WQ0031246_More Information (Received)_20210709

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WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM
NCAC 15A 8G -0201
TAB to Navigare I arm
Facility Name: RIVERSOUNU V#NWP
Permit tt W04031246
Facility Type: Yl1W Facility Grade: II SLIBMITA SEPARATE FORM FOR EACH CLASSIFICATION
Perinktee ownw/oFCoer Name: Riversound Property Owners Association, Inc. -George Hill
Email Address: Y 124@Yam-00m
Permittee Signature:
ORC
Operator in Responsible Charge
Full Name: Noah Deckard
Email Address: [e-mail]
- - Date- -7 �� ?- r
Work Phone: [phone]
Certificate Type; ww Certificate Grade: 11 Certificate #: __1009993
-''f 1
Signature: Effective Date: /2 I
[r-i w thot I agree to rrvy designation in _1h_V0pVTWor in Responsible Charge for the /ec&ty noted. I understand and wip
abide by the rates and regulation pertaining to the responsibdrites of the Oftc as .set forth in ISA wAc 08G .0204 and
failing to da So ran rem* in DiscipArearyActions by the Water Pofidtion Control System Operotars Ce tlfrcarran Commission.'
Full Name:
James Pittman
WH*UP OK
Certificate Type: WW Certificate Grade: IV
Work Phone: [phone]
Certificate #: 999085
Signature: Effective Date:.
ertify d wt I agree to my designation as a Back-up Operator in Responsible Charge far the for-dity noted I understand or+d wits
abide by the rules and rrguiaitans pertaining to tow rGWnsihulities of the ORC as ser forrh in I5A NCAC 08G _0204 and foiling to
do so can resuR rn DiscwknaryActions by the Water PaNution Control System Operarors Crrtifxarron Commission."
Full Name: Tony Lucas Work Phone: [phone]
Certificate Type: Select Certificate Grade: III Certificate N; 987037
Signature: Effective Date: ' z
"I certify h6 I agree to my designation as a 800-op Operator in Responsible Charge jar the faculNy ►noted r unde►stand and wHi
abide by the rules and regulations pertaining to the responvbilities of the OAC as set firth in ISA NCAC ABG -02N and toidng ro do
so can result in Olwrohnary Actions by the Water PbOut on Controt System Operators Certi"ian CarnnWsron-"
-qww-- -
1 of 2 41112021, 8.02 AM

STATE OF NORTH CAROLINA
COUNTY OF Select
Permit No. WQ0031246
OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (dl) and entered into this 18th day of
June 2021 by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
Riversound Property Owners Association
,anon -profit corporation organized
and existing under and by virtue of the laws of the State of North Carolina, hereinafter known as the
ASSOCIATION.
WITNESSETH:
The ASSOCIATION was formed for the purpose, among others, of handling the property, affairs and
business of the development known as Riversound Subdivision
thereinafter the Develc>pn7ent); of operating, maintaining, re -constructing and repairing the common
elements of the lands and improvements subject to unit Ownership, including the wastewater collection
system with pumps, wastewater treatment works, and/or disposal facilities (hereinafter Disposal System);
and of collecting dues and assessment to provide funds for such operation, maintenance, re -construction
and repair.
2. The ASSOCIATION desires, to construct and/or operate a Disposal System to provide sanitary sewage
disposal to serve the Development on said lands.
3. The ASSOCIATION has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
2t5.1 to construct, maintain, and/or operate the Disposal System.
4. The Development was created subject to unit ownership in [lie dwellings units, other improvements and
lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C of the North Carolina General Statutes.
5. The COMMISSION desires to assure that the Disposal System of the Development is properly
constructed, maintained and operated in accordance with law and permit provisions in order to protect the
duality of the waters of the State anti the public interest therein,
NOW, THlwltl. FOI )E, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and ASSOCIATION do hereby mutually agree as follows:
The ASSOCIATION shall construct the Disposal System and/or make any additions or modifications xo
the Disposal System in accordance with the permit and plates and specifications hereafter issued and
approved by the COMMISSION, and shall thereafter properly operate and maintain such systems and
facilities in accordance with applicable permit provisions and law.
2. The ASSOCIATION shall provide in the Declaration and. Amo:iation Bylaws that the Disposal System
and appurtenances thereto are part of the common elements and shall thereafter be properly maintained
and operated in conformity with law and the provisions of the permit for construction, operation, repair,
and maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire
wastewater treatment, collection and disposal system as a common element, which will receive the: highest
AJ priority for expetrditu es by the Association except for Federal, State, and local taxes and insurance".
FORM: HOA 01-20
Page 1 of 2

The ASSOCIATION shall provide in the Declaration and Association Bylaws that the Disposal System
will be maintained out of the common expenses. in order to assure that there shall be funds readily
available to repair, maintain, or construct the Disposal System beyond the routine operation and
maintenance expenses, the Declaration and Association Bylaws shall provide that a fund be created out of
the common expenses. Such fund shall be separate from the routine maintenance fund allocated for the
facility and shall be part of the yearly budget.
4. In the event the conunon expense allocation and separate fund(s) are not adequate for the construction,
repair, and maintenance of the Disposal System, the Declaration and Association Bylaws shall provide for
special assessments to cover such necessary costs. There shall be no limit on the amount of such
assessments, and the Declaration and Bylaws shall be provided such that special assessments can be made
as necessary at any time.
If a wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the ASSOCIATION shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit may require as condition of accepting the Development's wastewater.
6. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the ASSOCIATION to enter into voluntary dissolution without having made adequate provision for the
continued proper maintenance, repair and operation of its Disposal System, the ASSOCIATION shall
provide in the ASSOCIATION Bylaws that the ASSOCIATION shall not enter into voluntary dissolution
without first having transferred its said system and facilities to some person, corporation or other entity
acceptable to and approved by the C0MM]SS70N by the l&snance of permit
7. The ASSOCIATION shall not transfer, convey, assign or otherwise relinquish or release its responsibility
foe the operation and mm-Atenarce A its Disposal System until a permit has been reissued to the
ASSOCIATION's successor.
8. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, b, and 7 above shall be conditions of any
permit issued by the COMMISSION to the ASSOCIATION for the construction, maintenance, repair and
operation of the Disposal System.
A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration
is filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of
the Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENNIRONMF-N'T AL
MANAGEM ENT COMMISSION
S. Daniel Smith, Director
Division of Water Resources
Riversound Property Owners Association
Name of ASSOCIATION
A4�� P, 1�
(Signature)
Print Narrre and Title
61.1-11-Z--%
(Date) (Date)
FORM: HOA 0 1 -20
Page 2 of 2

Riversound WWTP - Envirolink Scope of Work
Operation, Maintenance, and Management of the Wastewater Treatment Plant
Envirolink will operate, maintain, and manage the Wastewater Treatment Plant for the Owner as
follows:
➢ Provide a Primary Operator in Responsible Charge (Grade II or greater);
➢ Provide a Back-up Operator in Responsible Charge (Grade II or greater);
➢ 24 hour, seven days a week on call emergency response;
➢ Attendance at regulatory agency inspections and meetings;
➢ Coordination with North Carolina regulatory agencies regarding the operation of the
wastewater treatment plant;
➢ Monitor and record key operational control parameters (in accordance with Envirolink's
standard Operating Procedures);
➢ Inventory levels for spare parts, supplies and equipment shall be established based on
Envirolink's standard operating procedures;
➢ Monitor inventory levels of parts, chemicals and supplies and coordinate replenishment for
the owner;
➢ Maintain an operator log that records all operational adjustments and maintenance
activities. Operator logs are the property of Envirolink. Copies of the logs will be provided
to the Owner upon request;
➢ Purchase the analytical testing over the term of the contract for those parameters listed in
the sample schedule (EXHIBIT F). For additional testing above this amount, Envirolink
would receive an equitable adjustment to the contract;
➢ Purchase the chemicals needed for treatment. Payment for chemicals is the responsibility
of the Owner and will be invoiced in accordance with EXHIBIT D;
➢ Preparation of the wastewater performance annual report;
➢ Preparation and file monthly monitoring reports with NCDEQ;
➢ Inspect seven (7) lift stations weekly as required by NCDEQ. Telemetry is currently on all
lift stations and weekly inspection is based on a properly functioning system;
➢ Test audible and visual alarms and telemetry as required by NCDEQ;
➢ Respond to customer inquiries concerning the wastewater treatment plant;
➢ Preventative maintenance as per manufacturer recommendations or Envirolink standard
operating procedures;
➢ Notify the Owner of any permit violations or specific equipment issues or capital
requirements immediately upon discovery. Envirolink will indicate the reason for the
violation or problems and provide an opinion of options and recommendation based on its
experience in managing utilities. Envirolink shall not be liable for decisions made by
Owner based on these recommendations.
➢ Continually maintain the operation of the 64,000 gallon per day (GPD) wastewater
treatment and high -rate infiltration facility consisting of the continued operation of an
81,165 GPD wastewater treatment facility (Phase A) consisting of an influent flow meter;
a mechanically cleaned cylindrical screen and a 30,000-gallon equalization basin.
➢ Continually maintain the operation of a 64,000 GPD high -rate infiltration facility (Phase
A) consisting of a groundwater management system with 23 groundwater management
wells.

➢ Division certified laboratory shall conduct all laboratory analyses for the required
effluent, groundwater or surface water parameters.
➢ Maintain all sample monitoring with a division certified laboratory to conduct all
laboratory analyses for the required effluent, groundwater or surface water parameters.
➢ Signs will be posted, and gates will be locked prohibiting automobiles or machinery on
the infiltration sites except during equipment installation or while maintenance is being
performed. Public access to the infiltration sites and wastewater treatment facilities shall
be prohibited as well.
➢ Please see Maintenance Schedule attached.
➢ Please see Spill Response Plan attached.
Adjustment to the Wastewater Treatment Plant— Owner may not authorize any adjustments or
maintenance of the distribution system by personnel other than Envirolink Employees or its
approved contractors, unless approved in advance by Envirolink.

Essential Maintenance Task Summary
Equipment TASK REQUIREMENTS FREQUENCY
Permeate Pump (Vogelsang)
Fine Screen (CO NTEC)
Blowers
retighten bolts/screws, check buffer fluid
Check buffer fluid
Check gear oil
Check gear oil
Retighten bolts and nuts securing unit & motor
Check coupling
Check buffer fluid
Change gear oil
visual inspection brush frame and press components
check brushes for even contact on perforation plate
check that scraper removes screenings uniformly
flush out screening press (open ball valve on top of press zone for 5 - 10 minutes)
replace scraper rubber buffers
check perforated plate for grease, growth, clogging
check drive, shaft bearing, scraper
check scraper brake for fast travel and noise
lightly lubricate moving parts ie brush frame ball bearing
conduct screenings press test run
clean perforated press zone
check for monotone sound, absence of vibration
check inlet and outlet manometers
check oil level and for oil leaks
complete inspection per blower manual section 9.3.4
replace air filter
first oil change
subsequent oil change incl o rings, gaskets
check blower bearings and seals overall if required
Titan Gear MP 90
clean as necessary
biodegradeable grease
first 20 hours
every 200 hours
every 500 hours
every 3 months
every 2,000 hours I yearly
every 2,000 hours / yearly
every 2,000 hours I yearly
every 2,000 hours / yearly
WEEKLY
WEEKLY
WEEKLY
WEEKLY
AS NEEDED
WEEKLY
WEEKLY
6 MONTHS
MONTHLY
after long idle
WEEKLY
DAILY
DAILY
MONTHLY
QUARTERLY
YEARLY
500 hours
2,000 hrs or 1 Year
3 YEARS
Recycle Pumps Inspect, clean pump and change oil replace seal if water evident YEARLY
overhaul 3 YEARS

Sludge Waste Pumps
grease pin pint 1
grease pin loint 2
inspect stator and shaft seal for leaks fvtaLial)
check for noise, oil level
re -grease
change oil
clean or replace vent plug
replace shaft seals
lubricate beadngs of gear unit
general overhaul
Seepex Grease 30321
2 YEARS
Seepex Grease 30321
2 YEARS
WEEKLY
6 MONTHS
6 MONTHS
2 YEARS
2 YEARS
if worn
PETAMD GHY 133N
4 YEARS
10 YEARS
Misc.
visual inspection of biomass DAILY
filterability test of biomass MONTHLY
membrane module cleaning 3 - 9 MONTHS

Envirolink
Riversound WWTP
PROCEDURES FOR CLEANUP AND REPORTING OF SEWAGE SPILLS
PURPOSE:
To protect the Citizens of North Carolina, and the environment by ensuring a timely and
thorough response to Sanitary Sewer Overflows (SSOs).
SCOPE:
This procedure applies to Envirolink employees that, in the course of their work may deal
with SSOs. At a minimum, these procedures will be reviewed on an annual basis or
whenever revised guidance from state or federal authorities dictate a revision is necessary.
REFERENCES:
A. 40 Code of Federal Regulations (CFR) Part 122-124. The Clean Water Act, 1969.
B. North Carolina General Statute 143.215.1
C. Title 15A, North Carolina Administrative Code, Subchapter 2T .0100-.1600
D. NC DENR Wastewater Collection System Permit # WQ0031246.
RESPONSE TIME REQUIREMENTS:
Utility Outage or Spill Response Time: Upon notification of a spill or utility outage in the
cantonment area, Envirolink, Inc. shall respond and take action to safeguard life and the
property during business hours and non -business hours.
PROCEDURE:
The following procedure should be followed upon notification of a sewage spill of 1000
gallons or more, or any spill in which wastewater reaches the surface waters of the State
(Note: Conveyances such as drainage ditches and storm sewers are considered waters
of the State). Discharges of 1,000 gallons or more of untreated wastewater to surface
waters shall issue a press release within 24 hours of first knowledge to all media (radio,
TV, newspapers) with general coverage in the county of the spill. Discharges of 15,000
gallons or more of untreated wastewater to surface waters shall publish a certified
public notice within 10 days and proof shall be provided to the Division within 30 days.
All other spills less than 1,000 gallons and are not to NC Surface Waters will be cleaned
up to NC DWQ Standards, but will not be reported to NC DWQ as a Reportable Spill.
REPORTING SSOs:
Before any SSO is reported to the State, the ORC or the Backup ORC must visit and evaluate
the spill site within 24 hours. Once the spill site has been evaluated by the ORC or the Backup
ORC, the responsible person should discuss the spill, determine estimated volume and cause
before calling the Division within the 24-hour time frame.

Containment
Upon learning of such an occurrence, the priority shall be to assess the situation and mobilize
resources necessary to remove the blockage, contain the SSO, and stabilize the overflow
condition to the max extreme. Notification should be made to the ORC at this time. As
soon as the extent of the SSO has been determined, a containment berm or a dam should be
established at the lower edge of the SSO or at an area that meets the needs of containment
and clean up operations. The containment dam should be large enough to prevent breaching
in dry weather conditions.
Force Main or Inaccessible Gravity Sewer Spill
In the event a spill occurs at a pump station with no bypass capability or at a force main or
gravity sewer where no access to a dump point exists, pump and haul or bypass operations
will be considered. Where pump and haul operations are deemed the best solution, sewer
will be collected from the closest tanker access point for continuous loading operations while
causing minimum environmental damage. Consideration should be made for traffic control,
noise, access, etc.
24-hour Pump Service Providers & Repair
1. Ben Aragona Phone# [phone]
2. Godwin Pumps Phone # [phone]
3. Sunbelt Rentals Phone# [phone]
4. Charles R Underwood
5. Electrical Solutions
6. Sanford Electric
Phone# [phone]
Phone# [phone]
Phone# [phone]
24-hour Pump and Haul Tanker Services
1. Envirolink, Inc. Phone# [phone]
2. Granville Farms Phone# [phone]
3. Lewis Farms
Phone# [phone]
**See attached Pump and Haul Record Form -Complete for each load
For Spills involving Asphalt or Concrete
1. Set up containment at or near any threatened storm drainage system; Every attempt
should be made to prevent the spill from entering the drainage structures.
2. Spread dry sand or absorbent material to a depth of 1 inch. Let stand for one hour and
sweep up. If moisture or grease is still present, repeat.
3. After removing the contaminated material, wash down the area with high water pressure
and a mild bleach solution and then pump residue back into the sewer system.
4. If the spill enters a storm drainage structure, a Reportable Spill has occurred and
therefore a Spill Report should be filed with NC DWQ and treated as a SSO affecting
Waters of the State. Reported volumes would include the initial estimated spill; plus and
flush water used; minus the calculated amount removed from storm drain system.

SSO affecting Waters of the State:
1. Take conductivity and dissolved oxygen readings of the receiving stream to determine the
proper placement of a dam within the intervals on the Conductivity Readings Form.
While taking the conductivity readings, be sure to notate them on the Spill &
Conductivity Reporting Form. The dam needs to be constructed near a manhole or at a
location which is accessible to the jet/vacuum truck. Placement of the dam should be at a
point where the lowest conductivity reading is measured.
2. Build the dam using dirt that is capable of handling creek and hydrant flow without
breaching during dry weather conditions. Position two pumps at the dam capable of
handling creek and hydrant flow with one pump in use and the second as backup. Have a
backhoe at the site with additional material at all times so that the earthen dam can be
rebuilt if a breach does occur. Pump SSO release from the dam into the manhole.
3. Put up warning tape, "Danger Do Not Enter" from the SSO site to the pump site on both
sides of the creek in populated areas. In unpopulated areas restrict access where there is
any chance of human contact with the SSO.
4. Flush the stream with de -chlorinated water from a sufficient number of hydrants to
remove the waste product from the creek. Continue to pump and flush the stream until
the conductivity measurements or readings are equivalent to upstream receiving stream or
hydrant water conductivity readings, whichever is higher. Make sure that all readings
taken during cleanup are recorded on the Spill & Conductivity Reporting Form and
taken within the intervals on the form.
5. If there is rip -rap in the creek, wash down with high water pressure until there is no
noticeable waste residue remaining on or within the rip -rap structure.
6. If the creek flows into a body of water used for recreation and/or drinking water supply,
notify the affected officials as soon as possible.
7. Continue periodic monitoring of conductivity and Dissolved Oxygen readings. All
additional readings should be notated on the Spill and Conductivity Reporting Form.
Take an upstream and downstream fecal coliform (fresh water) or enterococci (saline
water) every 24 hours as needed until the waterway is restored to pre -event condition.
SSO not reaching Waters of the State
1. In open areas spread powdered lime heavily over the spill site, till into the ground and
then repeat the procedure again but not within 24 hours of predicted rain fall event. Seed
the disturbed area and place straw over the tilled area. Soil may need to be removed and
replaced with clean fill material for a large spill where the ground has become saturated.
SSO REPORTING PROCEDURES
1. Upon discovery of a possible SSO, notify Envirolink at 252-235-4900
Tracy Miller Cell# 828-785-3323
David Strum Cell# 252-235-8763
Rebecca Manning Cell# 252-230-0707

2. The individuals listed above will be the Point of Contact between Envirolink and the NC
DWR or the Division of Emergency Management on SSO matters. These individuals
will report overflows from any sewer line or pump station, or the bypass of any
wastewater treatment system or any component thereof. If Media communications
become apparent, Envirolink President will be the POC for all Media questions.
3. Reportable spills must be called into NC DWR (910-796-7215) within 24 hours of first
knowledge of discharge. Document on the Spill Report Form the date, time, incident
number and person contacted.
4. During weekends and holidays when DWQ cannot be reached, The Division of
Emergency Management will be called at 1-800-858-0368 providing the information
requested. Document on the Spill Report Form the date, time, and person contacted.
Upon arriving to work after the weekend or a holiday, DWQ should be contacted to
receive the incident number for the reported spill.
5. The ORC/Backup ORC should be notified immediately so they have an opportunity to
visually see the spill. This will allow the ORC/Backup ORC to provide better estimated
volumes. The ORC or the Backup ORC is also required by the Collection System
Permit to visit the spill site.
6. The ORC/Backup ORC must fill out the State approved Sanitary Sewer Overflow Form.
A legible copy will be emailed or faxed within five (5) days to NCDENR, Wilmington
Regional Office: 127 Cardinal Dr, Wilmington, NC 28405 [phone]. If the
Director of Operations is unavailable, the ORC will ensure that the necessary paperwork
is completed. Records of spills, including those that are not required to be reported will
be maintained for at least three (3) years and will be made available to NCDENR staff
upon request.

SSO TELEPHONE CONTACT NUMBERS
NC DENR 910-796-7215
DWQ (Wilmington)
127 Cardinal Dr
Wilmington, NC 28405
NC Division of Emergency Management 1-800-858-0368
Envirolink, Inc. 252-235-4900
Tracy Miller, Area Manager 828-785-3323
Rebecca Manning 252-230-0707
David Strum, Director of Operations 252-235-8763
Ben Aragona 910-358-2249
Godwin Pumps 919-795-9020
Sunbelt Rentals 252-756-7177
Charles R Underwood 919-775-2463
Electrical Solutions 252-567-8826
Sanford Electric 919-356-9628

Press Release required for a discharge of 1,000 gallons or more of untreated wastewater to
surface waters of the State:
Example Press Release:
Notification of Discharge of Untreated Wastewater
General Statute 143-215.1C requires that the owner or operator of any wastewater collection or
treatment works to issue a press release when an untreated wastewater discharge of 1,000 gallons
or more reaches surface waters.
In accordance with that regulation, the following news release has been prepared and issued to
media in the affected county (ies):
The Town of Greenwood Valley had a discharge of untreated wastewater on July 1, 2014 of an
estimated 1,000 gallons at Pump Station # 1, located near the intersection of First Street and
Broadway Boulevard. The untreated wastewater was discharged into Turner's Creek in the
Savannah River Basin.
The Division of Water Resources was notified of the event on July 1, 2014 and is reviewing the
matter. For more information contact the Town of Greenwood Valley at [phone].
Public Notice required for a discharge of 15,000 gallons or more of untreated wastewater to
surface waters of the State:
Minimum content for public notice
• Caption must be: Notice of Discharge of Untreated Sewage;'
• Name of the facility (treatment facility, collection system component, outfall, etc.)
• Location of discharge
• Estimated volume of untreated wastewater discharged to surface water
• Time and date discharge occurred
• Duration of discharge
• Water body that was discharged into
• Action taken to prevent further discharge
• Contact person and phone number
NOTICE OF DISCHARGED OF UNTREATED SEWAGE
The (Utility, Municipality, District, etc.) had a discharge of untreated wastewater from our
(collection system, treatment facility, pump station, etc.) located at street/highway of
approximately (amount) gallons. The discharge occurred on (date) for approximately (amount)
hours. The untreated wastewater entered into (creek, river, uImamed tributary) in the (Name)

River Basin. The (list action taken) to prevent further discharge. This notice was required by
North Carolina General Statutes Article 21, Chapter 143.215C. For more information contact
(Name, Title). at (Phone Number).
Spill and Conductivity Reporting Form
Location of Spill:
Time of Spill:
Time of Clearing Spill
Cause of Spill:
Did spill reach surface water?:
AM or PM Date of Spill:
AM or PM Date of Clearing Spill:
Time ORC was notified:
Conductivity/DO Readings
Initial DO
Initial
Conductivity
2nd
DO
2nd
Conductivity
3rd
DO
3rd
Conductivity
Entry Point
Time Reed.
50'
Downstream
Time Reed.
100,
Downstream
Time Reed.
150'
Downstream
Time Reed.
200'
Downstream
Time Reed.
250'
Downstream
Time Reed.
**Note: 2nd and 3rd readings are to be taken during cleanup.

"More readings may be necessary depending upon the size of the spill and the time period in
which the stream is being flushed to maintain water quality.
Pump and Haul Record
Date:
Page _of
Tanker
Company
Tanker
Capacity
Drivers
Name
License
Plate#
Destination
Time
Loaded

Spill Incident Report Form
Facility: Incident#
Owner: Region:
City: County:
Source of SSO Sanitary Sewer Pump Station
Specific Location of SSO (example: Lift Station # 1, manhole on Main Street, etc)
Incident Start Date: Time:
AM or PM
Incident End Date: Time:
AM or PM
Estimated Duration rounded to the nearest hour
hour(s)
Estimated volume of the SSO gallons
Did SSO reach surface waters? Yes No
Volume reaching surface water gallons
Surface Water Name Did the SSO result in a fish kill?
If so, what is the estimated number of fish killed?
Specific Cause of the SSO:
Natural Disaster Grease
Roots
_Inflow & Infiltration _Pump Station Equip Failure
Power Outage
Vandilism Debris in Line
Other
Explaination:
Immediate 24-hour verbal notification reported to:
(Name)
DWQ Emergency Management
Date: Time:
AM or PM

Emergency contact list of contractors
Lewis Farms
Wesley Wooten
910-604-0049- Emergency
910-604-9823
AC Shultes (Lift Stations)
Kyle Schultes
354 Sawdust Rd
Rocky Point, NC 28457
910-285-7465
ORC Services (lift Stations)
Johnny English
2725 Old Wrightsboro Rd
Wilmington, NC 28405
910-271-0572
Godwin Pumps (Rentals)
Shawn Powell
4113 US Hwy 421 N
Wilmington, NC 28401
[phone]
Burnette Enterprises (Utility Contractor)
Will Burnette
837 Sunnyvale Dr
Wilmington, NC 28412
910-470-5549
Hanover Electric
602 Wellington Ave.
Wilmington, NC 28401
[phone]

ECLP Company (Electrician)
Tony Loretti
1011 Canal Dr
Carolina Beach, NC 28428
[phone]
Ferguson
Wilmington
[phone]
Core & Main
6501 Amsterdam Way
Wilmington 28405
[phone]
Environmental Chemists
Wilmington
Jay Baker
[phone]
[phone]
Ben Aragona
Jacksonville
910-358-2249
Jeff Jarmin
910-330-8167
Pete Duty & Associates (lift stations)
David Holt
[phone] Office
[phone] Nextel
Ed Wheeley 919-730-6525
Charles Underwood (lift station)
Russell Underwood
[phone] Office
[phone] Fax

Edgecombe Electric Service (lift station)
Tarboro, NC
[phone] Office
[phone] Freddie Webb
Sanford Electric Co. (lift station)
Sanford, NC
[phone]
[phone]
[phone]
Office
Mickey's home
Mickey's mobile
Haddock Enterprises (water/sewer line repair)
Princeton, NC
Eddie Haddock
[phone]
[phone]
[phone]
Office & Home
Cell
Pager
The sewer drain medic (pump & haul)
Wilmington
([phone]
Robinson Septic
Wilmington
[phone]
Coastal Septic Solutions
7814 Shiloh Rd
Wilmington, NC 28478
[phone]
Granville Farms( pump & haul)
Bryan Smith
[phone]
[phone]
[phone]

Triple S Farms
(pump & haul)
Johnny Smith
[phone]
Home
[phone]
Pager
[phone]
Mobile
Eric Smith
[phone] Home
[phone] Pager
Ray's Septic (pump & haul)
Jacksonville
[phone]
BioNomics Services (pump & haul)
Pete Fleetwood, David Motil
[phone]
[phone]
Hall Town Road Rewind (motor shop)
Jacksonville
[phone]
Sam's Motor Rewinding
Jacksonville
[phone]
North Carolina Motors & Controls (motor shop)
Ike Bullard — VP
[phone] Office in Bailey
[phone] Home
[phone] Mobile with emergency answering service
Rocky Mount Electric Motor Sales & Service, Inc.
[phone]
Marvin Stone - Manager
[phone] Cell
[phone] Home
Timmy Thorne — Asst Manager
[phone] Cell

[phone] Home
Mitchell Skinner — Sales Manager
[phone] Cell
[phone] Home
Chris Vick — Customer Service
[phone] Cell
[phone] Home
Adam Stone — Mechanic
[phone] Cell
William Williams — Route & Mechanic
[phone] Cell
[phone] Home
Jimmy Flood — Mechanic
[phone] Cell
Public Works Equipment Supply
[phone]
Brock Equipment Co. (equipment)
Lee Brock
[phone] Office in Bailey
[phone] Office in Bailey
[phone] Home
[phone] Mobile
Godwin Pumps (equipment)
[phone] Office
[phone] Fax
Freddie Hudson
[phone]
Harris Perry (equipment)
[phone] Mobile
[phone] Home
P & L Tractor Co. (equipment)
Goldsboro, NC
Bill Lane
[phone]
[phone]
[phone]

Lely Manufacturing (equipment)
[phone]
[phone]
Hank Vanderveen
[phone] Cell
Environmental Rental Services (equipment)
[phone] Office
[phone] Office
Gary McCutchen
[phone] Mobile
Barnes Equipment Co (equipment)
Sims, NC
Charles Barnes
[phone] Office
[phone] Home
Jet Vac Sewer Equipment ( equipment)
John Sutton
[phone] Office
[phone] Office
[phone] Cell
ABE Utilities (big combo jet/vac & video truck)
Randy Lawrence
[phone] Office
[phone] Cell
26*18998 Nextel
BioNomics Services (combo jet/vac trucks, video, tankers)
Pete Fleetwood, David Motil
[phone]
[phone]
Baysden Crane Inc. (big crane truck)
Lee Baysden
[phone] Office
[phone] Mobile

Neff Rental (rental)
3261 New Bern Hwy, Jacksonville
610-478-9704 Office
Brian "Max" Maxwell
[phone] Pager
[phone] Mobile
Scott McCallum
[phone]
Hertz Equipment Rental (rental)
Ayden, NC
[phone] Office
[phone] Fax
Thomas Turner
[phone]
Mobile
[phone]
Pager
Daryl Gaskins
[phone]
Pager
Apex, NC
[phone]
Office
[phone]
Fax
Bryan Kiser
[phone]
Mobile
Sunbelt Rental (rental)
Freddie Hudson
[phone] Office
[phone] Cell
United Rental (rental)
Corey Bissette
[phone]
Coble Trench (rental)
Dale May
[phone]
Office
[phone]
Mobile
150*24*22181
Nextel

HD Supply (parts)
Wilson, NC
[phone]
121 International Dr
Morrisville, NC
[phone]
[phone]
Danny Lee
[phone] Home
[phone] Mobile
Ramsey
[phone] Home
[phone] Pager
Raleigh -Durham Rubber & Gasket (parts)
[phone]
Office
[phone]
Office
Randy Yates
[phone]
Pager
[phone]
Mobile
Pipe Line Supply (parts)
3223 Hawkins Av
Sanford, NC
[phone]
[phone]
Office
Bill Dunn
[phone]
Home
Terry Paxson
[phone]
Home
[phone]
Pager
Danny Gray
[phone]
Home
[phone]
Pager
[phone]
Cell
Water Works Equipment Co. (parts)
Johnny Daniel
[phone] Office
[phone] Cell

TEC Utilities Supply (parts)
C. C. Hildteth
[phone]
Ferguson (parts)
Jacksonville
[phone]
HD Supply (parts)
Kinston
[phone]
Office
[phone]
Office
Jack
[phone]
Cell
[phone]
Pager
[phone]
Home
Dan (Branch Manager)
[phone]
Mobile
N. W. Poole Well & Pump Co. (pumps)
Knightdale, NC
[phone] Office
Harry Letchworth
[phone]
Hydromatic (pumps)
Hughes Hickory
[phone]
Cindy, Margaret & David
Thompson Pump (bypass pumps & plugs)
Goldsboro, NC
[phone]
Water Guard (chemicals)
[phone] Office
[phone] Office

Amerochem (Chemicals)
1-800-990-4949
Environment 1
[phone] Office
CMOM Solutions
John Fletcher
[phone] Office
[phone] Cell
Edgecombe County Emergency Management
Butch Beach
[phone]
U. S. Army Corps of Engineers
Doug Green
[phone]
[phone]
CSX Rail Road
[phone] Normal Office
[phone] Emergency