WQCSD0743_Report_20211027

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 DWR Regional Office within five business days of the first knowledge of the
sanitary sewer overflow (SSO).
Permit Number: WQCSD0743 (WOGS# if active, otherwise use WOCSD#)
Facility: Saddleridge Incident #: 202102067 Owner: Aqua North Carolina
Region: Raleigh City: Raleigh County: Wake
Source of SSO (check applicable): El 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.): The SSO occurred from the low pressure sewer main on Green
Downs drive leading to the lift station.
Latitude (degrees/minute/second): Longitude (degrees/minute/second):
Incident Started Dt: 10/20/2021 Time: 3:15 PM Incident End Dt: 10/20/2021 Time: 3:40 PM
(mm-dd-yyyy) (hh:mm) AM/PM (mm-dd-yyyy) (hh:mm) AM/PM
Estimated volume of the SSO: 14,500 gallons Estimated Duration (round to nearest hour): 1 hour(s)
Describe how the volume was determined: By calculating the normal runtimes and the amount the lift stations
pumps
Weather conditions during the SSO event: Sunny
Did the SSO reach surface waters? ❑ Yes ❑ No ❑ Unknown
Volume reaching surface waters: gallons Surface water name:
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 Conditions ❑ Grease ❑Roots
:]Pump Station Equipment Failure ❑ Power Outage ❑Vandalism
❑
Inflow &Infiltration
❑ Debris in line ®Pipe Failure (Break)
:]Other (Please explain in Part II)
4-hour verbal notification (name of person contacted): Cheng Zhang
®DWR ❑Emergency Management Date (mmAd-yyy): 10/21/2021 Time: (hh:mm AM/PM): 2 PM
Per G.S. 143-215.1 C(b), the owner or operator of any wastewater collection system shall:
In the event of a discharge of 1,000 gallons or more of untreated wastewater to the surface waters of the State, issue
a press release to all print and electronic news media that provide general coverage in the county where the
discharge occurred setting out the details of the discharge. The press release shall be issued within 24 hours after
the owner or operator has determined that the discharge has reached surface waters of the State.
In the event of a discharge of 15,000 gallons or more of untreated wastewater to the surface waters of the State,
publish a notice of the discharge in a newspaper having general circulation in the county in which the discharge
occurs and in each county downstream from the point of discharge that is significantly affected by the discharge. The
Regional Office shall determine which counties are significantly affected by the discharge and shall approve the form
and content of the notice and the newspapers in which the notice is published.
Foim CS-SSO Page 1

Form CS-SSO Page 2

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.
PART I1:
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 HAS BEEN SUBMITTED ELECTRONICALLY THROUGH THE ONLINE REPORTING SYSTEM
Form CS-SSO Page 3

Severe Natural Conditions (hurricane tornado etc.)
pescribe the "severe natural condition" in detail:
How much advance warning did you have and what actions were taken in preparation for the event? N/A
Comments: N/A
Form CS-SSO Page 4

Grease (Documentation such as cleaning, inspection enforcement actions past overflow repor#s, educational
material and distribution date, etc, should be available upon request.)
When was the last time this specific line (or wet well) was cleaned? N/A
Do you have an enforceable grease ordinance that requires new or retrofit of
grease traps/interceptors? ❑Yes
Have there been recent inspection and/or enforcement actions taken on near-
by restaurants or other nonresidential grease contributors? ❑ Yes
Explain:
Have there been other SSOs or blockages in this areas that were also caused
by grease ❑ Yes
When? N/A
If yes, describe them: N/A
Have cleaning and inspections ever been done at this location?
Explain.
Have educational material about grease been distributed in the past?
When: N/A
and to whom: N/A
Explain: N/A
Yes
❑ Yes
If the SSO occurred at a pump station, when was the wet well and pumps last checked
for grease accumulation: N/A
Were the floats clean?
Comments: N/A
❑ Yes
❑ No
❑ No
®NA ❑NE
NA ❑ NE
NA ❑ NE
NA NE
Form CS-SSO Page 5

Roots,
Do you have an active root control program on the line / area in question? F1 Yes 0 No FINA [I NE
Describe:
Have cleaning and inspections ever been increased at this location because
of roots? 0 Yes No MNA NE
Explain: N/A
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? 0 Yes El No NNA El NE
If Yes, when?
Comments: N/A
Form CS-SSO Page 6

Inflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule ❑ Yes ❑ No L>qNA Li NE
in any permit that addresses I/I?
Explain if Yes: N/A
What corrective actions have been taken to reduce or eliminate I & I related overflows this spill location
within the last year? N/A
Has there been any flow studies to determine I/I problems in the ❑Yes No NA NE
collection system at 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? ❑Yes ❑ No NA NE
If Yes, when and what actions are necessary and the status of such actions:
Are there I/I related projects in your Capital Improvement Plan? ❑Yes ❑ No NA NE
If Yes, explain: N/A
Have there been any grant or loan applications for I/I reduction projects? ❑Yes No NA ❑ NE
If Yes, explain: N/A
Do you suspect any major sources of inflow or cross connections ❑Yes ❑ No ®NA ❑ NE
with storm sewers?
If Yes, explain: N/A
Have all lines contacting surface waters in the SSO location and upstream ❑Yes ❑ No ®NA ❑ NE
been inspected recently?
If Yes, explain: N/A
What other corrective actions are planned to prevent future I/I related SSOs at this location? N/A
Comments: N/A
Form CS-SSO Page 7

Pump Station Equipment Failure Documentation of testing records, etc should be provided upon request)
What kind of notification/alarm systems are present?
Auto-dialer/telemetry (one-way communication) ❑ Yes
Audible ❑Yes
Visual Yes
SCADA (two-way communication) ❑Yes
Emergency Contact Signage ❑Yes
Other Yes
If Yes, explain:
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 ❑ NE
In no, explain:
If a pump failed, when was the last maintenance and/or inspection performed? N/A
What specifically was checked/maintained? N/A
If a valve failed, when was it last exercised? N/A
Were all pumps set to alternate?
Did any pump show above normal run times prior to and during the SSO event? ❑Yes ❑ No
Were adequate spare parts on hand to fix the equipment
Was a spare or portable pump immediately available?
If a float problem, when were the floats last tested? How? N/A
If an auto -dialer or SCADA, when was the system last tested? How?
• �.�7"1itLaJIMM
/1
/1
❑ NE
❑ NE
❑ NE
Form CS-SSO Page 8

rower outage (Documentation of testing records tec. should be provided of alternative.�saurco upon
re uest.
What is your alternate power or pumping source?
Did it function properly?
Describe?
When was the alternate power or pumping source last tested under load?
Yes � No LJNA L] NE
If caused by a weather event, how much advance warning did you have and what actions were taken to prepare for the
event? N/A
Comments: N/A
Form CS-SSO Page 9

Vandalism
Provide police report number: N/A
Was the site secured? Yes No � N A Lj NE
If Yes, how? N/A
Have there been previous problems with vandalism at the SSO location?
If Yes, explain: N/A
What security measures have been put in place to prevent similar El Yes No HNA NE
occurrences in the future?
Comments: N/A
Foirn CS-SSO Page 10

Debris in line (Rocks� �tick�, raq� and other items not allowed in the collection �Vstem etc.)
What type of debris has been found in the line? N/A
Suspected cause or source of debris: N/A
Are manholes in the area secure and intact? EI Yes F1 No ZNA [I NE
When was the area last checked/cleaned? N/A
Have cleaning and inspections ever been increased at this location El Yes No ZNA NE
due to previous problems with debris?
Explain: N/A
Are appropriate educational materials being developed and distributed Ej Yes No ZNA NE
to prevent future similar occurrences?
Comments: N/A
Form CS-SSO Page 11

Ocher (�iciure and police rep©rt, a applicable mini be available upon regue�i.)
Describe:
Were adequate equipment and resources available to fix the problem?
If Yes, explain: N/A
If the problem could not be immediately repaired, what actions
were taken to lessen the impact of the SSO?
Comments: N/A
[� Yes Lj No 12�JNA L] NE
Form CS-SSO Page 12

Pipe Failure (Break
Pipe size (inches)
What is the pipe material
2
Brass Valves and PVC Pipe
What is the approximate age of the line! pipe (years old) 45
Is this a gravity line? ❑ Yes No ❑NA ❑ NE
Is this a force main line? ®Yes ❑ No ❑NA ❑ NE
Is the line a "High Priority" line? ❑Yes No ❑NA ❑ NE
Last inspection date and findings No inspections complete. This is a low pressure system
If a force main then,
Was the break on the force main vertical? ❑Yes No NA NE
Was the break on the force main horizontal? ❑Yes ❑ No NA NE
Was the leak at the joint due to gasket failure ? ❑Yes ❑ No ®NA ❑ NE
Was the leak at the joint due to split bell? ❑Yes ❑ No ®NA ❑ NE
When was the last inspection or test of the nearest air -release valve to determine if operable? September 2021
When was the last maintenance of the air release performed?
If gravity sewer then,
Does the line receive flow from a force main immediately upstream ❑Yes ®No ❑NA ❑ NE
of the failed section of pipe?
If yes, what measures are taken to control the hydrogen sulfide production? N/A
When was the line last inspected or videoed? N/A
If line collapsed, what is the condition of the line up and down stream of the failure? N/A
What type of repair was made? This is a low pressure line that carries sewer from the step system tanks to the lift
station. A root was rubbing on the side of a brass shut-off. Over the years of vibration due to the pump tanks
coming on and off a hole was rubbed into the shut-off valve. Once the root was removed we replace the shut-off
valve, check valve, and 2 feet of 2 inch PVC pipe.
If temporary, when is the permanent repair planned? N/A
Have there been other failures of this line in the past five years?
If so, then describe N/A
■arm
Form CS-SSO Page 13

System Visitation
Name:
Certification Number:
Date visited:
Time visited:
ORC Lj Yes
backup r] Yes
Wayne Alford
10/20/2021
How was the SSO remediated (i./e. Stopped and cleaned up)?
Upon discovery, Aqua took immediate action by making the necessary repairs to stop the spill and contacted
our emergency contractors David Jacobs and Vision NC. The emergency contractor was able to recover and
dispose of roughly 8,500 gallons The area affected was then limed, re -seeded, and strawed.
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
Signature:
Telephone Number: 919-653-6966
Date: 10/25/2021
Any additional information desired to be submitted should be sent to the appropriate Division Regional Office within five
business 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).
Form CS-SSO Page 14