IN PART I 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 2

Pump Station Equipment Failure (Documentation of testing records etc should be provided upon request)
What kind of notification/alarm systems are present?
Auto-dialer/telemetry (one-way communication) ❑ Yes
Audible ® Yes
Visual ® Yes
SCADA (two-way communication) ® Yes
Emergency Contact Signage ® Yes
Other ❑ Yes
If Yes, explain:
Describe the equipment that failed: PUMP #1 & PUMP #2 FAILURE - HIGH WET WELL, LOW WET WELL, PUMP &
POWER FAILURE, HIGH TEMP
What kind of situations trigger an alarm condition at this station (i.e. pump failure, power failure, high water, etc.)?
Were notification/alarm systems operable? ® Yes ❑ No DNA ❑ NE
In no, explain:
If a pump failed, when was the last maintenance and/or inspection performed? JANUARY 2019
What specifically was checked/maintained? FLOATS, PUMPS AND CONTROLS
If a valve failed, when was it last exercised?
Were all pumps set to alternate?
® Yes ❑ No ❑NA ❑ NE
Did any pump show above normal run times prior to and during the SSO event? ❑ Yes ® No DNA ❑ NE
Were adequate spare parts on hand to fix the equipment
Was a spare or portable pump immediately available?
If a float problem, when were the floats last tested? How?
If an auto -dialer or SCADA, when was the system last tested? How?
Comments:
® Yes ❑ No DNA ❑ NE
® Yes ❑ No ❑NA ❑ NE
Form CS-SSO Page 7

System Visitation
ORC ® Yes
Backup ❑ Yes
Name: SCOTT LOWDER
Certification Number: 1003872
Date visited: 11-19-2019
Time visited: 9:05 AM
How was the SSO remediated (i./e. Stopped and cleaned up)?
PUMPS BACK ONLINE; WASHED AREA DOWN AND CLEANED UP SOLID DEBRIS. SPREAD LIME ON
GROUNDS.
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: Detria Turner Date: 1 I-25-2019
Signature: &A� JMme'y Title: �� la S /1 g Q r1) (o.Urd
V7
Telephone Number: 704-986-3686
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