WQCSD0116_Regional Office Historical File Pre 2018 (2)

Form CS-SSO
Collection System Sanitary Sewer Overflow Reporting Form
PART I
This form shall be submitted to the appropriate DWQ Regional Office within five days of the first knowledge of
the sanitary sewer overflow (SSO),
Permit Number : [� C 003
Facility n tY
Ruci-c14met ww71P
owner: �®0 Se C�� ., (kb V I Al co v& ✓
city-.� t
��M �j\�� s
Source of SSO (check applicable) : Sanitary Sewer 0 Pump Station
SPECIFIC location of the SSO (be consistert ii des
Manhole at Westall & Bragg Street, etc) •
Latitude (degrees/minute/second):
Time- 3 e 00 PM
Incident Started Dt:
(mm-dd-yyyy) hhtinm AM/PM
Estimated volume of the SSO: 1 8, SO° gallons
saal
Describe how the volume was determined:
Weather conditions during SSO event ■
Did SSO reach surface waters? VYes ❑ No 14 Unknown Volume reaching surface waters
Surface water name:
Did the SSO result in a fish kill? ❑ Ye
SPECIFIC cause(s) of the SSO:
❑ Severe Natural Condition
inflow and Infiltration
❑ Vandalism
Yes
�0iti,D0li
(WQCS# if active, otherwise use treatment plant NC/WQ#)
Incident #
Region:
County:
°loon/
URt N
umentation - i.e_ Pump Station 6,
Long itude(degreesfminutelse cond)•
Incident End Dt:3
(mm-dd-yyyy)
Estimated Duration (Round to nearest hour):
se'tva`�.
5
imme
iate 24-hour verbal notification reported to:
DWQ CI Emergency Mgmt.
to b, t4.e C,a �e-y o-C g00S� C\ ee
El Unknown if Yes, what is the estimated number of fish killed?
Time, I',•IS PM
hh:rnm AM/PM
L 5
gallons): � .
❑ Grease ❑ Roots
❑ Pump Station Equipment Failure D Power outage
0 Debris in line ❑ Other (Please explain in Fa 11)
`` a e.e• t-a.1 1 3 l) / borcisv 1 le-
Dafe (mm-dd-yyyy): 3- 1- a. Time (hh:mm AM/PM):6;�Q PM
if an SSO is ongoing, please notify Regional Office on a daily basis until SSO can be stopped.
Frer 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 publishedwithin 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 11 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 SIGNATURE IS REQUIRED AT THE END OF THIS FORM.
CS-SSO Form October 9, 2003 Page 1
e.hcmule 4' I

Exptaln if Yes:
What corrective actions have been taken to reduce or eliminate 1 & l related overflows at thls spill location within the last year? `
( tit IN
_ 0 �% I ( 0D �! �'� \I CCU l j `eCiitOtA lii rn
Has there been any flow studies to determine I/I problems in the collection system at the SSO location? Yeklo IJNAA UNE
If Yes, when was the study completed and what actions did it recommend?
Has the line been smoke.tested or videoed within the past year?
Ij
YesD No DNA ONE
If Yes, when and indicate what actions are necessary and the status of such actions: �[ r
st\G r vie)vol im.11J p'-0\xV6v ivt VAC aPr "ary7O"-
Are there I/l related projects in your Capital Improvement Plan? YesD No DNA ❑ NE
If Yes, explain: 0l v0. Et --
Have there been any grant or loan applications for I/1 reduction projects?
If Yes, explain:
a.`re
a_ 1.ba
ZIYest—I NO ONA ON>=
Iv, hp c-o ce ss a P�--
Do you suspect any major sources of inflow or cross connections with storm sewers?
If Yes, explain:
DY 0UNAONE
Have all lines contacting surface waters in the SSO location and upstream been Inspected race tly? ❑Yes No / NA ONE
Cg 4) vie o� -HAP t �v‘e. COu ure4- 5aeP l'e r�
If Yes, explain_
What other corrective actions are planned to prevent future I/1 related SSOs at this location?
5:.�. CAW pi 6. in.ov 't v�
Comments:
_CNA U3At
Pum• Sta'•n E.ui.ment Fail e Documentation o tin., recuretc.,
shoul be ro 'ded upon re.: -st
What kind of notifi = onlala ystems are present?
Au
CS-SSO Form October 9, 2003
e vet!
12.ev\
L.1Yes
Page 4

When k4a the area I ecked/d ed?
Hav cleaning and Inspections ever been Increased at this location due to previous problems with debris? ❑Ye
Explain_
Are appropriate education- ateriais being developed and distributed to prevent future
occurrences?
Comments:
Other (Pictures and a police report should be
Describe:
le upon request.)
Wens adequate equipment and resour = - available to fix the problem?
If Yes, explain:
NA DNE
liar ❑Yen No DNADNE
If the problem co not be immediately repaired, what actions were taken to lessen the impact of the
SSO?
Co rents:
®YesD No0NADNE
For DWQ Use Only:
DWQ Requested an Additional Written Report:
If Yes, What Additional Information is Needed:
LlYeD No LINA ONE
Comments:
Cs-SSO Form October 9, 2003 Page 7

I . V
As a representative for the responsible party l certify that the information contained in this re ort Is true and accurate
to the best of my knowleddc e_
Person submitting claim: t. t I 6 a vyi O �
Signature:
Title.
Date: / I ' Cl'CC )1 Jai ac '
VtiCE � t1 cvT
Telephone Number.
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•irtcident number (the incident number is only generated when electronic entry of this form
is completed, if used).
CS-SSO Form October 9, 2003 Page 8

Goose Creek Utility Company
1515 Mockingbird Lane
Suite 900
Charlotte, NC 28209
March 5, 2004
Mr. D. Rex Gleason, Regional Supervisor
Division of Water Quality
919 North Main Street
Mooresville, NC 28115
SUBJECT: Report of Wastewater Overflow
Fairfield Plantation WWTP
NPDES Permit No. NC0034762
Union County, NC
Dear Mr. Gleason,
Goose Creek Utility Company
Telephone. [phone]
This letter is sent as our final report of a wastewater overflow from the sewer system at
Fairfield Plantation.
1. Verbal Notice was given to "general Mail Box" at your office at 6:20 P.M. on
March rt. Since this overflow was an ongoing event lasting about 45 hours, we
made, by FAX, three successive reports on March 1t, 2nd, and 3rd(copies of the
three reports are attached hereto as Enclosures.). On the evening of March 3rd, we
also made the required news release to the three designated media contacts for
Union County.
2. We are also enclosing our final report herewith on the DWQ Form CS-SSO.
3. This overflow was caused by melting of a record -breaking snowfall in a period of
already saturated ground conditions. There were only slight traces of the
overflow event outside our WWTP enclosure, since the preponderance of the
wastewater had already been partly treated.
Please let us know if additional information is desired regarding this matter.
Sincerely,
GOOSE CREEI UTILITY COMPANY
Paul H. Trotter
President
Enclosures:
1. DWQ Form CS-SSO
2. Three daily reports
NC DEPT. OF RiViKaigniT
AND 'V, i I „1`L RESOURCES
t1:00RET(,:. '110I ALOFFICE
Cd
MAR 1 0 2004

GO0S cXzsy)OX:c X X'XX.zz-Y comcp :N r
1515 MOCKINGBIRD LANE
SUITE 900
CHARLOTTE, N.C. 28209
Goose CielC'Uttllty Company
TELEPHONE [phone]
[phone]
FAX[phone]
DATE:- - -
c \, 0 0 Li -
TO: P`\ . p m k€— 1r e
COMPANY: w , pj C&SV 4 1
FAX#: 1-/ p [._(- ®1-}-
FROM: L \ \ i a v.&
RE: D e old
THIS TRANSACTION CONSISTS OF 3 . PAGES(S), WHICH INCLUDES THIS
COVER SHEET.
I
COMMENTS: �i k S ,jS ()Ulr \ Y) ( l d
e C'A ) \‘. \ &Ara • g n
r9., �G'u \ met t(m
\,) - �\\LO nIAA QC'rDu) •
L.19.941 (May 1995)

(� Sewage Spill Response Evaluation:
0o&e _ (page 1) // 1'
Permitee �'� - CO Permit Number N,C0037u -762, County dd! Vl i o
qq kis
Incident Started: (Date/Time)/y�AY t /IncidentEnded: (Date/Time) C° h /J IIn% a
t
Ifspill is 1onggoing,please notify Regional Office on a daily basis until spill can be stopped.
Reported to: t)L3`Z Mc�5 1(1 k (Date/time) 5 pl�l Cflik t A c)
weather conditions: L.�Ot, ek, V V\061n3 Cd1.75; t/l\ '(-ci p idS�0 e /*.
I
Source of spill/bypass (check one): Sanitary Sewer Pump Station VWVTP
Level of treatment (check one): None V Primary Treatment
Secondary Treatment Chlorination Only
Estimated volume of spill/bypass 60©�A 1/k '`.gallons. Show calculations.
Did spill/bypass reach surface waters? 1,Yes No (If Yes, please fist the following)
Volume reaching surface waters? lS� gallon/h 1
Name of surface water Ma I 1 \ �t b t �J i '"� `/ C� C�
ice$. c -�
Did spill/bypass result in a fish kill? Yes a/ No/
If Yes, what is the estimated number of fish killed?
Please provide the followino information: 1. Locatiorl of spill/bypass: , A ‘1"j ,i *8- ` r9� I
ldv4 (1van` i ®'A '-+..)1L��i(iCtli6
2. Cause of'spill/bypass: V V \ ` 11� -� I/1'� r C/J rc "
d r' i AID1N'gl
3. Did you have personnel available to perform initial assessment 24 hours/day (including weekends and
holida s)?
Yes No
4. How long did it take to make an initial assessment of the spill/overflow after first knowledge?
Hours r ® Minutes
How long did it take to get a repair crew onsite?
O Hours 0 Minutes
Please explain the time taken to make initial assessment: Our- IN t A u *e r
d;\-- w l inr� 1) 0 R�,c
-CV1

Sewage Spill Response Evaluation:
o OS2 CR2• (Page 2)
N. Coo?j4062, t
Permitee VOA t `t 4- 7 (© Permit Number County 0 VI 10 4l
5. Acti n to erlto contain spill, clean �p waste, and/or remediate the s'te:
6� `5 t vn ov" is i Vn tioey
I
Is
tin6- S l/1ou0
6. Were'the equipmentand parts needed to make repairs redily avai le?et..{)
Yes No X. If no, please explain why:
"6 u *c.
7. If the spill/overflow occurred'at a pump station, or was the result of a pump station failure, •
was the alarm system functional at the time of the spill? Yes V No If the alarm
system did not function, please explain why:
8. Repairs made are: Permanent Temporary
Please describe what repairs were made. If the repairs are temporary, please indicate a date by
which permanent repapq will be completed, notify the Regional Office within 7 days of the
permanent repair. t— WN GL Ul, Q•N °� ( l',rs MVP-
0
9. What actj,have been m de to prevent this di arpe .from occuri g aga n n the fiuture?
(r,\. Lou s 'S 0?0S e
9. Comments:
Other agencies notifed:
Person reporting spill/bypass:
Signature
Phone Number(-104)5
1-7
Date: f%,OL , 200`f
For DWQ.Use Only:
DWQ requested additional written report? Yes
If yes, what additional information is needed?
Requested by
No

FAX#:
FROM:
RE:
"4-
GrOOBE CREES'C7Tix xTY CObliPliNY
1515 MOCKINGBIRD LANE
SUITE 900
CHARLOTTE, N.C. 28209
[phone]
FAX[phone]
DATE: ate- -Z _
TO:
Goose CieICUti1llty Company
IUIa. Jahn �,eSl�e
COMPANY: 1) ., M Ota Vim* V►O le
(-7 K63'g)t+O
u);1.1004
T—�-H-e-
tl�
,) i vkdoci1$—
THIS TRANSACTION CONSISTS OF
COVER SHEET.
TELEPHONE [phone]
e.,V 41.6uk.)
4, PAGES(S), WHICH INCLUDES THIS
COMMENTS: T� ' l ��k— end
ty t.r&I)to5r* vto
over4-kow; Fear te- 6. %Oft' o r sAct'--;01
L.19.94I (May 1995)

Sewage Spill Response Evaluation:
0 �S� C - e (Page 1)
Permitee �� L i CO , Permit Number C-o 1376 2, County U t n N
c P1illq Cts
Incident Started: (Date ime) J �(1. / f7W1 Incident Ended: (Date/Time)
if spill is ongoing, please notify Regional Office on a daily basis until spi can be stopped. GP
Reported to: D(� 1 I (Date/time) S� �5 �' e� — �� Lj41_44.14,€_tivc
weather conditions:- lv
Source of spill/bypass (check one): Sanitary Sewer Pump Station VWVTP
Level of treatment (check one): V None Primary Treatment ®5 Iy
Secondary Treatment —
Chlorination Only �e*a
s
Estimated volume of spill/bypass ® 10 gallons. Show calculations.
Did spill/bypass reach surface waters? Yes No (if Yes, please list the following)
Volume reaching surface waters?
6 000
Name of surface water / v t`YI�l��r ► bU 6 e1
Did spill/bypass result in a fish kill? Yes
If Yes, what is.the estimated number of fish killed.
Please provide the following information:
1. Location of spill/bypass:_
to 14 i,1Ian p
gallons
c gvO5 e C\ e &K
2. Cause of spill/bypass: Vn re C® -4 1 1
3. Did you have personnel available to perform initial assessment 24 hours/day (including weekends and
holidays)?
Yes No
4. How long did it take to make an initial assessment of the spill/overflow after first knowledge?
Hours 1 C1 Minutes
How lona did it take to get a repair crew onsite?
CI) Hours 0 Minutes
Please explain the time taken to make initial assessment: Q UV"— V ` Sk
\12)01- V- Vt SC) \--- MvP- k i-i o I Loan->n;
•S e _ "UC� (0 e a vl Q P 'kvk4c) rim a 1(!'+1/4___ b CP-C- 7
e

OOse CAE {G
Permitee ` 1+11 \ co
Sewage Spill Response Evaluation:
(Page 2) 1
Permit Number 0 r)3L..i C County ON, N, otq.
5. Action taken to contain spill, clean up waste, and/or remediate the site: I L1..P
..' lL0c)
lko 1 ) tr, &. k`" 1 co a sis
e - ` e
6. Were the equipment and parts needed to make repairs readily avable?
Yes No tf If no, please explain why: (',\/ t i 0(4} 1,001 S
Ca us ea •rP Ce\1/' G c
1 S $,Ea �A VI, v� lA '; . c.. d vl '' Vl lit I011
CNN/
111 -CC%t. rlC $
7. If the spill/overflow occurred at a pump station, or was the result of a pump station failure, •
was the alarm system functional at the time of the spill? Yes M No If the alarm
system did not function, please explain why:
8. Repairs made are: Permanent Temporary
Please describe what repairs were made. If the repairs are temporary, please indicate a date by
which permanent repairs will be completed, and notify the Regional Office within 7 days of the
permanent repair:
Mewl f G p i Q Vt
9. What actipns have been made to prevent this ischarge..from ccurin again in'the future?
�1-In Ornu % Pvt&Va i rmik 1ft A
C) fo- M e v1A s1s d ew, �s Vt 6 o s A
9. Comments:
Other agencies notifed:
N6vi y_e 1
Person reporting spill/bypass: ;\,1 k ry �� 1 reYkAtiPhone Numbe
Signature\. j)1011' /1\cC; , \r
For DWO.Use Only:
r7e3
Date: I n 2 �� L&
DWQ requested additional written report? Yes No
If yes, what additional information is needed?
Requested by

t
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FAX#:
FROM:
RE:
G OOBE Ci2EEX x rxx xx CO2SdPA
1515 MOCKINGBIRD LANE
SUITE 900
CHARLOTTE, N.C. 28209
[phone]
FAX[phone]
DATE:
TO:
A5o "to T
'Svllivah
l °CCIC- vYtol�s dM
/31'35
AL\ et-Y-C -- 0 0 /4'
1,f 1 r1 L e z L e
Goose CMek,`Utillty Company
TELEPHONE [phone]
COMPANY: J W CQ VV l 6/9 \--P5- S'V m 1 I C,-7
(Tr o14) G6--�oL J
)G,.S \, E oc-A C2ve T I
THIS TRANSACTION CONSISTS OF -- , PAGES(S), WHICH INCLUDES THIS
COVER SHEET.
COMMENTS: ` 1/"\
—0(1\0-4 4-- \
6orkA-- Las 15— —±D�
C>tA\--- $1 \Anti\ r e .&
d\\ nvr ouDs
L.19.941 (May 1995)

(° Sewaget—Spill Response Evaluation:
o�e `Cvee � (page 1)
3i`k ` ' y ( /o Permit Number?11C O b{-7 '2, County 1 I ® ri
Incident Started: (Date/Time) MetY l / ._I(11Incident Ended: (Date/Time q / L ; /,-
n..vo
/f spill is ongoing, please notify Regional office on a daily basis until spill can � be stopped.
Reported to: QO V � l I,� N ate/time) �7 M 4 Mr ./009.
weather conditions:
Permitee
u)d x ,iv, (D) a dam/
Source of spill/bypass (check one): Sanitary ewer Pump S Station VWVfP
Level of treatment (check one):
Estimated volume of spill/bypass 0, ‘g00 gallons. Show calculations.
a4- c e \.,3e)t-v\cl.usuk,
None Primary Treatment " i
E>cc
Secondary Treatment Chlorination Only o�ap,��V. 1 kSt
Did spill/bypass reach surface waters? V Yes No (If Yes, please list the following) *-�
Volume reaching surface waters? ! .5 00 gallons
Name of surface water %� ► cat �'r, ��g I ��
Did spill/bypass result in a fish kill? Yes
If Yes, what is the estimated number of fish kille
Please provide the following information:
1. Location of spill/bypass:
lose
QY'/ pU 5V-k-lon \A) P`� \s�� �� .
l
2. Cause of:spiNbyp ss:
v ut4s\.01 1,
1
►u
weer g_ A. e r-ca
rib cku ra`t-1 D mil, -- v i g
V d
uwt
3. Did you have personnel available to perform initial assessment 24 hours/day (including weekends and
ol�daps
Yes 1 /' 1 No
4. How long did it take to make an initial assessment of the spill/overflow after first knowledge?
Hours y ® Minutes
How lona did it take to get a repair crew onsite?
6 Hours (''a Minutes
Please explain the time taken to make initial assessment:
S P-tlt s o r & r v LADa
-Th - P- t.<'
QUV 1(1`ofL Weecer
t Su ES 7uLl-tit'i

Sewage Spill Response Evaluation:
(Page ?)
8c,5e CTee IC NC
U h
Permitee A"; \ i �`� CC7 • Permit Number 0 (7.'S �- � � 2. County '1 o ri
71
5. Action taken to c¢ontain spill, clean up waste, and/or re daate t lCi e site: ( V e `— l GO
n casEal r'�-- I2: I5 ?w\ AA(4c14 �N. 0 `'. C_
ClEiatn
6. Were the equipment and parts needed to make repairs readily available 1
Yes No v' If no, please explain why: c VP-N. el u_, LO a 5
C GA v El ~ 7 d (a t- N5-Pc \'l V -' etci v'K
1 % eon r i 6n i k--- 'S , C. , C_ . 0 +n A U vl I OW �riutt'1'
7. If the spill/overflow occurred at a pump station, or was the o a pump station failure, •
was the alarm system functional at the time of the spill? es No lithe alarm
system did not function, please explain why:
8. Repairs made are: Permanent Temporary
Please describe what repairs were made. If the repairs are temporary, please indicate a date by
which permanent repairs will be completed, and notify the Regional Office within 7 days of the
permanent repair:
E e U* ?at its G C1P r of' s
9. What actions have been made to prevent this discharge..fromccurin again in the fti ture
9. Comments: L lA� (")\ ow Va4A. WI, 1t s l c)u06
k\NA
e �Ln 1A ��r . (11n V1' C� "} �/l
'C Ea oL ..v. r l.,tJ� ti w
Other agencie notife¢: 2uUl��1 » Ia� a to W ��.
(`I e,-s Ya �t �r 6111 � 00 �r---1 v — JQV � k — �7
Person reporting spill/bypass:l.‘i raw A • k'�• 0 x Phone Number(-7, 0 1-}-)b --� -1 l sn
Signature
loom
lrt
Date:J%\Q ) L C) Lt.
For DWQ Use Oniy:
DWQ requested additional written report? Yes
If yes, what additional information is needed?
Requested by
No

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03/03/2004 06:49 FAX [phone] WILLIAM TROTTER COMPANY
001
cooeom cxrxaaxx xrrxx..xr comcartsi-varx
1515 MOCKJNGBIRD•LANE
BUTTE 900 .
CHARLOTTE. N.C. 26209
[phone]
FAX[phone]
DATE:.. y� a-k c— - . -0o y-
FAX#:
FROM:
RE:
Goose Ctzek 'Utilltg Company
LTO: jam, '+h. eC-a.
COMPANY: c, M 66 re? s v Ill 1 C
0(4) ) G6'3-- 6040
"i1\t a wtit-
Ove \-- ow
THIS TRANSACTION CONSISTS OF �- . PAGES(S), WHICH INCLUDES THIS
COVER SHEET.
COMMENTS: 1 `e"1
eN 1 \f‘\1\-4
AO:\ t-e 9 k o.r �, �� 0 v e -i Uv
1/4‘r lft eon La: 15 -�-�
1
Mai
\\nua(?crouD,
L.19.941 (May 1995)

03/03/2004 06:49 FAX [phone] WILLIAM TROTTER COMPANY
la002
weather conditions:
Sewage Spill Response Evaluation:
apple Ocee (page 1) .
Permitee Uia t 1 47 (-0 Permit Number$r OD 3 (y_7F 2 County t O n
Incident Started: (Date/Time) M1( / � ll' UM `
_ � Incident Ended: (Date/T,me [� r / � , 15
�va`t .9.00Li.
lfspill is ongoing, please notify Regional Office ,on a daily basis until spill can be stopped.
I► " od v t ` Lei ` �ceiUate/tim4, e) en ,. Altor r 3 , �%9L
Reported to: b
-2 o
, (T11°) -t- aou.d y —t-0Q r
Source of spill/bypass (check one): Sanitary Sewer Pump Station eWWyP
Level of treatment (check one):
Estimated volume of spill/bypass
None Primary Treatment
VSecondary Treatment Chlorination Only
v, WOO
gallons. Show calculations.
o /M \r' fr% is
Sze a c eel vvc1.os Ll
Did spill/bypass reach surface waters? Y Yes No (If Yes, please list the following)
Volume reaching surface waters? 7.500
Name of surface water Alk t yt of
Did spill/bypass result in a fish kill? Yes
If Yes, what is ,the estimated number of fish kille
Please provide the following information:
1. Location of spill/bypass:
o.,n d
2. Cause of spl by• -ss:
Ss\pi-rpvx
r3i
gallons
° ale C-e-e- '
u)e r, .
civcd
a./
Vta Kit 4 1
3. Did_you have personnel available to perform initial assessment 24 hours/day (including weekends and
•o^li�-�rya.3,�
4. How lono did it take to make an initial assessment of the spill/overflow after first knowledge?
Hours Y f Minutes
How Iona did it take to get a repair crew onsite7
05 Hours (7 Minutes
Please explain the time taken'to make initial assessment: 0 t4 Y I(1; b l r—
iOv.'t 1-WA 4b t a lki „

03/03/2004 06:49 FAX [phone] WILLIAM TROTTER COMPANY
Z 003
Sewage Spill Response Evaluation:
(Page 2)
Permmtee C�i 1 1 ` CC7. Permit Number 1,4169 County U n t on
t
71
5. Action taken to ontain pill, clean up waste, and/or re. diate the site: g ve ti lt9 (A)C L ' (C1 a : 1 ' $ wk AA d‘ e in . ,c !) c
trvatt 0 \re t i 1;6 Ck-ate‘ Up iviii. s1
-To ellowe II)y C\E1cL — Ill x-- acif 1tCCA t inn of l i rtne-.
6. Were the equipment and parts needed to make repairs read
ily available
Yes No V If no, please explain why: V1 a a S
S-'<.e y 7' A-i a t�P��t`v ac*rrL\
DIN C
7. If the spilUoverflow occurred al a pump station, or was the
was the alann system functional at the time of the spill?
system did not function, please explain why: 1�
pump station failure,
No If the alarrn
B. Repairs made are: Permanent Temporary
Please describe what repairs were made. If the repairs are temporary, please indicate a date' by
which permanent repairs ill be completed, and notify the Regional Office within 7 days of the
permanent repair. _
ex— ,rNt/tevA \fa,N.S Gt-e. vtcol Ule`c
9. What actions have been made to prevent this d ipcharge.from. Rccuring,again •in thee-firtu
I VoPb fa f7V �ff
9. Comments: lU1�' r ow vo►D'. Ug S t)l v(4
do s A , 1
rg � Clt^ -t t► utb� C7 t
took '�Ninr)u. ■ t
Other agencic.5 notife : Nteok l a
Person reporting spill bypass:,
Signature
For DWQ•IJse Only:
t IAN►
DWQ requested additional written report?
If yes, what additional information is needed?
: k.o i K e -i--
Phone Numbed—?f) 1-1-�5 -17 (�3
Date JA )
Yes No
Requested by

03/03/2004 06:49 FAX [phone]
WILLIAM TROTTER COMPANY
Z004
‘62„:2
1.; 9V..-e-r7KNe.4)....
t cu\... :ir:.iOval-F1acJ
vd\mvet
tiv
E��
3o 33Q0
. 0
3so ...4 9,9 J
65d

0t/i)1/:.t)04 05:56 FAX [phone] WILLIAM TROTTER COMPANY
Z001
cooeom cxrlmxmmr xrrxx.rrsr com leAu rx
1515 MOCKINGBIRD LANE
SUITE 900
CHARLOTTE. N.C. 28209
Goose Creek:UtWty Company
TELEPHONE [phone]
[phone]
FAX[phone]
DATE- • •
a� c�► 1, 200 4.
To: ' V` afAm Le-.s. Vzt.
COMPANY: \ v/ )1\ V 4 i l &
FAx#: (1DL 4•6-- _ Go 4-0
FROM: ` 1rh-%'er
RE: \) &s` 'er e \ O V e r 1 DLO
THIS TRANSACTION CONSISTS OF 3 . PAGES(S), WHICH INCLUDES THIS
COVER SHEET_
COMMENTS:
e oPc's‘) nth \ n n
a
ilk) mu tvi O VV -).
L.19.941 (May 1995)

0J/01/C004 05:56 FAX [phone]
WILLIAM TROTTER COMPANY
Z 002
Sewage Spill Response Evaluation:
p,0o&e (page 1)
Permitee � r �► �` (n _ Permit Number N.0 OO 1/`762 County ()Vi s c n
Incident Started: (Dateliime)fil pl( Incident Ended; (Date/Time) CO VI /J D I ��
If spill is ongoing, please notify Regional Office on a daily basis until spill can be stopped.
Reported to: bLo C mores reS Y t I k (Date/time) j S �4 i* 5 t*' J
weather conditions:
Source of spill/bypass (check one):
Level of treatment (check one):
Sanitary Sewer
Estimated volume`` of spill/bypass 606
Cu V1 �-5" C O 0
None
Pump Station VWVVTP
Primary Treatment
Secondary Treatment Chlorination Only
r.gallons, Show calculations.
ve au)
Did spill/bypass reach surface waters? V.Yes No (If Yes, please list the following)
Volume reaching surface waters? ."? gallon r
Name of surface water S ma I I \ rj b t a �� � C��e
Did spill/bypass result in a fish kill? Yes No
If Yes, what is the estimated number of fish killed?
Please provide the followina information:
1. Locatio of spiilll//bypass; , r — e
n ing {) u m f A t etyk
Loel)(Loyci- I
2. Cause of.spill/bypass:
e I
3. Did you have personnel available to perform initial assessment 24 hours/day (including weekends and
holida s)7
Yes No
4. How long did It take to make an initial assessment of the spill/overflow after first knowledge?
Hours © Minutes
How long did it take to get a repair crew onsfte7
Hours Q Minutes
Please explain the time taken to make initial assessment:
r

O'/01/2004 05:56 FAX [phone] WILLIAM TROTTER COMPANY RI003
Sewage Spill Response Evaluation:
C (Page 2)
gp oSQ l�` CO�coo3w�62.
Permitee l Cti L CO Permit Number County On l0 n
5. Actin tok�(erlto contain spill, ?Jean yp waste, andLor remediate the te:
t Wft\iert' 60. to4.? OVtrV4IAA) T
6. Were the equipm nt
Yes No
nd parts needed to make repairs re dily avai le?
If no, please explain why: 5/Q-QL(' Las
%t cLC i" "1
7. If ttie spill/overflow occurred at a pump station, or was the result of a pump station -failure, •
was the alarm system functional at the time of the spill? Yes_ No lithe alarm
system did not function, please explain why:
B. Repairs made are: Permanent Temporary
Please describe what repairs were made. If the repairs are temporary, please indicate a date by
which permanent repa will be completed, notify the Regional Office within 7 days of the
permanent repair. w' 4 lit, IZS- \-- $ Ant ¥t iA Vs,
VViR
9 What actiot ave been mede to prevent this disOar9e.from occurjg again n the future?
f k,PU..n 1 111Q V et -fit �1� OT �" �
9. Comments:
Other agencies notifed: ~ p N e-
Person reporting spill/bypass: Phone Number064) 5 DS-
Signature \�1 Date: ! r ► L , 2 Od
For DWQ Use Only:
DWQ requested additional written report? Yes
If yes, what additional information is needed?
Requested by
No

03/02/2004 06:
FAX [phone]
11®
WILLIAM TROTTER COMPANY
Gi00BE GR]lEoimacY7 Z'Y%YTY COmmp'3(.D7Y
• 1616 MOCKINGBIRD LANE
SURE 900
CHARLOTTE. N.C. 28209
[phone]
FAX[phone]
DATE:
Goose CieJCLJtWty. Company•
. .. .
TO: MR. Job lei ("_PS LiQ
COMPANY: M 60 it v i I
FAX#: (—/) 66 3 -66'+ o
FROM; lj )1 I 1 o * 1{- _I to -I--i--e r
RE: ( t_n wa s`ta ��`�ec— (7v e- r 4lo �)
TELEPHONE [phone]
THIS TRANSACTION CONSISTS OF 4 . PAGES(S), WHICH INCLUDES THIS
COVER SHEET.
COMMENTS: -Ilk is is &Ayr-- coot
dot \s--t1 cift *co s-- -Ale% its ow vto
over-410w. ur1e#- r Hna* e
will '0 0t41 +ovi er-rct-ti�
L_ 19.941 (May 1995)

03/02/2004 06:44 FAX [phone]
WILLIAM TROTTER COMPANY 002
Sewage Spill Response Evaluation:
0 OSe C e ►z (page 1)
Permitee 0+i i l A' CO C. Permit Number CD D 3 4�6 2 County UNION
OH a`,elinl a
Incident Started: (Date :me) Any I / 3 P MIncident Ended: (Date/Time) yy � �A qv
If spill is ongoing, , pe t7 f 1
p g g, please notify Regional Office on a daily basis until spr can be stoppea. / 2 h t
5 �S f w\ — Alia t— t51--
Reported to: 1 �, ►,i �• �/ (' (Date/time) ----#k sVilk-
weather conditions:
Source of spill/bypass (check one): Sanitary Sewer Pump Station VVWVTP
Level of treatment (check one): Y None Primary Treatment _ O5t ot y J
IV Secondary -Treatment Chlorination Only
Estimated volume of spill/bypass So ` 0 gallons. Show calculations.
A olck ec ell- k '3 haei-~ C'.K C 10S art—fl 0
Did spill/bypass reach surface waters? ' Yes
Volume. reaching surface waters?
6000
Name of surface water M i v' It` t �jll�dt
Did spill/bypass result in a fish kill? Yes
If Yes, what is ,the estimated number of fish kille
Please provide the following information:
1. Location of spill/bypass:
2. Cause. of'splll/bypass:
No (if Yes, please list the following)
gallons
OP' @a()S e-
e 1 -, cr eo -e — 6-e-04
3, Did you have personnel available to perform initial assessment 24 hours/day (including weekends and
holidays)?
Yes No
4. How long did it take to make an initial assessment of the spill/overflow after first knowledge?
Hours I (') Minutes
How long did it take to get a repair crew.onsite?
n Hours l7 Minutes
Please explain the time taken to make initial assessment:
von( k-- rs()r drivLtaat-b\i UT4-
t t Act e a vl Ar) Y-Mn a {Ov v

•
03/02/2004 06:44 FAX [phone] WILLIAM TROTTER COMPANY Z 003
Sewage Spill Response Evaluation:
(Page 2)
GooSe Cre MC
Permitee -VI k (L 4.V co Permit Number Q P)�i 3'"j C 1. County ON \. OR
5. Action taken to contain spill, clean up waste, and/or remediate 1he,site: L el v 'L °3
ii$9 tkr5 LA-1 (-5vOO 10 :'2c'a la w, } A tkr(n (sT" ccabitn
-c-- iPa`: Ili, nef- Lo `ter • - �rov� AVle-
c at re of -t-Ae_ WW1-- P.
6. Were the equipment and pars needed to make repairs readily avable?
Yes No V' If no. please explain why: ()\ P I ' +aw u 0r S
Caters1 Y A. *--.r- . p t ce-c IV e- a c l' On
1 Snag Q Vt u t-- <-.1, , �,. an Ot tA It 10k
COvtVl c Ct V?t-e\.
7. If the spill/overflow occurred at a pump station, or was the result of a pump station failure, •
was the alarm system functional at the time of the spill? Yes V No If the alarrn
system did not function, please explain why:
8. Repairs made are: Permanent Temporary
Please describe what repairs were made. If the repairs are temporary, please indicate a date by
which permanent repairs will be completed, and notify the Regional Office within 7 days of the
permanent repair.
k--*1` IAA am OA '4 pails ct re 00)1 VI- gal •
9. What ecti4ns have been viade to prevent this ischarge.from ccurin again' in the future?
TkotoAt-i�vl9ve itYlA ��
clot\ sy'Stems, Ls ?t QS 4
9. Comments:
Other agencies notifed: t Y er
Person reporting spill/bypass:\,1';IN lAt41/\ V0k►t1Phone NumberCZv t'{) J 1-7 83
9 �. ►X `.
5i nature � ©"M VIr) "- \t,r Date:1-�'-
For DWQ Use Only:
DWQ requested additional written report? Yes No
If yes, what additional information is needed?
Requested by

06:46 FAX [phone] WILLIAM TROTTER COMPANY
,osixa icx=caenoxic iO'rxx.rx-ir orx'3i br r
515 MOCKINGBIRD LANE
SUITE 900
CHARLOTTE, N.C. 28209
Goose C6ek.`Utility Company
TELEPHONE [phone]
[phone]
FAX[phone]
DATE: -
TO: Afik. �Ja h h tE="'S l l
COMPANY: Lt_..) Q . M , o rt• Svi l 1 @
FAX#: el 0 4) 663-664-0
FROM: 1 I i-0 ZN J• L t`_'a e
RE: O'Oh Gr,Id WA SI& firer— OVP't+1 el1
THIS TRANSACTION CONSISTS OF 1 , PAGES(S), WHICH INCLUDES THIS
COVER SHEET.
COMMENTS: T14 is t_S coin- a vNp�
U c i 1 t-e- WA- t- 'l�1 iS )'1 1 Yt
evet ow . Fuiile t- r►'PrWo*€)V
‘xii1k %-i7e) 114 rr ou.d
L_ 19.941 (May 1995)

4 06:46 FAX [phone]
WILLIAM TROTTER COMPANY ffj002
Sewage Spill Response Evaluation:
O OSe Ct �C (page 1)
Permitee f +i l l T �D , Permit NumberM COo3 4 6 2, County U ti t b N
Incident Started: (Date ime)Ave t / 3 m incident Ended: O h O! h /j Q S
;ovp7far
ifspill is ongoing, please notify Regional Dice on a daily basis until spi can be stoppea. Y1
r2eported to: b R.,/tbc,„-.5 v;1 i e (Date/time)'" ÷s f ' -*a
t- iststAk-
weather conditions; 5 l < < '. 1 e ,
,.. � '•► Y 1 ► � / I i • � mil/ VA
Source of spill/bypass (check one): Sanitary Sewer Pump Station /WVVTP
Level of treatment (check one): V None Primary Treatment
VI 05f �
Ve Secondary Treatment Chlorination Only ( -eaCt Estimated volume of spill/bypass SO ` 0 gallons. Show calculations.
aacke V.)dfk SheCv+,cl0surt 0
Did spill/bypass reach surface waters? Yes No (If Yes, please list the following)
Volume reaching surface waters?
6 DOo
gallons
Name of surface water M { pelt- 1t- bu,lid,t- O @t)o5 e C
Did spill/bypass result in a fish kill? Yes
If Yes, what. is the estimated number of fish kille
Please provide the following information:
1. Location of spill/bypass: rA� , P- r t ? l0
O,nt rIAIM� 5 d �1r9'Vk e uu
2. Cause of spill/bypass:
Vl MA, a tI
e ►-�-r`w re corei ; to
3. Did you have personnel available to perform initial assessment 24 hours/day (including weekends and
holidays)?
Yes \ /r No
4. How lona did it take to make an initial assessment of the spill/overflow after first knowledge?
Hours I a Minutes
How long did it take to get a repair crew.onsite?
Hours CI Minutes
Please explain the time taken to make initial assessment:
.c.t)bSe
o —
OC d Vl Q () inn- a trMA oL 1(Otk-
Tj

146 FAX [phone] WILLIAM TROTTER COMPANY 1j003
Sewage Spill Response Evaluation:
(Pagc 2)
pOse Ct
Permitee ; \ i �y Permit Number 0 a:S4.7 C 2, County O� 1. OL�I
5. Acton taken to contain spill. clean up waste, and/or rernediate The site: j %►,.p r, vef f LO
-00 liLQui Chi kitoe to :-&() ?trot) Patrt, (s7"\ cows'
f i ete X SAG- Looller
-% 't tree-
c \ctt V A`E- "gent?-
6, Were the equipment and parts needed to make repairs readily av "able?
Yes No V' If no, please explain why: tN t '�tk) u)OI S
(i.1 r rP-C'ft Oi c
-s t-- , g tit 1Oh
C� rnvl T� 'Crht'C`Gt ��. .
Y
7. If the spill/overflow occurred at a pump station, or was the result of a pump station failure, •
was the alarm system functional at the time of the spill? Yes V No lithe alarm
system did not function, please explain why:
8. Repairs made are: Permanent Temporary
Please describe what repairs were made. If the repairs are temporary. •please indicate a date by
which permanent repairs will be completed, and notify the Regional Office within 7.days of the
permanent repair. i
9. What Tactiopns have been ade to prevent this ischarge.from ccurin again 'in the future?
1 IA orDut% \-ev1UvQ IM ti t�
9. Comments:
Other agencies notifed:
f\ton
Person reporting spill/bypass: ),1; WA. refit Phone Number(Z(1-1 83
Signature\ ""110: 2
Date: �a ,,2-00/÷
For DWQ.Use Only:
DWQ requested additional written report? Yes
If yes, what additional information is needed?
Requested by
l
No

06:46 FAX [phone]
WILLIAM TROTTER COMPANY E 004
S (} 131 5IM
!LA 1/1._ rp‘
dy_e:r41,0_to •
d \r ---.....� t_._.o_.�
- -
-o-
mAR
0.._�,.._._ to
;Dp
m
00.
.___._... _. ate
OD am_
t_\:, dry a
- ST
G4G0
300 13:0 0
330 ` 90 ,8010

Form CS-SSO
Collection System Sanitary Sewer Overflow Reporting Form
PART I
This form shall be submitted to the appropriate DWQ Regional Office within five daysof the first knowledge of
the sanitary sewer overflow (SSO).
Permit Number : NC0034762 (WQCS# if active, otherwise use treatment plant NC/WQ#)���d ,
WWTP incident #
I dal
Goose Creek Utility Company Region: #�
Stallings, NC County' Union
Facility:
Owner:
City
Source of SSO (check applicable) : Sanitary Sewer ❑ Pump 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, eta) : Clarifier and'' adration tank at WWTP
Latitude (degrees/minute/second)- Longitude(degreeslminute/second)•
Incident Started Dt 0.4=14=05 Time. 4 : 00 A.M.
(mm-dd-yyyy)
Estimated volume of the SSO:
hh:mm AM/PM
4700 gallons
Incident End Dt Q_4.-14-05 Time, 9:00 P.M.
(mm-dd-yyyy) hh:rnm AM/PM
Estimated Duration (Round to nearest hour);18
Describe how the volume was determined: visual; estimation
Weather conditions during SSO event Heavy rain changi .g to partly clojidy (after 2 days of rain)
Did SSO reach surface waters? Q Yes ❑ No ❑ Unknown Volume reaching surface waters (gallons):
Surface wafer name: small tributary of Goose Creek
Did the SSO result in a fish kill?
SPECIFIC cause(s) of the 550:
Q Severe Natural Condition
❑ inflow and Infiltration
❑ vandalism
Immediate 24-hour verbal notification reported to:
DWQ EJ Emergency Mgmt.
❑ Yes ® No ❑ Unknown if Yes, what is the estimated number of fish killed?
o
Grease
Pump Station Equipment Failure
Debris in line
❑ Roots
❑ Power outage
❑ Other (Please explain in Part II)
Ms. Barbara Sifford at DWQ (Mooresville)
Date (mm-dd-yyyy): 4-14-05 Time (hh:mm AM/PM): 4: 40 P . M.
if an SSO is ongoing, please notify Regional Office on a daily basis until SSO can be stopped.
Tier 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 11 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 1l IS COMPLETED, A SIGNATURE l5 REQUIRED AT THE END OF THiS FORM.
CS-SSO Form October 9, 2003 Page 1

.uc
Form CS-SSO
Collection System Sanitary Sewer Overflow Reporting Form
PART I I
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 SECTIONS 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 DWQ REGIONAL OFFICE
UNLESS IT HAS BEEN SUBMITTED ELECTRONICALLY THROUGH THE ONLINE REPORTING SYSTEM
Severe Natural Condition (hurricane, tornado, ete.1 •
Describe the "severe natural condition" in detail -
Rainfall very heavy for a prolong-d period on.,theoprevious aftesnooi, evening and night
How much advance warring did you have and what actions were taken in preparation for the event?
Weather forcasts gave notice; wet well alarm sounded.
Comments:
The cause being I & I, no hasty preparations were feasible —
Grease (Documentation such as cleaning, inspections, enforcement
actions, past overflow reports, educational material and distribution date,
etc. should be available upon reguest.)
(Not applicable)
en was the last time this specific line (or wet well) was cleaned?
Do you have at : nforceable grease ordinance that requires new or retrofit of grease traps/interceptors?
Have there been recent insp: ons and/or enforcement actions taken on nearby restaurants or other Yes:No ONA ❑NE
nonresidential grease contributo
Explain.
Have there been other SSOs or blockages in this area the ere also cau -. by grease?
When?
If yes, describe them:
Have cleaning and inspections = - r been increased at this location?
Explain.
CS-SSO Forrn
DY
EINAONE
LlYesD No ❑NA ONE
❑ YesD No DNA O NE
October 9, 2003 Page 2

ve educational materials about grease been distributed in the past?
When?
and to whom?
Explain?
(Not Applicable)
if + - SSO occurred at a pump station, when was the wet well and pumps last checked for grease
accu lation?
Were the fioa clean?
Comments:
Roots
Do you have an active root control program
Describe
Have cleaning and inspections ever been increased at thls locati
Explain:
use of roots?
DYest.,J
❑NAONE
NA LINE
OYesID NoCNAElNE
UYe80NoDNA ONE
What corrective actions have been accompiishe• t the SSO location (and surrounds • system if
associated with the SSO)?
What corrective actions are planned • he SSO location to reduce root intrusion?
Has the line been smoke t
if Yes, when?
Com ts:
d or videoed within the past year?
OYes0 No0NAONE
inflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule in any permit that
addresses 1/I?
fElYes: No DNA ONE
CS-SSO Form October 9, 2003
Page 3

Explain if Yes:
What corrective actions have been taken to reduce or eliminate I & 1 related overflows at this spill location
within the last year?
Video tape of col l ecti nn S ,St flow study leading to major con j--�
Has there been any flow studies to determine ill problems in the collection system at the SSO location? YesD No DNA UNE
Flow studies VY1Ae`C -keY►MS o-- our SOC hay Leh Com etea(,r
If Yes, when was the study completed and what actions did it recommend?
FP b D-coSs P S'i V £ i 01 Yi c ; L i +ot 0 h •
Has the line been smoke.tested or videoed within the past year? Ye No NA NE
If Yes. when and indicate what actions are necessary and•the status of such actions:
Extensive renovation. proposed in our SOC application, and now unde�yrr� contract
Are there IA related projects in your Capital Improvement Plan? lAYesD No Li NA 0 NE
If Yes, explain: k' tA, yA 1 S In Q V 9 q e h ( \\ o c Q+Go
car I
Have there been any grant or loan a • plicatio s for I/1 reduction projects? � Yesi No DNA ONE
If Yes, explain:
Do you suspect any major sources of inflow or cross connections with storm sewers?
If Yes. explain:
Have all lines contacting surface waters in the SSO location and upstream been Inspected recently? YeeNo DNA ONE
If Yes, explain:
�D i 1rti GS are -ilk
DYen No ❑NA ONE
Co VACI,c4 L* 1S 4,4a Ce- t.oq `r5
What other corrective actions are planned to prevent future I/1 related SSOs at this location?
Our proposed actions are very comprehensive. starting with the mnct critical areas
Comments:
The small amount of sludge eft on the ro
been limed.
Pum2 Station Equipment Failure (Documentation of testing, records etc.,
shout be erovided upon request.) (Not applicable)
What kind of notification/alarm systems are present?
Auto-dialer/telemetry (one-way communication)
CS-SSO Form October 9, 2003
near the WWTP enclosure have
Page 4

(Not applicable
Audible
Visual
SCADA (two-way communication)
ergancy Contact Signage
Other
Describe the equipment that faile
What kind of situations trigger an alarm • ndition at this station (I.e. pump failure, power failur: , high
water, etc.)?
Were notification/alarm systems operable? DYe D No DNA ONE
1_lYee
Eyes
QYes
Yes
If no, explain:
If a pump failed, when was the last maintenance and/or insp ction parlor ed?
What specifically was checked/maintained?
• If a valve failed, when was it last exercised?
Were ail pumps set to alternate?
Did any pump show above normal run times r 'or to and during the SSO event?
Were adequate spare parts on hand t. ix the equipment (switch, fuse, valve, seal, etc.)?
Was a spare or portable pump ' mediately available?
If a float problem, when ere the floats last tested? How?
If an auto -dialer o SCADA, when was the system last tested? How'?
Comment
S-SSO Form October 9, 2003
❑Yesf No DNADNE
oYeso No DNA LINE
DYesD NoDNADNE
DYesD No DNA DNE
Page

Power outage (Documentation of testing , records, etc. should
provided of alternative power source upon request.)
What is your alternate power or pumping source?
On -Site Generator w/ATS
Did it
(Not Applicable
ction properly?
Describe?
When was the alternate power or
•
QYesu No
NE
ping source last tested under load?
If caused by a weather event, how much advan : warning did you have and wh ctions were taken to .
prepare for the event?
Comments:
Vandalism
Provide police report number:
Was the site secured
if YPa
P
•
ocked Control Panel
Not Applicable
EllJDNo❑NADNE
ere been previous problems with vandalism at the SSO location? ❑YesLJ No
If Yes, explain:
What security measures have be
Comments:
ut in place to prevent similar occurrences in the future?
NE
�Ye30 NoENADNE
Debris in line (Rocks, sticks rags and other items flowed in the
collection system, etc.)
What type of debris has been found in the line?
How could it have gotten there?
Are manholes in th
ea secure and intact?
CS-SSO Form October 9.2003
Page

as the area last checked/leaned?
Have cleaning and Inspection er been increased at this location due to previous problems with debris?
Explain_
Are appropriate educational materials being dev
occurrences?
Comments:
o DNA ONE
and distributed to prevent ' - - similar D Yon No❑NAONE
Other (Pictures and a police report should be available upon request.)
-Describe:
\
Were adequate equip - - . nd resources available to fix the problem?
if Yes, explain:
If the problem could not be immediately rep
SSO?
Comments:
For DWQ Use Only:
DWQ Requested an Additional Written Report:
If Yes, What Additional Information is Needed:
, what actions were taken to le
omments:
(Npt Applicable)
the impact of the
®YesD NoDNADNE
LiYe5D No ❑NA ONE
CS-SSO Form October 9, 2003 Page 7

IIU I T G.V VT I T. I V
As a representative for the responsible party, l certify that the information contained in this report Is true and accurate
to the best of my knowledge_
Person submitting claim:
Signature:
Date: April 19, 2005
Title ?ecen+
Telephone Number: CI ®Li•-) ti 83
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 October 9, 2003
Page 8

Goose Creek Utility Company
1515 Mockingbird Lane
Suite 900
Charlotte, NC 28209
April 19, 2005
Mr. D. Rex Gleason, Regional Supervisor
Division of Water Quality
610 East Center Avenue, Suite 301
Mooresville, NC 28115
SUBJECT: Report of Waste Water Spill
Fairfield Plantation WWTP
NPDES Permit No. NC0034762
Union County, NC
Dear Mr. Gleason,
Goose Creek Utility Company
Telephone.[phone]
14G DEPT. OF E MRON Et
AN €;s `: �,, ��;, .,... 7 ` 1 CE .
RR 2 ; 2005
This letter is to report a waste water spill from the sewer system at Fairfield Plantation.
1. Verbal Notice was given to Ms. Barbara Sifford of your office at 4:40 P.M. on April
14th. On the evening of April 15th, we also made the required news release to the three
designated media contacts for Union County.
2. We are also enclosing our final report herewith on the DWQ Collection System
Sanitary Sewer Overflow Reporting Form.
3. This overflow was caused by a long period of very heavy rainfall in a period of
already saturated ground conditions.
Please let us know if additional information is desired regarding this matter.
Sincerely,
GOOSE CREEK UTI ,ITY COMPANY
Paul H. Trotter
President
Enclosure: DWQ Form (CS-SSO)

Collection System SSO 24-Hour Notification
Required Information
Incident No.
AooSO/Q/
Incident Reviewed (Date):
Incident Action Taken: ,/ BPJ
NOV
Spill Dat
Reported Date
,('o 0 444 q,9 ?j
Time 5:30 am pm
Time 4.445 am
Reported To (SWP Staff) 6S
Reported By
Phone
Address of Spill 1��ag-- k)ct7 P
City (Spill Location)
a
County
Collection System: SSO
WQCS00
Map Location
Cause of Spill
0-Y\ 0-err‘...
EstimatedLZallon�
Stream L6� Fish Kill: CID Yes, How many?
WWTP Spill: Bypass
NPDES NC00 3W7&
WWTP
diozial Gal to Surface Waters A--/C
Comments
?5S i

Immediate 24-hour verbal notification reported to:
❑ DWQ 1-X1Emergency Mgmt.
Form CS-SSO
Collection System Sanitary Sewer Overflow Reporting Form
PART I
This form shall be submitted to the appro riate DW4Q.ereizr al Office within five days of the first knowledge of A,_
the sanitary seweroverflclui{SSQ11"2_ �
Permit Number: NC0034762 A�oaga�
(WQCS# if active, otherwise use treatment plant NC/WQ#)
Facility: Collection System Incident#
Owner: Goose Creek Utility Company Region:
city; Stallings, NC County: Union
mko
Source of SSO (check applicable) : D Sanitary Sewer
❑ Pump Station
SPECIFIC location of the SSO (be consistent in description from past reports or documentatio i e. mp Station 6,
Manhole at Westall & Bragg Street, etc.) : 6776 Stoney Ridge Road
Latitude (degrees/minute/second):
Incident Started Di: 09-10-05 Time_ 4:00 PM
(mm-dd-yyyy) hh:mm AM/PM
Estimated volume of the SSO: 80 gallons
Describe how the volume was determined; Estimated from
Weather conditions during SSO event Dry, sunny
Did SSO reach surface waters? (1 'Yes ❑ No ❑ Unknown
Surface water name: Neighborhood storm drain
Longitude(d egreesfmieute/second):.
Incident End Dt- 09-11-05
(mm-dd-yyyy)
Time 11:00 AM
hh:rnm AM/PM
Estimated Duration (Round to nearest hour):
eye witness descriptions
1.0
Volume reaching surface waters (gallons): 78 gal.
5p- Coo e—
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 Condition ❑ Grease
❑ inflow and Infiltration 0 Pump Station Equipment Failure
❑ Vandalism ® Debris in line
Weekend Phone# [phone]`
N/A
❑ Roots
❑ Power outage
❑ Other (Please explain in Part II)
Date (mm-dd-yyyy): 09-11-05 Time (hh:mm AM/PM): 2: 30 PM
If an SSO is ongoing, please notify Regional Office on a daily basis until SSO can be stopped.
er 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, ma take enforcement action for SSOs that are re aired to be re orted 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 11 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 11 IS COMPLETED, A SIGNATURE IS REQUIRED AT THE END OF THIS FORM.
CS-SSO Form October 9, 2003 Page 1

T.

,v U, t L u U t , t. 1 V
wer outage (Documentation of testing, records, etc., should be
'ded of alternative power source upon request.)
What is ur alternate power or pumping source?
Did it function p
Describe?
When was the alternate power or p
If caused by a weather event, how much a
prepare for the event?
Comments:
Vandalism
Provide police report number:
Was the site secured?
If Vc hnvol
Padlocked Control Panel
Have there been previousprob ms with vandalism at the SSO location?
If Yes, explain:
What security easures have been put in place to prevent similar occurrences in the future?
Com - nis:
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?
Paper; sewer solids
How could it have gotten there?
Residential Customers flushin
Are manholes in the area secure and intact?
CS-SSO Farm October 9, 2003
Yesu No NA ONE
❑Ye� No❑NAONE
DYeslu No UNA' NE
❑Y No❑NADNE
IIYeJJ No LJNA v NE
Page 6

I4L. JLi1n PI no
1 GA. 7 UYUU,JUUYU
NCI
T C. V U T 1 T. 1 1! 1. ,0 1
When was the area last checked/cleaned?
Have cleaning and inspections ever been increased at this location due to previous problems with debris? ® Yesfl No ❑NA DNE
explain: Complete system —wide
cleaning in 2003
Are appropriate educational materials being developed and distributed to prevent future similar ®YesEJ No DNA EINE
occurrences?
Comments: We intend to put appropriate instructions in our next
written communication to customers
Other (Pictures and a police report should be available upon request.)
•
Describe; This was an intemittent overflow at a manhole .in the street.
It flowed down the curb to a catch basin.
Were adequate equipment and resources available to fix the problem?
If Yes, explain_ Our regular contractor (Roto, Rooter Plumbing Co.) sent a
specially equipped truck promptly, when called.
®YesD NoDNA ONE
If the problem could not be immediately repaired, what actions were taken to lessen the impact of the
SSO? The flow occurred only at two brief, peak periods en Saturday and Sunday.
Comments: We were not notified until after the last flow stopped.
For DWO Use Only:
DWQ Requested an Additional Written Report:
If Yes, What Additional Information is Needed:
Comments:
CS-SSO Form
October 9, 2003
LJYes No DNA ONE
Page 7

IYLUCNII PM) rdr,: sU4UOJOU4U
I,IdI 4 GUU4 14. 1 U I . UU
As a representative for the responsible party, 1 certify that the information contained in this report Is true and accurate
to the best of my knowledge_
Person submitting claim:
Signature:
Paul H. Trotter
Title'
Date: September 13, 2005
President
Telephone Number: 704-525-1783
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 October 9, 2003 Page 8

Goose Creek Utility Company
1515 Mockingbird Lane
Suite 900
Charlotte, NC 28209
September 13, 2005
Mr. D. Rex Gleason, Regional Supervisor
Division of Water Quality
610 East Center Avenue, Suite 301
Mooresville, NC 28115
SUBJECT: Report of Waste Water Spill
Fairfield Plantation WWTP
NPDES Permit No. NC0034762
Union County, NC
Dear Mr. Gleason,
GC. I2.2i
Goose Creek Utility Company
Telephone.[phone]
GA,R5 T C. OF EN'V ! C: 2r'i Ettt
AND r l.A 'URAL
4`JIGGRE Nt.i j_,
SE[- 5i n.,r,`
�Uh�.)
u ACE t II0K
This letter is to report a waste water spill from the sewer collection system at Fairfield
Plantation.
1. Verbal Notice was given by telephone on Sunday, September 11, 2005, at 2:30 P.M.
to the North Carolina Office of Emergency Management. V 6
2. We are also enclosing our final report herewith on the DWQ Collection System
Sanitary Sewer Overflow Reporting Form.
3. This overflow was caused by debris in .a collection line.
Please let us know if additional information is desired regarding this matter.
Sincerely,
GOOSE CREEK UTILITY COMPANY
Paul H. Trotter
President
Enclosure: 1. DWQ Form (CS-SSO)

Collection System SSO 24-Hour Notification
Required Information
Incident No.
Incident Reviewed (Date):
Incident Action Taken: BPJ
NOV
Spill Date Cj l 4 Time IRO
O
Reported Date q 1 bl
Time 02: am
(SWP Staff 6 i` 4ftez,
Reported To ( )/�/ ('xx(`''��
1
Reported By �i(J• r J'� Phone 0r 5 5 rI�/♦ V�
Address of Spill 40 77C2 Adv. a
County 'rn.) , a . City (Spill Location) di4.14)1
4-67itite
‘44a44,ex)
Collection System: SSO
WQCS00
Map Location
Cause of Spill
Estimated Gallons 100
Gal to Surface Waters PO SD
WWTP Spill: Bypass
NPDES NCO D ,__
Stream
Comments
WWTP
,„)
Fish Kill: No Yes, How many?

LyF w A rV
'O
CO
o.
G
.. ' . •Form CS-SSO
.
a Tomy .... Callecfivn System Sanitary Sewer OverFlovd'Re"PoringlFormi�bNA ,
...
AND 4 AI 744 t" S0LIPCES
MOORESVJL•ART•!i<t �;J FIC
•
This form shall be submitted to the appropriate DWQ Regional Office within five days of the first knowledge of
•the sanitary sewer overflow. (SSO). . 1
,Permit Number: NC• 00.34.7.62.. •.. • •• •-: j.i_ %Q�' S (� PIN' GJin� •
Fairfield SWQCS# if active, otherwise use WQCSD# �QR 2 ,. Facility: , Plantation WWTP ;... )
• Owner: se Creek utility Company Incidental o�0a�% Or'j 3� !�
City; Stallings Region:
Source of 5S0 (check applicable) ; ® . . County:ion / Lift Station
•Union
Sanitary Sewer ❑ Pui��if_i ����II,
SPECIFIC location of the SSO (be consistent in description from past reports or dop cumentation - Le, PumpStation 6 ��� ���� ��`` r u �l ��
Manhole at Westall & Bragg Street, etc.) : Back yard at 15913 Fairfield n =•
anhole# y Drive
(vicinit of MH #21)
atitude (degrees/minute/second):
1 cident Started Dt: 01-01-2007 11:30• AM
(rm-dd-yyyy) lime;
hh:mm AM/PM
Estimated•volume of the SSO:. 950
gallons
Time: 06�00 PM
hh:mm AM/PM
Estimated.Duration (Round to nearest hour);
• ascribe how the volume'wasdeterrriined ;Estimated by experienced observer. .
leather conditions during:s50 event' • Cloudy
4rracewtername:
id SSO reach surface wters? ❑ Yes ❑ No❑ Unkown Volume reachng surface waters(lons):
small tributary to Goose Creek
Longitude (degrees/mi nutelsecond):.
incident End Dt: 01-02-2007 .
(mm•dd-yyyy)
Df d the SSO result in a fish kill? 0 Yes L.0 No❑ Unknown
• SPECIFIC cause(s) of the SSO:
0 Severe Natural Condition 0 Grease
.❑ inflow and Infiltration . ❑ Pump Station Equipment Failure
0 Vandalism Debris in line
❑ Pipe Failure (Break) ••
verbal notification (name•ofperson"contacted) 11s. Barbara Sifford, Mooresville Office
•I f I .DWQ • . Q Emergency Mgrrit •• . •
Date (mm-dd-yyyy): 1-08-200.7 Time (hh:mm AM/PM).
If art SSO is ongoing; please notify Regional Office on a daily basis until SSO can be Stopped.
r'G.S: 143:215:1'C(b); the responsible party of a discharge of 1,000 gallons or more of untreated Wastewater to surface
‘raters shall issue a press release within 48-hours of first knowledge to ail print and electronic news media providing general
.verage in the•count w i charge occurred. When 15,000 gallons or more of untreated wastewater enters surface
tars, a public notice shall be published within 10 days and proof of publication shall be provided to the Division within 30 days.
fer to the reterencea statute for further detail.
30
600
❑ Roots
❑ Power s5utage
D Other (Please explain in Part II)
T e Director, Division of Water Quality, may take enforcement action for SSOs that are required to be reported to Division unless it
�s • emons ra e. a
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
a d/or owner, and the discharge could not have been prevented by the exercise of reasonable control.
A_ rt II must be completed to provide a justification claim for either of the above situations. This information will be the basis
fo the•determination of any enforcement action. Therefore, it is important to be as complete as possible.
ETHER OR NOT PART 11 IS COMPLETED, A SIGNATURE IS REQUIRED AT THE END OF THIS FORM.
-SSO Form
Page 1.

11. LJ LI-11-1,-1 1 J • 1 - I -I 1 • LJU
• •••:•;:• •••••,•. • • • :; ';" • • • • • .•
CS
'. • : . • . • Form CS-.SSO•• •
Collection System' Sanitary Sewer= Overflow Reporting Form
•• PART I
THEANSWER THE FOLLOWING QUESTIONS FOR EACH RELATED CAUSE CHECKED IN PART 1 OF THIS FORM AND
INCLUDE APPROPRIATE DOCUMENTATION AS REQUIRED OR DESIRED
COMPLETE ONLY THOSE SECTIONS 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 Td THE APPROPRt DWQ REGONAL OFJC
UNLESSITHASBEENSUBMITTEDELECTRONICALLYTHROUGHTHEONLINEREPORTINGSYSTEM
GENERAL COMMENTS:
1. This Report (Form CS-SSO) is submitted to explain an overflow which occurred on
jilnuary 1st and ended On January 2nd, 2007.
2. This spill began about 11:30 on January 1st when a plumber employed by the•
residents opened a rear yard clean out to relieve the possibility of an
• overflow into the house. The said overflow was reported to. us on the following
_dity by Ms. Baker, a resident of this house.
•
3. The overflow was reported to our Company on the morning of January 2nd. After
first speaking with Ms. Baker at about 9:30 AM, by 9:40 AM (Jan. 2nd) our
representative (Mr. Phil Felten) had called our contractor (Roto-Rooter) fpr
• _ emergency service on the .sewer main in the street in front of this house '
(15913 Fairfield Drive).
* 4. Dud' to unexpected delays by the Roto Rooter Company, their truck and operator
did not arrive at this site until after 4:30 PM. But by 6:00 PM they reported
that the sewer main .in Fairfield Drive line was unclogged, and that they had
removed a lot of liflushable wipes". Mr. Thomas Baker also stated that by
6:00.PM the commodes in this house were again operating.
SSO Porn)
ga 64 - .dt,e zvaie,P
C/6 cold, gs..
Page 2

•
D,ebris 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? •
Primarily grease and "washable wipes"
SusOected cause or source of debris:.
Re:ular domestid use '
Are manholes in the area secure and intact? .
When was the area last checked/leaned?
Y: No D NAD NE'
n 2005 •
Have cleaning and inspections ever been increased at this locationdue to previous problems with debris? D Yea No D NAD NF
.Explain: .
We adopted a 24—month clean out policy
Are appropriate educational materials being developed and distributed to prevent future similar ' .
occurrences?
Comments_
:.:No•tiCe'. to, a'll .,customers js''to..be sent out. within. 60 days. •
SSO Form • '
No D NAD NE
Page 11

• •
System Visitation •
ORC
Name:
Cert#
Date visited:
Time visited:
EI Yes
DYes
Jerry Sullivan
. . #6828
January 3, 2007
3:30 PM -
How was the SSO. remedlated (Le, Stopped and cleaned up)? . Overf low was stopped by 6:00 PM January 2.nd.
Cleanup and lime application January 3rd and • January 4th. •
As a representative for the responsible party, l certify thatthe informatiOn containedin this report is true and accurate to,
the best of my knowledge. . .l•
Person SUbraittincj Goose Creek Utility Company
Signature:
Paul fl. Trotter
Telephone Number: [phone]
• Date: January 18, 2007
• • President. .
Any additional information desired to be submitted should be sent to the appropriate-Division'Regional Officewithin'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 15 '

Collection System SSO 24-Hour Notification
Required Information
•
Incident No.
Incident Reviewed (Date):
Incident Action Taken: BPJ
NOV
Spill Date / /o 7 Time / f
l /�
Reported Date 0 �r'g[J am/
Reported To (SWP Staff)
Reported By — I d444Phone
4leAle
City. (Spill Location) ratr4 thiAtv-('
Address of Spill
County
Time
65
Collection System: SSO WWTP Spill: Bypass �G���
WQCS00 NPDES NCO() c7
Map Location WWTP
Cause of Spill
Estimated Gallons
Gal to Surface Waters
Stream Fish Kill: No Yes, How many? //4c,t
'12040-1-
cebse.12..4, p
lAY SA -AU -Ls- C s ?c1-- 67c 'p
Comments
4

Goose Creek Utility Company
1515 Mockingbird Lane
Suite 900
Charlotte, NC 28209
November 27, 2006
Mr. D. Rex Gleason, Regional Supervisor
Division of Water Quality
610 East Center Avenue, Suite 301
Mooresville, NC 28115
SUBJECT: Report of Waste Water Spill
Fairfield Plantation WWTP
NPDES Permit No. NC0034762
Union County, NC
Dear Mr. Gleason,
Goose Creek Utility Company
Telephone. [phone]
�� V Y�:dJ1 ,ty LTlr�
NOV 2 9 200,
1PIATERQUALITYS CTF I
This letter is to report a waste water spill from the sewer system at Fairfield Plantation.
1. Verbal Notice was given to Mr. John Leslie of your office at 3:40 P.M. on November
22na Later that same afternoon, we also made the required news release to the three
designated media contacts for Union County.
2. We will also publish the "public notice" required by NCDENR and send copies to
DWQ.
3. We are also enclosing our final report herewith on the DWQ Collection System
Sanitary Sewer Overflow Reporting Form (only the applicable pages are included).
4. This overflow was caused by an extremely heavy rainfall in a period of already wet
ground conditions. This rainfall also occurred within a short period of time (4.1 inches
within 32 hours, of which 3 inches fell within 19 hours, as measured by a gauge at this
WWTP).
Please let us know if additional information is desired regarding this matter.
Sincerely,
GOOSE CREEK UTILITY COMPANY
[it
Paul H. Trotter
President
Enclosure: 1. DWQ Form (CS-SSO)

Form CS-SSO
Collection System Sanitary Sewer Overflow Reporting Form
PART I
This form shall be submitted to the appropriate DWQ Regional Office within five days of the first knowledge of `l `
the sanitary sewer overflow (SSO), r i/� r J1� J ! ((�
Permit Number : NC0034762 (WQCS# if active, otherwise use treatment plant NC/WQ#)
Facility: WWTP Incident #
Goose Creek Utility Company
Owner: Region: City. Stallin s, NC County Union
Source of SSO (check applicable) : ® Sanitary Sewer ❑ Pump Station
SPECIFIC location of the SSO (be consistent in description from past reports or documentation - i.e. Pump Station 6,
Manhole at Weston & Bragg Street, etc.) : Clarifier at WWTP
Latitude (degrees/minute/second):
Incident Started Dt: 11-22-06 rime. 12:01 A.M. Incident End Dt 11-22-06 Time, 8: 00 P.M.
(mm-dd-yyyy) hh:mm AM/PM
Estimated volume of the SSO: 24, 000 gallons
Longitude(d egreesfminute/second)•
(mm-dd-vyyy) hh:rnm AM/PM
Estimated Duration (Round to nearest hour)? 20
Describe how the volume was determined: visual; estimation
Weather conditions during SSO event_. extremely heavy rainfall . chancina t
Did SSO reach surface waters? g Yes ❑ No 0 Unknown
Surface water name: small tributary of Goose Creek
Did the SSO result in a fish kill? ❑ Yes EINo ❑ Unknown If Yes, what is the estimated number of fish killed?
Volume reaching surface waters (gallons): 23, 000
SPECIFIC cause(s) of the SSO:
alSevere Natural Condition El Grease ❑Roots
O inflow and Infiltration ❑ Pump Station Equipment Failure ❑Power outage
❑ Vandalism El Debris in line ❑ Other (Please explain in Part II)
f�'` ediate 24-hour verbal notification reported to: Mr. John Leslie at DWQ (Mooresbille)
I 1 DWQ ❑ Emergency Mgmt. Date (mm-dd-yyyy): 11-22-06 Time (hh:mm AM/PM): 3 : 40 P . M.
if an SSO is ongoing, please notify Regional Office on a daily basis until SSO can be stopped.
I�er 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 4a-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 Permittea
and/or owner, and the discharge could not have been prevented by the exercise of reasonable control.
Part 11 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 SIGNATURE IS REQUIRED AT THE END OF THIS FORM.
CS-SSO Form October 9.2003 Page 1

Form CS-SSO
Collection System Sanitary Sewer Overflow Reporting Form
PART 1 I
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 SECTIONS 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 DWQ REGIONAL OFFICE
UNLESS lT HAS BEEN SUBMITTED ELECTRONICALLY THROUGH THE ONLINE REPORTING SYSTEM
Severe Natural Condition (hurricane, tornado, etc.)
Describe the "severe natural condition" in detail.
Extremely heavy rainfall, whirloccurred within a relatively short period of time.
How much advance warning did you have and what actions were taken in preparation for the event?
Weather forcasts. gave notice; ORC was nearby and on alert.
Comments:
The cause being I & I. no hasty preparations were feasible.
Grease (Documentation such as cleaning, inspections, enforcement
actions, past overflow reports, educational material and distribution date,
etc. should be available upon request.) (Not applicable)
n was the last time this specific line (or wet well) was cleaned?
Do you have a = nforceable grease ordinance that requires new or retrofit of grease traps/interceptors?
D YesD
NA ONE
Have there been recent inspions and/or enforcement actions taken on nearby restaurants or other • Yes1=1 No DNA D NE
nonresidential grease contributo
Explain.
Have there been other SSOs or blockages in this area the ere also cans
When?
If yes, describe them:
Have cleaning and inspections
Explain.
r been increased at thls location?
y grease?
❑Yes0 No DNA LINE
❑YesEl NoDNAONE
Cs-SSO Form October 9, 2003 Page

Ir L. ULIrn I'I11V
I dY: fU4UUJUU4U
I,Idf 4 L UU4 14; 10 r. uo
ave educational materials about grease bean distributed in the past? DYes0 NoDNAD
When?
and to whom?
Explain?
lfthe SSO occurred at a pump
accumulation?
Were the floats clean?
Comments:
Roots
bon, when was the wet well and pumps last checked for grease
Do you have an active root control program?
Describe
Have cleaning and inspections ever been increased
Explain:
DYesD NoDNADNE
❑Ye>D NoDNIA LINE
this location because of
What corrective actions have been a
associated with the SSO)?
ots?
ElYeap No DNA ONE
omplished at the SSO location (and surrounding system
What corrective actions are
nned at the SSO location to reduce root intrusion?
Has the line been s
If Yes. when
Com
ents:
e tested or videoed within the past year?
dOrT APRoLIEGYM^LE-)
�fnfl'�w ndwin�lt�atioct�
Are you under an SOC (Special Order by Consent) or do you have a schedule in any permit that
addresses Ill?
CS-SSO Form October 9, 2003
e1:1 DNA ONE
0YeieNo DNA LINE
Page 3

11UIJLuI11 1'117V
106.7 W*UUUUUYU
NOI Y L U V Y It. l U 1• AJ ,
Explain if Yes:
What corrective actions have been taken to reduce or eliminate l & I related overflows at thls spill location
within the last year?
Total renovation of more than half of the collection system n
Has there been any flow studies to determine I/1 problems in the collection system at the SSO location? �1ri Yes1�.�n No DNA I ENE
If Yes, when was the study completed and what actions did it recommend?
Feb. 2005; extensive repairs and rehabilitation
Has the line been smoke.tested or videoed within the past year? ID Ye Na DNA NE
if Yes, when and indicate what actions are necessary and•the status of such actions:
Are there l/1 related projects in your Capital Improvement Plan?
The remainder of the collection system is to be renovated within the next year.
If Yes, explain:
DYesu No❑NA❑NE
Have there been any grant or loan applications for I/1 reduction projects?
If Yes, explain:
Do you suspect any major sources of inflow or cross connections with storm sewers?
°Yes® No 1JNA ONE
❑Yes12 No❑NAQNE
If Yes, explain: Have all lines contacting surface waters in the SSO location and upstream been Inspected recently?
❑Yesgl NoDNA EINE
If Yes, explain:
No lines are in contact with surface waters.
What other corrective actions are planned to prevent future I/1 related SSOs at this location?
Our planned actions are very compreltgnsiire,_to Lapp Union Country's SpecifiratinnG-
Comments:
The thin layer of sluAge left- on the ground -within the WWTP enclosure will .he limed.
P •Station Equipment Failure (Documentation _of testing, records etc., / I Q p �� 1 e )
hour. .rovided upon request) ems .; ( lv r
hat kind of of ion/alarm systems are�present?
Auto-dialeiem (one-way communication)
CS-SSO Form
October 9, 2003
QYss
Page 4

u ,_,{/Lnn rl nu.
I d15. f 1.1400J0U4U
'tar 4 GUU4 14; 113 r. u!
en was the area last checked/cleaned?
NO TTAP PLI CABLEY-'
Have clean • and inspections ever been increased at this location due to previous problems with debris? ❑Yesr1 N
Explain:
NE
Are appropriate educational materia •eing developed and distributed to prevent future similar ❑YesD No DNADNE
occurrences?
Comments:
Other (Pictures and a police report should be availa• - u • request.)
Describe:
Were adequate equipment and resources avail • e to fix the problem?
®YesO NotJAIADNE
If Yes, explain:
If the problem could n
SSO?
Comme
e immediately repaired, what actions were taken to lessen the impact of the
For DWQ Use Only:
DWQ Requested an Additional Written Report:
if Yes, What Additional information is Needed:
Comments:
DYesEJ NO DNA ONE
CS-SSO Form . October 9, 2003
Page 7

IYUUCIYhf I'lN) rdX: /U40000U4U
lIdf 4 LUU4 14. I U r. uu
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: November 27, 2006
Paul H. Trotter
Title:
President
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 October 9, 2003 Page 0

Memo
Division of Water
Quality
To: Collection System Permittee ��/
From: Barbara Sifford�— U� ���
Date: 11/1/2006
Re: Revised CS-SSO Form
On October 18, 2006 the spill reporting form was revised with a new section under causes for pipe
failures. These have previously been listed as other cause. This includes specific questions for spills
related to force mains and high priority line failures. Documentation of the annual inspection is also
required. An additional section after the questions has been added for spill cleanup documentation for
the OCR or Backup ORC site visitation documentation.
A copy of the spill report form is included with this letter for those utilities that fax or mail reports into the
regional office. This was made available on line on October 18, 2006 and will need to be completed on
future spills. If you have any questions please call me at 704-663-1699 in the Mooresville Regional
Office.
The questions under Part II are required to be completed in their entierty to justify an SSO. An NOV,
civil penalty and /or moratorium on the addition of waste to the system may be issued if adequate
justification for an SSO is not submitted to the regional office.
1