WQCS00253_Regional Office Historical File Pre 2018

Collection System SSO 24-Hour Ngtificaaork-_ S
Collection System: Number and Name WQCS#c�j3
Incident Number from BIMS�2
Incident Reviewed (Date):
Incident Action Taken: BPJ
NOV-2012-DV
I O M a®Mumma "coma Ems OEM WHEN a a■ a a BOWFUNUMMONC 0 t s ®a a a N a E R a E R RONDO manna BEDROOM
Spill Date `� Time
Reported Date Time
Reported To SWP Staff or EM Staff _
Reported By '` •Jt�l� S
Address of Spill
County
11DC � �
Cause of Spill �oele_
City
T( 3 c f pm
,e ab/ pm
r`
Phone -7c)q 34 ( 0644 -
Total Estimated Gallons Est. Gal to Stream 75 o
Stream 6� Fish Kill: Yes Number Species
Non Required Information and other comments relating to SSO incident:
Response time minutes Zone Map Quad
S c 'ram 6j& ,,J )�s�

NOU-09-2012(FRI) 13:57 Carolina Water Service, Inc. (FRX)7045553034 P.002/004
v Q� Form CS-SSO
Colleen SysWm Sanitary Sewer Overflow Reporting Form
ra V 112009
PART
This form shall be submitted -to the appn*riate DWq Regional Office within five days of the first knowledge of
the sanitary sewer overRow (SSO). "-
Permit Number: WQCSDO0253
Facility. -
Owner
.Bradfield Farms
(WQCS9 if active, otherwise use WOCtS09)
Carolina water Service Inc of NC
Cif Charlotte ..
Source of SSO (check applicuble) -
M Ssniiary Sewer ❑
• inC'sdent � . - - -
Region: Mooresville
Coursty_ Mecklenburg
Purnp Station f Uft Station
SPECIFIC location of the SSO (be consistent in desaiption $fin pastreports or documentation - i_e_ Pump Station 0,
Manhole at WQstalt & Bragg Street. etc,) : Manhole in frcmt of 11106 Pale Hickory --._
Manhole# N/A
Latiluda (degreeslminuWsecond): LonQiuula(dagrfts/minuhWs =nd),-
11/4/2012 9:30am 11/4/2012 1200pm
Incident Started Dt Time: 1nr:tt3emrt End t7b Time:
(MM-d -yyyy) hh:mm AWM (mm,dd-yyyy) hh.mm AMIPM
Estimated volume of the SSO:. , 750 gallons Estimated Duration (Pound to nearest hour), 3hrs
Estimated amount using a 5 gallon Wc:ket. Pdllcd out 5 5allor,d tu,d it
-Describe how the volume was determined: - s
clear
Weattrer conditions during SSO evenC---.__... _...._.
Did $SO reach surface waters? ❑ Yes❑ Not=l tlnknown
Volume reaching surface waters (gallons):
Surface water name:
Did the SSO result in a f h kill? ❑ YAB N.0 Unknown tf Yes, what 1s the estimateC numtser of irSh klltsd?
SPECIFIC cause(s)ofthe SSO*
l_I Severe Natural Condltion © Grease ❑ Roots
❑ Inflow and Infiltration ❑ Pump Station Equipment Failure t❑ Power outage
❑ Vandalism ❑ Debris in line ❑ Other (Pleaso explain in Fart 11)
❑ Pipe Failure (Break)
24-hhour verbal notification (name of person contactEdl Lon snider
ID k D1NQ ❑ Emergency Mgmt pat$ (mm-dd-ym)• 11/5/20I2 rime (hh:rnm AMIPM)- 64 Sam
If an SSO is ongoing, please notify Regional Tice on a daily basis until SSO can be stopped.
Per G.S. 143-215.1C(b), ttto responsiiNe party of a discharge of 1,000 gallons or mwn of untssated wastewater to surface
Waters shall Issue a pness release within 4t3-(•iours of first knowledge to all print and electmrfic news media providing general
coverage In the county wh rMUWA3dwrge 4)=n KL When -IS17db gallons or more of ontreated wastewater enters surface
waters, a pub4c netice shall be published within 10 days and proof of pubGzution shag be provided to the Division within 30 days.
Refer to the re ren statute for further detail.
The Director, Division of Water Quality, may take enforoemant action for SSOs thatamra resit ired to be reported to Division unless it
IS Demonstrated that — -
1)the discharge was caused by severe natural Condiduns and then$ were no feasible alternatives to the discharge; or
2) the discharga was oxceptiomL unintentional. temporary and caused by tactors beyond tho reasonable control of the Perm ittee
and/or owner, and the discharge could notttrmbeen prevermd byttle enrcise of reasonable control.
Part 11 must be completed to provide a justificationn claim for either of the above situations_ This information wili be the basis
for the determination of any enforcement action. Therefore. i6s; important to be as comptete as passible_
WHETHER OR NOT PART 11 IS COMPL.El1=D, A SIGNATURE IS REQUIRED AT THE END OF THIS FORM.
CS--SSO Form Page 1

NOV-09-2012(FRI) 13:57 Carolina Water Service, Inc
(FAWN5553034
,7-.e 4*
P. 0011004 .
UHIMES,
Inc."
P.O_ Box 240908, Charlotte NC 28224.0908
Office (704)-52S-7990
Fax [phone]
FACSIMILE TRANSMITTAL,. SHEET
TO:
FROM:
Lan Snider
Adam .lames
COMPANY:
DATE:
NCDENR
1 VM012 _
FAX NUMBER:
TOTAL NO- OF PAGES INCLUOING COVER:
704-663-6040
PHONE NUMBER:
SENOSA'S REFERENCE NUMBER:
RE:
YOUR REFERENCE NUMBER
Jr day report
❑ URGENT FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY 13 PLEASE RECYOLF-
Attached is the 5 day report for the SSO at Bradfield Farms that
occurred 1114/2012
Let me know if you need something else, l also emalled you a copy

NOU-09-2012(FRI) 13:57
Carolina Water Service, Inc. (FRk)7045553034 P.003/004
Grease (Documentation such as deaning, inspections, entbrcement actions, paist overflow re arts,
e_ducationat`maaen�d on ame, etc. should_'be avalt a upon n:c�u
When was the last time this specific line (or wet wells was deanev Gleaned prior to 2004
Do you have an enforceable grease ordinance that tequkes new or mWit of grease traps/interceptors? ❑ YeQ No [DNA[--] NE
Have there been recent inspections and/or entreement actions taken on nearby restaurants or other El Yeo No @ NAn NE
nonresidendal grease contributors?
Explain.
Have them been other SSOs or blodcages in this area that were also caused by grease? Y x No Q NAQ NE
When?
If yes, descrft them:
Have olearting and inspections ever been increased at this location? TT�^ _- �~ tJ Ye Nn Q NAQ NE
Explain_
Have educational materials about grease been distributed in the past? �^ . YeNo NAQ NE
When?
and to whom?
8/1/2012
All sewer Customers
Explain?
we send a FOG brochure to all sewer customers 2 times a year, mailed with there bill.
If the $SO occurred at a pump station, when was the wet well and pumps last checked forgrvase
accumulation? '�--T-
wore the floats clean?
Comments:
0 Y00 No 2-j NACI NE
GS-SSO Form Page 4

NOV-0972012(FRI) 13:58 Carolina Water Service, Inc
_r Jr-.j
(FAX)7045553034 P.004/004•
Stem Visitation
ORC
Backup
Name:
Cert#
Dste visibsd�
Time visited:
Yes
Y.
Larry Henry
27955
1X/5/2p4.2
a15an
Wow was the $SO remedlated.(F.e. -Mopped and Cleaned up)?
Contractor jetted sewer main and cleaned up spill area and added -lime
As a representative for the responsible party, I certify that the information Contained in this report is true end accurate to
Wiest o—my
krsow a ge- _ _r -
Person submitting claim: Adam ,lames Date: 11/9/2012
Signature: Area Manager
Title:
Telephone Number. 704-S25-7990
Any additional information desired to be submitted should be sent to ftae appropriate Division Regionol Office within five days of first
knowledge of the SSO with reference to the incident number(the incident number is only generated when electronic entry of ?his
form is r ompleWdd, if used).
CS-SSO Form Page 15