WQCS00341_Regional Office Historical File Pre 2018

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Collection System SSO 24-Hour Notification
Collection System: Number and Name WQCS# (90
Incident Number from BIMS A07) ( 0 /
Incident Reviewed (Date):
Incident Action Taken: V/ BPJ
NOV-2009-DV
Spill Date . �l �9 Time pm
Reported Date ( Time �� 3C� am pm
Reported To SWP Staff or EM Staff
Reported By 4(+ lVi'6kajlL Phone'®"
Address of Spill -7kS- —" 0
County ,9DOa,,) City
Cause of Spill
Total E timated Gallons = 6 M Est. Gal to Stream —
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Stream �tO�) Fish Kill: Yes No Number Species
Non Required Information and other comments relating to SSO incident:
Response time minutes Zone Map Quad
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Form CS-CCO
Collection System Sanitary Sewer Overflow Reporting Form
PART
This form shall be submitted to the appropriate DWQ Regional Office within five days of the first knowledge of the sanitary sewer
overflow (SSO). MAR 2 5 2009
Permit Number: 341 (WQCS# if active, overwise use WQCSD#)
Facility: _Town of Chinw'&64-,CW6' -6tion system Incident # 200900761
® ' � t "' 4� " , -or l ' "° ' ' Region: Moorseville office
Owner: >tI�S�C�na`Cr"ii�e�i k- (� ,;:-�4 �, ;� g
City: —China—Grove County: —Rowan-
Source of SSO (check applicable): X 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.): Thom Street outfall, one manhole below connection of Kirk Street outfall
Manhole#
Latitude (degrees/minute/second):
Incident Started Dt: 03-182009
(mm-dd-yyyy)
Estimated volume of the SSO:
600
Describe how the volume was determined:
Longitude (degrees/minute/second):
Time: ? Incident End Dt: _03-2019-2009 Time: _10:48 AM
hh:mm AM/PM (mm-dd-yyyy) hh:mm AM/PM
gallons Estimated Duration (Round to nearest hour): 24-
Pooling size and depth
Weather conditions during SSO event: sunny
Did SSO reach surface waters? XYes ❑ No ❑Unknown Volume reaching surface waters (gallons): 200
Surface water name: ,.wet weather ditch,connected to. Grants Creek .
Did the SSO result in -a fish kill? ❑ Yes XNo ❑Unknown- - If Yes; what is the estimated-# of fish killed? N/A --
SPECIFIC cause(s) of the SSO
o: Severe Natural Condition.,. ❑ Grease X Roots
o Inflow & Infiltration- ❑ . Pump Station Equipment Failure ❑ Power outage ,
❑ Vandalism ❑ Debris in line ❑ Other (Please explain in Part II)
❑ Pipe Failure (Break)
24-hour verbal notification (name of person contacted) _Ms. Barbara Sifford
XDWQ ❑ Emergency Mgmt. Date (mm-dd-yyyy): 03-20-2009 Time (hh:mm AM/PM): 09:00 AM_
If an SSO is ongoing, please notify the Regional Office on a daily basis until SSO can be stopped.
Per G.S. 143-215.1 C(b), the responsible party of a discharge of 1,000 gallons or more of untreated wastewater to surface
waters shall issue a press release within 48-hours of first knowledge to all print and electronic news media providing general coverage in the
county where the discharge occurred. When 15,000 gallons or more of untreated wastewater enters surface waters, a public notice shall be
published within 10 days and proof of publication shall be provided to the Division within 30 days. Refer to the referenced statute for further
detail.
The Director Division of Water Quality, may take enforcement action for SSOs that are required to be reported to Division unless it is
demonstrated that:
1) the discharge was caused by severe natural conditions and there were no feasible alternatives to the discharge; or .
2) the discharge was exceptional, unintentional, temporary, and caused -by; factors beyond the reasonable control of, the Permittee and/or
owner, and the discharge could not have been prevented by the exercise of reasonable control.
Part Il must be completed, to. provide a justification claim for either of the above situations. This information will be the basis
for the determination of any enforcement action. Therefore, it is important to be as complete as possible.
WHETHER OR NOT PART II IS COMPLETED.; A _SIGNATUREIS REQUIRED AT THE END OF THIS FORM.
Form CS-CCO
CS-SSO Form Page 1

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Have educational materials about grease 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 for
grease accumulation?
Were the floats clean? ❑ Yes ❑ No ❑ NA ❑ NE
Comments:
Roots
Do you have an active root control program on the line/area in question?
❑YesxNo❑NA❑NE
Describe:This outfall was replaced in it's entirety in 2002. It is inspected routinely with overall system.
Have cleaning and inspections ever been increased at this location because of roots? ❑ Yes x No ❑ NA ❑ NE
Explain. New outfall
What corrective actions have been accomplished at the SSO location, (and surrounding system if associated with the SSO)?
Removal of debris and contaminated soil, limed, and area seed and strawed.
What corrective actions are planned at the SSO location to reduce root intrusion?
Root ball appeared to have come from section of older system upstream. No root intrusion at this point verified by camera.
Has the line been smoke tested or videoed within the past year? ❑ Yes Xno❑ NA ❑ NE
If Yes, when?
Comments:
Inflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule in any permit that
Addresses UP
❑ Yes ❑No❑NA❑NE
CS-SSO Form Page 3

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Name:
Cert#
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: Rory Kent Mishak
Signature: �K'—f'�� Title: Utilities Director
Telephone Number: [phone]
Any additional information desired to be submitted should be sent to the appropriate Division Regional 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 this form is completed, if used).
CS-SSO Form Page 9