The URL can be used to link to this page

Home My WebLink AboutWQCS00372_5 day Report_20200703State of North Carolina Department of Environment and Natural Resources Division of Water Resources Collection System Sanitary Sewer Overflow Reporting Form Form CS-SSO Form CS-SSO Page 1 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# if active, otherwise use WQCSD#) Facility: ______________________________ Incident #: _________________ Owner: ____________________ Region: _____________________________ City: ________________ County: ___________________ 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.): _________________________________________________________ Manhole #: ___________________________________ Latitude (degrees/minute/second): __________________ Longitude (degrees/minute/second): __________________ Incident Started Dt: _____________ Time: __________ Incident End Dt: _____________ Time: _________________ (mm-dd-yyyy) (hh:mm) AM/PM (mm-dd-yyyy) (hh:mm) AM/PM Estimated volume of the SSO: _________________ gallons Estimated Duration (round to nearest hour): ____hour(s) Describe how the volume was determined: ________________________________________________________________ Weather conditions during the SSO event: ________________________________________________________________ Did the SSO reach surface waters? Yes No Unknown Volume reaching surface waters: __________________gallons Surface water name: _______________________ 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 II) 24-hour verbal notification (name of person contacted): ______________________________________________________ DWR Emergency Management Date (mm-dd-yyy): __________ Time: (hh:mm AM/PM): ____________ Per G.S. 143-215.1C(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 Briar Chapel WWTP 202002054 Old North State Water Company Raleigh Chapel Hill Chatham X Liftstation A 6/22/2020 19:00PM 6/22/2020 19:50PM 5,000 .83 X Erin Deck 15:00PM6/23/2020 Pokeberry Creek4,000 manhole behind Liftstation A Time and volume clear X WQCS00372 - 1128 Great Ridge Parkway X X Form CS-SSO Page 2 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 12 Pipe 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? Yes No NA NE Is this a force main line? Yes No NA NE Is the line a "High Priority" line? Yes No NA NE Last inspection date and findings: ________________ If a force main then, Was the break on the force main vertical? Yes No NA NE Was the break on the force main horizontal? Yes No NA NE Was the leak at the joint due to gasket failure ? Yes No NA NE Was the leak at the joint due to split bell? Yes No NA NE When was the last inspection or test of the nearest air-release valve to determine if operable? __________________ When was the last maintenance of the air release performed? _________________________ If gravity sewer then, Does the line receive flow from 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 lineup and downstream of the failure? ________________________________ What type of repair was made? __________________________ If temporary, when is the permanent repair planned? __________________________ Have there been other failures of this line in the past five years? Yes No NA NE If so, then describe __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 8" Plastic New X X 6-22-2020 at installation X X There have been no previous failures in this area as this is a new installation by Carolina Civil Works and the "weld" was apparently weak and did not hold due to the force. NA X "weld failure" Form CS-SSO Page 13 System Visitation ORC Yes No Backup Yes No Name: __________________________ Certification Number: __________________________ Date visited: __________________________ Time visited: __________________________ How was the SSO remediated (i./e. Stopped and cleaned up)? __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 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: __________________________ Date: __________________________ Signature: ______________________________________________ Title: ___________________________________ Telephone Number: 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). X William Lamm 06/22/2020 11693 Repairs were made to the pipe 6/30/2020Rebecca Manning 984-365-9155 Pump and Haul was implemented due to the heavy flow using our Vac truck. 8:00AM by Carolina Civil Works- the contractor that originally installed the section of pipe.