WQCS00055_DV-2021-0062_20210423 (3)

DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT
Violator: City of Henderson
Facility Name: Henderson Collection System
Permit Number: WOCS00055
County: Vance
Case Number: DV-2021-0062
Incident No. 202100366
ASSESSMENT FACTORS
1) The degree and extent of harm to the natural resources of the State, to the public health, or to private
property resulting from the violation;
A total of 18,000 gallons overflowed from a manhole due to severe natural condition and I/I. All 18,000 flowed to Sandy
Creek, Class B; NSW in the Tar Pam River Basin. Increased nutrients and pathogens to surface waters. Orakict
2) The duration and gravity of the violation;
The SSO started on 01.31.2021 at 1:00 pm and ended the same day at 6:00 pm.
3) The effect on ground or surface water quantity or quality or on air quality;
The effect on surface water quality include risks to public health and increased nutrients and pathogens to surface waters,_
C00-3Pt c v-02_ /o,. Sur ry ea �+-c-i b s A- S
4) The cost of rectifying the damage; V
A cost of rectifying the damage was not given.
5) The amount of money saved by noncompliance;
It is believed that no money was saved by the noncompliance.
6) Whether the violation was committed willfully or intentionally;
It does not appear that the violation was committed willfully or intentionally.
7) The prior record of the violator in complying or failing to comply with programs over which the
Environmental Management Commission has regulatory authority;
DV-2021-0039, DV-2020-0135, DV-2020-0113, DV-2020-0100, DV-2020-0086, DV-2020-0081.
8) The cost to the State of the enforcement procedures.
$36.57
Date
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ

DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT
Violator: City of Henderson
Facility Name: Henderson Collection System
Permit Number: WQCS00055 Incident No. 202100368
County: Vance
Case Number: DV-2021-0062
ASSESSMENT FACTORS
1) The degree and extent of harm to the natural resources of the State, to the public health, or to private
property resulting from the violation;
A total of 12,000 gallons overflowed from the Sandy Creek Pump Station due to severe natural condition and Ill. All
12,000 flowed to Sandy Creek, Class B; NSW in the Tar Pam River Basin. Increased nutrients and pathogens to surface
waters. Cam. %Act. crA+� 54046r44C IcC49105,
2) The duration and gravity of the violation;
The SSO started on 01.31.2021 at 1:00 pm and ended the same day at 9:00 pm.
3) The effect on ground or surface water quantity or quality or on air quality;
The effect on surface water quality include risks to public health and increased nutrients and pathogens to surface waters,
c LA-S2 Swr c.c_ ct3-ir S�c rr.i leS
4) The cost of rectifying the damage; (Ado
A cost of rectifying the damage was not given.
5) The amount of money saved by noncompliance;
It is believed that no money was saved by the noncompliance.
6) Whether the violation was committed willfully or intentionally;
It does not appear that the violation was committed willfully or intentionally.
7) The prior record of the violator in complying or failing to comply with programs over which the
Environmental Management Commission has regulatory authority;
DV-2021-0039, DV-2020-0135, DV-2020-0113, DV-2020-0100, DV-2020-0086, DV-2020-0081.
8) The cost to the State of the enforcement procedures.
$36.57
Date
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ

DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT
Violator: City of Henderson
Facility Name: Henderson Collection System
Permit Number: WQCS00055 Incident No. 202100365
County: Vance
Case Number: DV-2021-0062
ASSESSMENT FACTORS
1) The degree and extent of harm to the natural resources of the State, to the public health, or to private
property resulting from the violation;
A total of 6,000 gallons overflowed from a manhole due to severe natural condition and III. All 6,000 flowed to Sandy
Creek, Class B; NSW in the Tar Pam River Basin. Increased nutrients and pathogens to surface waters.0.9,Jek 6e„K91.
£ %,4--4-tor auA S i),D (c,146-. ( .
2) The duration and gravity of the violation;
The SSO started on 01.31.2021 at 1:00 pm and ended the same day at 7:00 pm.
3) The effect on ground or surface water quantity or quality or on air quality;
The effect on surface water quality include risks to public health and increased nutrients and pathogens to surface waters}
q�t cam l� cat e- Ca. U
4) The cost of rectifying the damage;
A cost of rectifying the damage was not given.
5) The amount of money saved by noncompliance;
It is believed that no money was saved by the noncompliance.
6) Whether the violation was committed willfully or intentionally;
It does not appear that the violation was committed willfully or intentionally.
7) The prior record of the violator in complying or failing to comply with programs over which the
Environmental Management Commission has regulatory authority;
DV-2021-0039, DV-2020-0135, DV-2020-0113, DV-2020-0100, DV-2020-0086, DV-2020-0081.
8) The cost to the State of the enforcement procedures.
$36.57
3Y)
Date
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ

City of Henderson
Public Works Department
Post Office Box 1434 • 900 S. Beckford Drive
Henderson, NC 27536-1434
Phone: [phone] / Fax: [phone]
March 9, 2021
Mr. Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
1628 Mail Service Center
Raleigh, NC 27699-1628
Re: Response to Notice of Violation & Intent to Issue Civil Penalty
Tracking No. — NOV-2021-DV-0123
Sanitary Sewer Overflows — January 2021
Henderson Collection System
Permit No. — WQCS00055
Dear Mr. Vinson:
1 am writing in response to the above mentioned violation that we received on February 24, 2021. The
overflows in each incident were due to inflow and infiltration during extended periods of heavy rainfall.
Once the rain event ended, the overflows subsided. Following the overflows, we cleaned debris and
placed lime as needed. We continue to search for sources of I/! via smoke testing and CCTV equipment.
Moving forward, Henderson City Council has approved a CIP project for an EQ basin at the Sandy Creek
Pump Station for fiscal year 2020-2021. This project is contingent on council allocating the funds for the
project. The EQ basin wi`i increase capacity at the pump station to help prevent spills.
Henderson has also hired a consultant, WK Dickson, to assist our efforts in reducing I/1. WK Dickson has
started a sewer model that will help us assess the prob'--ern areas in our system. With their help we have
received a letter of intent for a loan in the amount of $2.5 million from the Clean Water State Revolving
Fund for sewer rehabilitation in an effort to alleviate sources of IAI. The Henderson City Council voted
unanimously to accept this funding at its March 8, 2021 Council meeting.
We take our responsibility to maintain compliance for our colection system very seriously. Public Works
is working closely with Engineering and HWRF to come up with solutions to fight our I/1 problem. 1 trust
that you find the City's actions for compliance are satisfactory. Thank you very much for the opportunity
to respond. Please feei free to contact our staff or myself should you need any further information.
Sincerely,
Lee Owen
Assistant Public Works Director

CC: Edward Terrell Blackmon, City Manager
Andy Perkinson, Public Works Director
Joey Long, Distribution & Collection System Supervisor — Collection System ORC
Christy Lipscomb, KLRWP Director/ORC, HWRF ORC
File

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CERTIFIED MAIL: 7017 2680 0000 2219 5930
RETURN RECEIPT REQUESTED
February 17, 2021
Terrell Blackmon, City Engineer
City of Henderson
PO Box 1934
Henderson, NC 27536-1434
SUBJECT: NOTICE OF VIOLATION & INTENT TO ISSUE CIVIL PENALTY
Tracking No.: NOV-2021-DV-0123
Sanitary Sewer Overflows - January 2021
Collection System Permit No. WQCS00055
Henderson Collection System
Vance County
Dear Mr. 8tackmon:
A review has been conducted of the self -reported Sanitary Sewer Overflows (SSO's) 5-Day Report/s submitted by
City of Henderson. The Division's Raleigh Regional Office concludes that the City of Henderson violated Permit
Condition I (2) of Permit No. WQCS00055 by failing to effectively manage, maintain, and operate their collection
system so that there is no 550 (Sanitary Sewer Overflow) to the land or surface waters and the SSO constituted
making an outlet to waters of the State for purposes of G.S. 143-215.1(a)(1), for which a permit is required by
G.S. 143-215.1.
The Raleigh Regional Office is providing the City of Henderson an opportunity to provide evidence and justification
as to why the City of Henderson should not be assessed a civil penalty for the violation(s) that are summarized
below:
Total Vol
Total Surface
incident Start Duration Vol Water
Number Date (Mins) Location Cause (Gals) (Gals) DWR Action
202100363 1/31/2021 120 Bridgers St. Inflow and 360 360 Noke of Violat n
Infiltration, Severe
Natural Condition
-DIE 7).
•
- 1 ' - • - - - - ° _

Total
Incident Start Duration Vol
Number Date (Mins) location Cause (Gals)
Total Vol
Surface
Water
(Gals) DWR Action
202100364 1/31/2021 120 Intersection of Pinkston Inflow and 1,200 600 Notice of Violation
St & Farrar Ave. Infiltration, Severe
Natural Condition
202100365 1/31/2021 360 Alexander Ave. & 5 Inflow and
Elizabeth St Infiltration, Severe
Natural Condition
6,000 6,000 Notice of Violation -
Notice of Intent
202100366 1/31/2021 360 Alexander Ave. &
Willow Lane
202100367 1/31/2021
Inflow and
Infiltration, Severe
Natural Condition
18,000
18,000 Notice of Violation -
Notice of Intent
120 Neatherly St
Inflow and
Infiltration, Severe
Natural Condition
1,200
1,200 Notice of Violation
202100366 1/31/2021 480 Sandy Creek Pump Inflow a0d
Station
Infiltration, Severe
Natural Condition
12,000 12,000 Notice of Violation -
Notice of Intent
This Notice of Violation / Notice of Intent to Enforce (NOV/NOI) is being issued for the noted violation. Pursuant
to G.S. 143-215.6A, a civil penalty of not more than twenty-five thousand dollars ($25,000.00) may be assessed
against any person who violates or fails to act in accordance with the terms, conditions, or requirements of any
permit issued pursuant to G.S. 143-215.1.
This office requests that you respond to this Notice, in writing, within 10 business days of its
receipt. In your response, you should address the causes of non-compliance, remedial actions, and all other
actions taken to prevent the recurrence of similar situations. The response to this correspondence will be
considered in this process. Enforcement decisions will also be based on volume spilled, volume reaching surface
waters, duration and gravity, impacts to public health, fish kills or recreational area closures. Other factors
considered in determining the amount of the civil penalty are the violator's history of non-compliance, the cost of
rectifying the damage, whether the spill was intentional and whether money was saved by non-compliance.
C_

It you have any questions, please do not hesitate to contact Mitchell Hayes with the Water Quality Section in
the Raleigh Regional Office at 919-791-4200 or via email at mitch.hayes@ncdenr,gov.
Sincerely,
Xte-)4(s
fra Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, MCDEQ
Cc: Raleigh Regional Office - WQS File
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TERREt1. OLACXMON, CITY ENGINEER
CITY OF HENDERSON
PO Box 1434
HENDERSON, NC 27536.1434
NOV 2021 DV-0123: WQC300055: HENDERSON CCU. SYM.
VANCE COUNTY. NOV & INFENT TO ISSUE CP
02/17/2021. MAILED* 02/19/2021: HAVES
Posinwdc
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or on the front If space permits.
1. Article Addressed to-
TERREIL R1 ACRMON„ CITY ENGINEER
C11Y 01 HENDERSON
PO BOX 1434
IItNDERSOU. NC 27536.1434 NOV 2021.0V-0123' WQCS00055:1#ENOERSON COI SYNI
VANCE COUNTY- NOV & INTENTT0ISSUT CP
07/17/2021. MAILFO' 02/19/7021. I IAYES
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Water Resources
ENVIRONMENTAL DUALITY
April 17, 2018
Mr Frank Frazier, City Manager
City of Henderson
PO Box 1434
Henderson, NC 27536
Subject. Permit No WQCS00055
City of Henderson
City of Henderson Collection System
Vance County
Dear Mr Frazier.
ROY COOPER
Goi.e„ro,
MICHAEL S REGAN
Sas ciao.
LINDA CULPEPPER
Into rn, Drr ecror
In accordance with your application received March 28, 2018, we are forwarding herewith Permit No
WQCS00055, dated April 17, 2018, to the City of Henderson for the operation and maintenance of the subject
wastewater collection system
This permit shall be effective from May 1, 2018 until April 30, 2026 and shall be subject to the conditions and
limitations specified herein. It is your responsibility to thoroughly review this permit Please pay particular
attention to the monitoring and reporting requirements in this permit and any special conditions
Changes have been made to the boiler plate language of the permit Most of the changes are for clarification
purposes, however Condition 1(3) has been removed. The Department of Environmental Quality (DEQ)
believes that condition was included erroneously in previous permits It was included based on proposed
rulemaking by EPA which was never promulgated and, in the continued absence of Federal regulations, DEQ
lacks authority to include such language in a permit DEQ will continue to exercise enforcement discretion
when evaluating sanitary sewer overflows that may be considered to be beyond the reasonable control of the
Permittee A highlighted copy of the permit identifying the changes made is available at:
http://ncdenr.s3 amazonaws com/s3fs-
public/Water%20Quality/Surface%20Water%20Protection/PERCS/WCS%20(Collection%20Svstem)/Updated
%20WQCS%20Template%2015 05 18%20(highlighted).pdf
For purposes of permitting, the collection system is considered to be any existing or newly installed system
extension up to the wastewater treatment facility property or point of connection with a separately owned
sewer system The collection system is considered all gravity lines, pump stations, force mains, low pressure
sewer systems, STEP systems, vacuum systems, etc and associated piping, valves and appurtenances that
help to collect, manage and transport wastewater to a wastewater treatment plant under the Permittee's
ownership or maintained and operated by the Permittee through a perpetual legal agreement Satellite
systems are systems tributary to the Permittee's collection system but those collection systems are not owned
or maintained by the Permittee. The system description provided on Page 1 of this permit is meant to provide
a general idea about the size of the system and may not be all inclusive of the collection system at the time of
permit issuance or afterward.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone [phone] Internet www ncwaterquality org
An Equal opportunity \ Affirmative Action Employer— Made rn part by recyc ed paper

City of Henderson Collection System
April 17, 2018
A discharge of wastewater to the environment from the Permittee's wastewater collection system prior to
reaching the wastewater treatment facilities is referred to herein as a Sanitary Sewer Overflow (SSO) The
evaluation of enforcement options after an SSO will be determined considering all relevant information
available or requested of the Permittee Compliance with all conditions of the permit as well as all statutes
and regulations pertaining to the wastewater collection system must be maintained or appropriate
enforcement actions may be taken as noted in Condition VI(2)
A reportable SSO is an SSO greater than 1,000 gallons to the ground or an 550 of any amount that reaches
surface water (including through ditches, storm drains, etc) Reporting requirements including the required
verbal report and written report to the appropriate regional office are referenced in Condition IV(2). Form
CS-SSO can be downloaded from the SSO Reporting area at
http•//ncdenr s3.amazonaws com/s3fs-
public/Water%20Quality/Surface%20Water%20Protection/PERCS/WCS%20(SSO%20Dacuments)/CS-
SSO(2015) doc
A notice of deficiency (NOD), notice of violation (NOV), civil penalty, and/or a 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.
In order to submit a claim for justification of an SSO, you must use Part II of form CS-SSO with additional
documentation as necessary DWR staff will review the justification claim and determine if enforcement
action is appropriate Please be advised that the information needed to justify a spill is very comprehensive
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty days following the receipt of this permit.
This request must be in the form of a written petition, conforming to Chapter 150E of the North Carolina
General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC
27699-6714 Unless such demands are made, this permit shall be final and binding
If you have questions regarding compliance, contact the appropriate regional office If you need additional
information concerning this permit, please contact Steve Lewis at [phone]
Sincerely,
&skr-LA, Asust__
for Linda Culpepper
Interim Director, Division of Water Resources
by Deborah Gore, Supervisor
Pretreatment, Emergency Response, Collection System Unit (PERCS)
enclosure Permit No WQCS00055
cc Raleigh Regional Office, Water Quality Regional operations (electronic)
Water Resources Central Files — WQCS000SS (electronic)
Maureen Kinney, NC Operators Certification Program (electronic)
PERCS Files (electronic)

Owner : City of Henderson
Facility : Henderson Collection System
permit : WQCS00055
Region : Raleigh
Case
Number
MR
Permit Enforcement History Details by Owner
County : Vance
Penalty Remission Enf Enf EMC EMC OAH Collection
Assessment Penalty Enforcement Request Conf Remission Hearing Remission Remission MemoSent
Approved Damages Received Held Amount Held Amount Amount To AGO
PP Amount Costs
Total
Paid
4/22/2021
Balance
Due
Has
Pmt Case
Plan Closed
DV-2011-002; 6/21/11 $2,500.00 $74.48 7/20/11 $2,574.48
$0.00 No 6/8/15
DV-2011-003: 8/23/11 $1,500.00 $74.48 9/22/11 $1,574.48
$0.00 No 6/8/15
DV-2016-0061 7/26/16 $250.00 $29.45 $279.45 $0.00 No 2/17/17
DV-2018-004:
6/11/18 $2,000.00 $31.76
$2,031.76
$0.00 No 7/9/18
DV-2019-004' 2/27/19 $2,750.00 $32.36 $2,782.36 $0.00 No 4/2/19
DV-2019-010:
718/19 $750.00 $32.36
$782.36 50.00 No 8/13/19
DV-2020-0081 8/10/20 $500.00 $35.01 $535.01 $0.00 No 8/28/20
DV-2020-0086
8/22/20 $2,000.00 $35.01
$2,035.01 No
DV-2020-0100
9/4/20 $2,750 00 $35 01
$2,785.01 $0.00 No 10/21/2(
DV-2020-01110/2/20 $1,000,00 $35.01 $1,035.01 $0.00 No 10/21/2(
DV-2020-013;5 10117/2051,000.00 $35.82 $1,035.82 $0.00 No 12/2/20
DV-2021-0039 3/22/21 $7,000.00 536.57
$7,036.57 No
Total Cases:
12 Total Penalty Amount: $24,000
Total Enforcement Cost: $487.32
Sum Of Total Paid:$11,266.78
Total Balance Due : $9,071.58
Sum of Total Case Penalties: $24,487 32 Total Penalties After Remissions : $20,338 36

DWR
DMslon of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Co'lection System Sanitary Sewer Overflow Reporting Form
Form CS-SSO
PART I:
This form shall be submitted to the appropriate DWQ Regional Office within five business days of the first knowledge of the
sanitary sewer overflow (SSO).
Permit Number: WQCS00055 (WQCS# if active, otherwise use WQCSD#)
Facility: Henderson Collection System
Owner: Ci of Henderson
City: Henderson
Incident #: 202100368
County: Vance Region: Raleigh
Source of SSO (check app icable): ❑ Sanitary Sewer gl Pump Station / Lift Station
SPECIFIC local on of the SSO (be consistent in description from past reports or documentation - i.e. Pump Station 6,
Manhole at Westall & Bragg Street, etc): Sandy Creek Pump Station
Manhole #:
Latitude (Decimal Degrees):
Incident Started Dt: 01/31/2021 Time:
(mm-dd-yyyy)
Estimated Volume of the SSO: 12,000
Longitude (Decimal Degrees):
1:00� Incident End Dt: 01/31/2021 Time: 09:00pm
(hh:mm AM/PM) (mm-dd-yyyy) (hh:mm AM/PM)
gallons Estimated Duration (Round to nearest hour): 8:0 hours
Describe how the volume was determined: Visual Estimation
Weather conditions during the SSO event: Rain Event
Did SSO reach surface waters? Q Yes ❑ No ❑ Unknown Volume reaching surface waters (gals): 12000
Surface water name: Sandy Creek
Did the SSO result in a fish kill? ❑ Yes ❑ No 10 Unknown If Yes, what is the estimated number of fish killed?
SPECIFIC cause(s) of the SSO:
▪ Severe Natural Con El Inflow and infiltration
24 hour verbal notification (name of person contacted ): Eric S Rice
Q DWR ❑ Emergency Mgmt Date (mm-dd-yyy): 02/01/2021 Time (hh:mm AM/PM): 11:30 00 E...
If an SSO is ongoing, please notify the appropriate Regional Office on a daily basis until SSO can be stopped.
Per G.S. 143-215.1C(b), the responsible party of a discharge of 1,000 or more of untreated wastewater to surface waters
shall issue a press release within 24-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 reference statute for further detail.
The Director. Division of Water Resources, may take enforcement action for SSOs that are reauired to be reported to
Division unless it is demonstrated that:
1) the discharge was cause by sever natural conditions and there were no feasible alternative 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 II must be completed to provide a justification claim for either of the above situations. This information will be the basis
WHETHER OR NOT PART III IS COMPLETED, A SIGNATURE IS REQUIRED AT THE END OF THIS FORM
CS-SSO Form
Page: 1

PART II:
ANSWER THE FOLLOWING QUESTIONS FOR EACH RELATED CAUSE CHECKED IN PART I OF THIS FORM AND
INCLUDE THE APPROPRIATE DOCUMENTATION AS REQUIRED OR DESIRED
COMPLETE ONLY THOSE SECTONS PERTAINING TO THE CAUSE OF THE SSO AS CHECKED IN PART I
(In the check boxes below, NA = Not Applicable and NE = Not Evaluated)
A HARDCOPY OF THIS FORM SHOULD BE SUBMITTED TO THE APPROPRIATE DWR REGIONAL OFFICE UNLESS IS
Severe Natural Condition
Describe the "severe natural condition" in detail?
snow and rain event
How much advance waming did you have and what actions were taken .n preparatio
for the event?
couple of days
Comments:
Inflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule in any r Yes WI No [! NA r NE
permit that addresses III?
Explain if Yes:
What corrective actions have been taken to reduce or eliminate I & I related overflow
at this spill location within the last year?
Has there been any flow studies to determine 1/1 problems in the collection system at r Yes r No r NA ❑ NE
the SSO location?
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?
If Yes, when and indicate what actions are necessary and the status of such actions:
Are there Ill related projects in your Capital Improvement Plan?
If Yes, explain:
Have there been any grant or loan applications for Ill reduction projects?
If Yes, explain:
rYes rNo [NA [NE
[I Yes 0 No E NA ❑ NE
r Yes r No r NA r NE
CS-SSO Form Page: 2

Do you suspect any major sources of inflow or cross connections with storm sewers: 0 Yes r] N o C NA r NE
If Yes, explain:
Have all lines contacting surface waters in the SSO location and upstream been ❑ Yes ❑ No NA ❑ NE
inspected recently?
If Yes, explain.
What other corrective actions are planned to prevent future Ill related SSOs at this
location?
Comments.
S sum Visitation
ORC
Backup
Name:
Clarissa Lipscomb
Cert#
Date vis ted:
02/01/2021
Time visited:
09:00 AM
How was the SSO remediated (i.e. Stopped and cleaned up)?
rain stooped and lime put down where needed
Yes
7 Yes
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: Clarissa M Lipscomb Date: 02/03/21 06:17 pm
Signature: Title:
Telephone Number:
Any addition information desired to be submitted should be sent to the appropriate Division Regional Office within five days of 1
knowledge of the SSO with reference to the incident number (the incident number is only generated when electronic entry of th
form is completed, if used).
CS-SSO Form Page: 3

DWR
DfNslon of later Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Collection System Sanitary Sewer Overflow Reporting Form
Form CS-SSO
PART !:
This form shall be submitted to the appropriate DWQ Regional Office within five business days of the first knowledge of the
sanitary sewer overflow (SSO).
Permit Number: WQCS00055 (WQCS# if active, otherwise use WQCSD#)
Facility: Henderson Collection System Incident #: 202100365
Owner: City of Henderson
City: Henderson
County: V�nc:E Region: Ra eigh
Source of SSO (check applicable): Q Sanitary Sewer ❑ Pump Station / Lift Station
SPECIFIC location of the SSO (be consistent in description from past reports or documentation - i.e. Pump Station 6,
Manhole at Westall & Bragg Street, etc): Alexander Ave. & S Elizabeth St
Manhole#: HEND50-MH109
Latitude (Decimal Degrees): Longitude (Decimal Degrees):
Incident Started Dt: 01/31/2021 Time: 1.00 pm Incident End Dt: 01,3112021 Time: 07:00 pm
(mm-dd-yyyy) (hh:mm AM/PM) (mm-dd-yyyy) (hh:mm AM/PM)
Estimated Volume of the SSO: 6,000 gallons Estimated Duration (Round to nearest hour): 6:0 hours
Describe how the volume was determined: Estimated by eye :30rpm x 120mins j ;10gpm x 240mrns.
Weather conditions during the SSO event: Raining
Did SSO reach surface waters? Q Yes ❑ No ❑ Unknown
Surface water name: Sandy Creek
Volume reaching surface waters (gals): 6000
Did the SSO result in a fish kill? ❑ Yes 0 No ❑ Unknown If Yes, what is the estimated number of fish killed? 0
SPECIFIC cause(s) of the SSO:
0 Severe Natural Con( Q Inflow and Infiltration
24 hour verbal notification (name of person contacted ): Eric S Rice
DWR ❑ Emergency Mgmt Date (mm-dd-yyy): 02/01/2021 lime (hh:mm AM/PM): 10:+ 9 00 am
If an SSO is ongoing, please notify the appropriate Regional Office on a daily basis until SSO can be stopped.
Per G.S. 143-215.1 C(b), the responsible party of a discharge of 1,000 or more of untreated wastewater to surface waters
shall issue a press release within 24-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 reference statute for further detail.
The Director. Division of Water Resources. may take enforcement action for SSOs that are required to be reported to
Division unless it is demonstrated that:
1) the discharge was cause by sever natural conditions and there were no feasible alternative 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 II must be completed to provide a justification claim for either of the above situations. This information will be the basis
WHETHER OR NOT PART Ill IS COMPLETED. A SIGNATURE IS REQUIRED AT THE END OF THIS FORM
CS-SSO Form
Page: 1

PART II:
ANSWER THE FOLLOWING QUESTIONS FOR EACH RELATED CAUSE CHECKED IN PART I OF THIS FORM AND
INCLUDE THE APPROPRIATE DOCUMENTATION AS REQUIRED OR DESIRED
COMPLETE ONLY THOSE SECTONS PERTAINING TO THE CAUSE OF THE SSO AS CHECKED IN PART I
(In the check boxes below, NA = Not Applicable and NE = Not Evaluated)
A HARDCOPY OF THIS FORM SHOULD BE SUBMITTED TO THE APPROPRIATE DWR REGIONAL OFFICE UNLESS IS
Severe Natural Condition
Describe the "severe natural condition" in detail?
We had a rain event.
How much advance waming did you have and what actions were taken n preparatio
for the event?
We knew it was going to rain from the local news. Manho es in the area was checked to make sure the mains where
flowing freely.
Comments:
Inflow and Infiltration
Are you under an SOC (Specia Order by Consent) or do you have a schedule in any [ Yes No ❑ NA ❑ NE
permit that addresses III?
Explain if Yes:
What corrective actions have been taken to reduce or eliminate I & I related overflow
at this spill location within the last year?
We are in the process of hiring a company to help find III related problems.
Has there been any flow studies to determine IA problems in the collection system at rr% Yes r No ❑ NA r' NE
the SSO location?
If Yes, when was the study completed and what actions did it recommend?
In 2018 we installed flow trackers in the area to help find high flows during a rain event.
Has the line been smoke tested or videoed within the past year? � Yes ❑ No [l NA NE
If Yes, when and indicate what actions are necessary and the status of such actions:
We done smoke testing back in November 2020. The problems that was found has been fixed.
Are there I/I related projects in your Capital Improvement Plan? Yes ❑ No NA D NE
If Yes, explain:
We are trying to upgrade some of the sewer mains in the area.
Have there been any grant or loan applications for III reduction projects? ❑ Yes No r' NA r' NE
If Yes, explain:
CS-SSO Form Page: 2

Do you suspect any major sources of inflow or cross connections with storm sewers i r Yes 7 No r' NA r NE
If Yes, explain:
Have all lines contacting surface waters in the SSO location and upstream been I Yes ❑ No r NA [ NE
inspected recently?
If Yes, explain:
They are checked weekly.
What other corrective actions are planned to prevent future III related SSOs at this
location?
We are going to continue to smoke the area and going to reinstall flow trackers.
Comments:
System Visitation
ORC � Yes
Backup ❑ Yes
Name:
Joey G. Long Jr.
Cert#
990227
Date visited:
2-1-2021
Time visited:
8:30 A.M
How was the SSO remediated (i.e. Stopped and cleaned up)?
When the rain subsides the manhole stop surcharging. We washed the street off for the clean up.
As a representative for the responsible party, I certify that the information contained in this report is true and accurate to the
best of my knowledge.
Person submitting claim: Date:
Signature: Title:
Telephone Number.
Any addition information desired to be submitted should be sent to the appropriate Division Regional Office within five days of I
knowledge of the SSO with reference to the incident number (the incident number is only generated when electronic entry of th
form is completed, if used).
CS-SSO Form Page: 3

DWR
DMsloo of Water ltesoarces
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Collection System Sanitary Sewer Overflow Reporting Form
Form CS-SSO
PART I:
This form shall be submitted to the appropriate DWO Regional Office within five business days of the first knowledge of the
sanitary sewer overflow (SSO).
Permit Number: WOCS00055 (WQCS# if active, otherwise use WQCSD#)
Facility: Henderson Collection System Incident #: 202100366
Owner: City of Henderson
City: Henderson County: Vance Region: Raleigh
Source of SSO (check applicable): Q Sanitary Sewer ❑ Pump Station / Lift Station
SPECIFIC location of the SSO (be consistent in description from past reports or documentation - i.e. Pump Station 6,
Manhole at Westall & Bragg Street, etc): Alexander Ave. & Willow Lane
Manhole #: HEND50-MH-112
Latitude (Decimal Degrees):
Incident Started Dt: 01/31/2021 Time:
(mm-dd-yyyy)
Estimated Volume of the SSO: 18,000
Longitude (Decimal Degrees):
1:00pm incident End Dt: 01/31/2021 Time: 07:00 pm
(hh:mm AM/PM) (mm-dd-yyyy) (hh:mm AM/PM)
gallons Estimated Duration (Round to nearest hour): 6 0 hours
Describe how the volume was determined: Estimated by eye (509pm x 360min.)
Weather conditions during the SSO event: Raining
Did SSO reach surface waters? [.J7 Yes ❑ No ❑ Unknown
Surface water name: Sandy Creek
Volume reaching surface waters (gals): 18000
Did the SSO result in a fish kill? 0 Yes p No ❑ Unknown If Yes, what is the estimated number of fish killed? 0
SPECIFIC cause(s) of the SSO:
▪ Severe Natural Conc [l Inflow and Infiltration
24 hour verbal notification (name of person contacted ): Eric S Rice
[r%f DWR 0 Emergency Mgmt Date (mm-dd-yyy): 02/01r2021 Time (hh:mm AM/PM): 10-09:00 am
If an SSO is ongoing, please notify the appropriate Regional Office on a daily basis until SSO can be stopped.
Per G.S. 143-215.1C(b), the responsible party of a discharge of 1,000 or more of untreated wastewater to surface waters
shall issue a press release within 24-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 reference statute for further detail.
The Director. Division of Water Resources, may take enforcement action for SSOs that are reouired to be reported to
Division unless it is demonstrated that:
1) the discharge was cause by sever natural conditions and there were no feasible alternative 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 II must be completed to provide a justification claim for either of the above situations. This information will be the basis
WHETHER OR NOT PART III IS COMPLETED, A SIGNATURE IS REQUIRED AT THE END OF THIS FORM
CS-SSO Form
Page: 1

'ART II:
ANSWER THE FOLLOWING QUESTIONS FOR EACH RELATED CAUSE CHECKED IN PART I OF THIS FORM AND
INCLUDE THE APPROPRIATE DOCUMENTATION AS REQUIRED OR DESIRED
COMPLETE ONLY THOSE SECTONS PERTAINING TO THE CAUSE OF THE SSO AS CHECKED IN PART I
(In the check boxes below, NA = Not Applicable and NE = Not Evaluated)
HARDCOPY OF THIS FORM SHOULD BE SUBMITTED TO THE APPROPRIATE DWR REGIONAL OFFICE UNLESS IS
severe Natural Condition
Describe the "severe natural condition" in detail?
We had a rain event.
How much advance waming did you have and what actions were taken in preparatio
for the event?
We knew it was going to rain from the local news. Manholes in the area was checked to make sure the sewer mains was
flowing freely.
Comments:
iflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule in any 7 Yes L7 No r NA ❑ NE
permit that addresses Ill?
Explain if Yes:
What corrective actions have been taken to reduce or eliminate I & r related overflow
at this spill location within the last year?
We are in the process of hiring a company to help find 111 related problems
Has there been any flow studies to determine Ill problems in the collection system at [ail Yes r' No IT NA f NE
the SSO location?
If Yes, when was the study completed and what actions did it recommend?
In 2018 we inslalled flow trackers in the area to help find high flows.
Has the line been smoke tested or videoed within the past year? WI Yes 0 No 0 NA G NE
If Yes, when and indicate what actions are necessary and the status of such actions:
We smoked test back in November of 2020. The problems that where found has been fixed.
Are there I11 related projects in your Capital Improvement Plan? W Yes ❑ No ❑ NA ❑ NE
If Yes, explain:
We are trvino to upgrade some of the sewer mains in the area.
Have there been any grant or loan applications for I/1 reduction projects? D] Yes 177 No [I NA ❑ NE
If Yes, explain:
:S-SSO Form Page: 2

no you suspect any major sources of inflow or cross connections with storm sewers': r Yes 17 No [- NA r Nf-
if Yes, explain:
Have all lines contacting surface waters in the SSO location and upstream been Yes ❑ No ❑ NA [ NE
inspected recently?
If Yes, explain:
They are checked weekly.
What other corrective actions are planned to prevent future 1!1 related SSOs at this
location?
We are going to continue with our smoke testing program and about to reinstall flow monitors in the area.
Comments:
System Visitation
ORC
M Yes
Backup ❑ Yes
Name:
Joey G. Long Jr.
Cert#
990227
Date visited:
2-1-2021
Time visited:
8:30 A.M
How was the SSO remediated (Le. Stopped and cleaned up)?
When the rain subside the manhole stops surcharging. We put lime around the manhole.
As a representative for the responsible party, I certify that the information contained in this report is true and accurate to the
best of my knowledge.
Person submitting claim: Date:
Signature: Title:
Telephone Number.
Any addition information desired to be submitted should be sent to the appropriate Division Regional Office within five days of 1
knowledge of the SSO with reference to the incident number (the incident number is only generated when electronic entry of th
form is completed, if used).
CS-SSO Form Page: 3