NC0020656_WWTP Spill_20031105

Untitled Document
Enter/Maintain SSO 5 Day report:
Page 1 of 1
Permit Number
Facility:
Owner:
City:
ih1C0020656.
Leiths Creek
City of Laurinb
iLaurinburg
irg
Report #:
Incident #:
20906
200300188
Region: Fayetteville
County:
Scotland
onfirmation Screen
SSO 5 day ( Report Number : 20906) has been successfully created/maintained.
Save SSO 5 Da Report (Hard copy)
:\12'-/;•2
Save and Continue
.cU4 ltiQ�
http://bims. enr. state.nc.us:7001/bypass/bypassPanel.j sp 3/26/2004

;Jntitlec3 Document
Page 1 of 1
Enter/Maintain SSO 5 Day report:
Permit Number
Facility:
Owner:
City:
t C0020656
Leiths Creek WWTP
City of Laurinburg
aurinburg
Report #: ik2017G
Incident #: [200300188
Region: 1Fayettevii
County: IScotiand
Confirmation Screen
SO 5 day ( Report Number : 20176) has been successfully created/maintained.
Save SSO 5 Da Report (Hard copy)
Save. and Continue
http://bims. enr.state.nc.us:7003/bypass/bypassPanel.j sp 12/22/2003

Pater Incident Page 1 of 2
Incident SSO 24 Hour Evaluation Form:
;r 1,c;,c6 ,1,-I-7F 00(7 3 pot r' `vim
*Type of Incident:
SSO 24 hr.
*County:[Scotland
*Started Date:
*Time:
City:
11/05/2003 Imn/dd/yyyy
11:00 AM J hh:mm am
Laurinburg
Responsible Party:(owner/permitee representive)
First Name
Middle Name:_
Last Name::
Owner:
Address:
City:
State/Zip:
Phone number: 1(555)555-1212
Permit Number: NC ° 0 () /p 5 ((a
Facility Name:
°Find Owner
Find,.Permit
Material Category:
Material type: Estimated Qty,
Sewage
Incident Questions:
ind_ Facility
Unit of Measure
o gallons
*Location of Incident:
On Site Contact:(oN
First Name:
Middle Name:
Last Name:
Contact Agency:
Phone Number:
Cell/Pager Number:
(5:
Reporting Person:(pe
First Name: Rc
Middle Name:
Last Name:rEI
Contact Agency: Ci
Address:
City:�a
State/Zip: N(
Phone Number:
Cellular Number:
Date:r
Time:_
Cause of Incident:
Located at EQ basin at WWTP.
Leaking of liner of F
Action Taken:
Comments:
City. is in the process of
draining EQ basin.
http://bimsdev.enr.state.nc.us:7001/sso/enterSSO24hr.jsp 11/5/2003

Ineident
Page 2 of 2
• •-• _•••••
Did the Material reach the Surface
Waters?
Did the Spill result in Fish Kill?
Containment?.
Cleanup Status?
* yes
0 no
O unknown
O yes
0 unknown
O yes
©no
• unknown
O complete
started
0 unknown
Surface
Estima
Standard Agencies Notified:
add Row
Delete.Agency.Phone Number.First.Middle.Last.Date.Time.
Other Agencies Notified:
add Row
Delete.Agency.Phone Number.First. Middle. Last. Date. Time.
DWQ Information:
RO Person Referred To:
Report Taken By: Additional Region:
„Seledr
Phone: [phone]
Date: mm/dd/yyyy
Time: hh:mm am/pmP
Henson, Belinda S 'Henson, Belinda S
[phone] Ext.727.i(910)436-1541 Ext.7271
Referred via: --Select Value ---
---Select Value--LI
-
*bruit]
Averitte, Kenneth L
[phone] Ext.7:
L
1
---Select Value--ri
-
• ct,ion„P?ne: .10 )11
,
cail 1-8QQ-85S-604
http://bimsdev.enr.state.nc.us:7001/sso/enterSS0241r.jsp
11/5/2003

r"
Iv1
Atjz-
NOVI7 2003
Form CS-SSO
Collection System Sanitary Sewer Overflow Reporting Form
J 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 : gC0026 66, (WQCS# if active, otherwise use treatment plant NC/WQ#)
Facility: C/Ty OF LARA/NA/iR9. Lk-s�I.r)A R //-EminE/KT PIRA& Incident # '^1�0 3O0
Owner: CITY F Lfiunrnl6uR9 Region: FAd//=T7E l u
City: LRuRipraw'o NC County: C477-RNn
Source of SSO (check applicable) :
12/
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, etc) : F Q-BA-3/A( LAIER (NAIL .STREET Ev-T .3/ON)
Latitude (degrees/minute/second):
31.71053
Incident Started Dt: /l - . 51. 03
(mm-dd-yyyy)
Estimated volume of the SSO:
Time• 10: 30 Ant
hh:mm AM/PM
500 gallons
Longitude(degrees/minute/second) •
79. L/I/S�v
Incident End Dt: 11-05-2603 Time j I:°O14m
(mm-dd-yyyy)
Estimated Duration (Round to nearest hour):
hh:mm AM/PM
.5
Describe how the volume was determined: EtbitRED—INF AREA / D eu73le FEErTU %)E-rEkin,NE
Weather conditions during SSO event Lr jh+ /4/Al
Did SSO reach surface waters? "Yes 0 No 0 Unknown Volume reaching surface waters (gallons):
Surface water name: ; ,- 1-glTNCPEEM
Did the SSO result in a fish kill? 0 Yes 'No D Unknown If Yes, what is the estimated number of fish killed? N//9
SPECIFIC cause(s) of the SSO:
O Severe Natural Condition
D Inflow and Infiltration
O Vandalism
Immediate 24-hour verbal notification reported to:
DWQ Emergency Mgmt.
O Grease
O Pump Station Equipment Failure
O Debris in line
�jE11njDP /]E/ 50/4
Date (mm-dd-yyyy): /J-D5-203 Time (hh:mm AM/PM): 43:i5 PM
ehlint .
S X (J/oN3
O Roots
O Power outage
V.Other (Please explain in Part II)
If an SSO is ongoing, please notify Regional Office on a daily basis until SSO can be stopped.
Per G.S. 143-215.1 C(b), the responsible party of a discharge of 1,000 gallons or more of untreated wastewater to surface
waters shall issue a press release within 48-hours of first knowledge to all print and electronic news media providing general
coverage in the county where the discharge occurred. When 15,000 gallons or more of untreated wastewater enters surface
waters, a public notice shall be published within 10 days and proof of publication shall be provided to the Division within 30 days.
Refer to the referenced statute for further detail.
The Director, Division of Water Quality, may take enforcement action for SSOs that are required to be reported to Division unless it
is demonstrated that:
1) the discharge was caused by severe natural conditions and there were no feasible alternatives to the discharge; or
2) the discharge was exceptional, unintentional, temporary and caused by factors beyond the reasonable control of the Permittee
and/or owner, and the discharge could not have been prevented by the exercise of reasonable control.
Part II 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 I I
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 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, etc.)
Describe the "severe natural condition" in detail.
How much advance warning did you have and what actions were taken in preparation for the event?
Comments:
Grease (Documentation such as cleaning, inspections, enforcement
actions, past overflow reports, educational material and distribution date,
etc. should be available upon request.)
When was the last time this specific line (or wet well) was cleaned?
Do you have an enforceable grease ordinance that requires new or retrofit of grease traps/interceptors? ❑Yes❑ No ❑ NA ❑ NE
Have there been recent inspections and/or enforcement actions taken on nearby restaurants or other ❑Yes❑ No ❑NA ❑NE
nonresidential grease contributors?
Explain.
Have there been other SSOs or blockages in this area that were also caused by grease?
When?
If yes, describe them:
❑Yes❑ No ❑ NA ❑ NE
Have cleaning and inspections ever been increased at this location? ❑Yes❑ No ❑ NA ❑ NE
Explain.
CS-SSO Form
October 9, 2003
Page 2

Have educational materials about grease been distributed in the past?
When?
and to whom?
Explain?
❑Yes❑ No NA ENE
If the SSO occurred at a pump station, when was the wet well and pumps last checked for grease
accumulation?
Were the floats clean? ❑ Yes❑ No ❑ NA ❑ NE
Comments:
Roots
Do you have an active root control program?
Describe
❑Yes❑ No DNA ONE
Have cleaning and inspections ever been increased at this location because of roots? DYes❑ No DNA ❑ NE
Explain:
What corrective actions have been accomplished at the SSO location (and surrounding system if
associated with the SSO)?
What corrective actions are planned at the SSO location to reduce root intrusion?
Has the line been smoke tested or videoed within the past year? ❑Yes❑ No ❑ NA ❑ NE
If Yes, when?
Comments:
Inflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule in any permit that ❑Yes❑ No ❑ NA ❑ NE
addresses I/1?
CS-SSO Form October 9, 2003 Page 3

Explain if Yes:
What corrective actions have been taken to reduce or eliminate I & I related overflows at this spill location
within the last year?
Has there been any flow studies to determine I/1 problems in the collection system at the SSO location? ❑Yes❑ No ❑NA ❑NE
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? ❑Yes❑ No ❑ NA ❑ NE
If Yes, when and indicate what actions are necessary and the status of such actions:
Are there I/1 related projects in your Capital Improvement Plan? ❑Yes❑ No DNA LINE
If Yes, explain:
Have there been any grant or loan applications for I/1 reduction projects? ❑Yesn No ❑ NA ❑ NE
If Yes, explain:
Do you suspect any major sources of inflow or cross connections with storm sewers?
If Yes, explain:
❑Yes❑ No LINA LINE
Have all lines contacting surface waters in the SSO location and upstream been inspected recently?
If Yes, explain:
❑Yesn No LI NA Lil NE
What other corrective actions are planned to prevent future I/1 related SSOs at this location?
Comments:
Pump Station Equipment Failure (Documentation of testing, records etc.,
shoul be provided upon request.)
What kind of notification/alarm systems are present?
Auto-dialer/telemetry (one-way communication) El Yes
CS-SSO Form October 9, 2003 Page 4

Audible ❑Yes
Visual ❑Yes
SCADA (two-way communication) ❑Yes
Emergency Contact Signage ❑Yes
Other ❑Yes
Describe the equipment that failed?
What kind -of situations trigger an alarm condition. at this station (i.e. pump failure, power failure, high
water, etc.)?
Were notification/alarm systems operable? ❑Yes❑ No NA ONE
If no, explain:
If a pump failed, when was the last maintenance and/or inspection performed?
What specifically was checked/maintained?
If a valve failed, when was it last exercised?
Were all pumps set to alternate?
Did any pump show above normal run times prior to and during the SSO event?
Were adequate spare parts on hand to fix the equipment (switch, fuse, valve, seal, etc.)?
Was a spare or portable pump immediately available?
If a float problem, when were the floats last tested? How?
❑Yes❑ No ❑ NA ❑ NE
❑Yes❑ No ❑ NA LINE
❑Yes❑ No ❑ NA ❑ NE
❑Yes❑ No DNA LINE
If an auto -dialer or SCADA, when was the system last tested? How?
Comments:
CS-SSO Form October 9, 2003 Page 5

Power outage (Documentation of testing, records, etc., should be
provided of alternative power source upon request.)
What is your altemate power or pumping source?
Did it function -properly? ❑Yes❑ No DNA ONE
Describe?
When was the altemate power or pumping source last tested under load?
If caused by a weather event, how much advance warning did you have and what actions were taken to
prepare for the event?
Comments:
Vandalism
Provide police report number:
Was the site secured?
If Yes, how?
❑Yes❑ No DNA ONE
Have there been previous problems with vandalism at the SSO location? ❑Yes❑ No DNA LINE
If Yes, explain:
What security measures have been put in place to prevent similar occurrences in the future? ❑Yes❑ No DNA LINE
Comments:
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?
How could it have gotten there?
Are manholes in the area secure and intact? ❑Yesu No DNA ❑NE
CS-SSO Form October 9, 2003
Page 6

When was the area last checked/cleaned?
Have cleaning and inspections ever been increased at this location due to previous problems with debris? Yes❑ No DNA ❑NE
Explain:
Are appropriate educational materials being developed and distributed to prevent future similar DYesD No DNA ❑ NE
occurrences?
Comments:
Other (Pictures and a police report should be available upon request.)
Describe:
PIEA3E SEE Apiched S'XEEr
Were adequate equipment and resources available to fix the problem? ❑Yes❑ No DNA ONE
If Yes, explain:
If the problem could not be immediately repaired, what actions were taken to lessen the impact of the
SSO?
Comments:
For DWQ Use Only:
DWQ Requested an Additional Written Report:
If Yes, What Additional Information is Needed:
❑Yes❑ No DNA ONE
Comments:
CS-SSO Form
October 9, 2003 Page 7

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: o3Eg fEthiS Date: //145/63
Signature:Ng)-eJ
Telephone Number: (010) c)77-92/4
Title: , /3T/nENT / x13 J/REe-m
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

Explanation Page 7
Incident # 200300188
Other
Describe:
On March 31, 2003 we notified your office that our equalization basin liner had failed
and was leaking through the under drain system. The contractors notified us that the
repairs were complete on October 30, 2003. We were in the process of testing the basin
liner by diverting all of our influent flow to the EQ Basin and monitoring the under drain
collection system. Wednesday afternoon we had flow from the under drain system. We
immediately closed the valve to stop this discharge. The contractors have been notified
of this problem and have been scheduled to retest the liner as soon as possible or as soon
as we can empty the basin. After retesting we hope this will correct the problem.