WQCSD0662_Correspondence_20220224

DivisionState of North Carolina
Collection System Sanitary Sewer Overflow Reporting Form
Form CS-SSO
PART 1:
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: WQ0038589 (WQCS# if active, otherwise use WQCSD#)
Facility: Avocet Collection System Incident : 202200257 Owner: Aqua North Carolin
Region: Raleigh City: Holly Springs County: Wake
Source of SSO (check applicable): Z 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.): Manhole located behind 7016 Rex Road, Holly Springs, NC
Manhole #: n/a
Latitude (degrees/minute/second): 33/36'9.62" N Longitude (degrees/minute/second): 78/52'15.63"W
Incident Started Dt: 2/21/22. Time: 11:40 a.m. Incident End Dt: 2/21/22 Time: 12:28 p.m.
(mm-dd-yyyy) (hh:mm) AM/PM (mmAd-yyyy) (hh:mm) AM/PM
Estimated volume of the SSO: 200 gallons Estimated Duration (round to nearest hour): 0.75 hour(s)
Describe how the volume was determined: volumed was based on the amount of flow coming out the manhole (4
gpm) times the duration of the overflow (48 minutes).
Weather conditions during the SSO event: sunny, dry
Did the SSO reach surface waters? ® Yes ❑ No ❑ Unknown
Volume reaching surface waters: 200 gallons Surface water name:
Did the SSO result in a fish kill? El Yes ®No
If Yes, what is the estimated number of fish killed?
SPECIFIC cause(s) of the SSO:
❑Severe Natural Conditions ElGrease
❑Pump Station Equipment Failure ElPower Outage
❑Other (Please explain in Part ll)
El Unknown
❑Roots
❑Vandalism
24-hour verbal notification (name of person contacted): Molly Nicholson
®DWR ❑Emergency Management Date (mm-dd-yyy): 2/22/22
❑Inflow &Infiltration
® Debris in line ❑Pipe Failure (Break)
Time: (hh:mm AM/PM): 10;15 a.rn.
Per G,S. 143-215,1C(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 signcantly 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.
Form CS-SSO Page 1

Mate of North Carolina
Department of Environment and Natural Resources
VR I Division of Water Resources
Collection System Sanitary Sewer Overflow Reporting Form
�f Water Resources Form CS-SSO
Fo►•m CS-SSO Page 2

In order to submit a claim for justification of an SSO, you must use Part 11 of form CS-SSO with additional documentation as
necessary. DWR staff will review the justification claim and determine if enforcement action is appropriate.
PART 11:
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 55O 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 t®rnado etc.
Describe the "severe natural condition" in detail:
Now much advance warning did you have and what actions were taken in preparation for the event?
Comments:
Form CS-SSO Page 4

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

MOM
Cho you have an active root control program on the line / area in question? ( Yes No
Describe:
Have cleaning and inspections ever been increased at this location because
of roots? ❑ Yes ❑ No
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
If Yes, when?
Comments:
[ ]NA
�m
Form CS-SSO Page 6
NE

Inflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule ❑ Yes ❑ No
in any permit that addresses I/I?
Explain if Yes:
What corrective notions have been taken to reduce or eliminate I & I related overflows this spill location
within the last year?
❑NA
Has there been any flow studies to determine I/I problems in the ❑Yes ❑ No ❑NA
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
If Yes, when and what actions are necessary and the status of such actions:
Are there 1/1 related projects in your Capital Improvement Plan? ❑ Yes ❑ No NA
If Yes, explain:
Have there been any grant or loan applications for I/I reduction projects? ❑Yes ❑ No NA
If Yes, explain:
Do you suspect any major sources of inflow or cross connections ❑Yes ❑ No ❑NA
with storm sewers?
If Yes, explain:
Have all lines contacting surface waters in the SSO location and upstream ❑Yes ❑ No ❑NA
been inspected recently?
If Yes, explain:
What other corrective actions are planned to prevent future I/I related SSOs at this location?
Comments:
❑ NE
❑ NE
❑ NE
Form CS-SSO Page 7

Pump Station E ui ment Failure Documentation of testincl records, --etc should be orovided 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?
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? ❑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?
If an auto -dialer or SCADA, when was the system last tested? How?
Comments:
Form CS-SSO
■
❑NA
❑NA
�Q
❑ NE
❑ NE
❑ NE

Power Data e ®ocumentotion of testis reoords tec., should be rovided of �Iternative owes source a on
request.)
What is your alternate power or pumping source?
did it function properly? L=.j Yes Lj No LA NA �] NE
Describe?
When was the alternate 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:
Form CS-SSO Page 9

vandalism
Provide police report number:
11 Was the site secured?
If Yes, how?
Have there been previous problems with vandalism at the SSO location?
If Yes, explain:
What security measures have been put in place to prevent similar
occurrences in the future?
Comments:
Form CS�SSO
Yes LJ No UNA L=j NE
Page 10

( eDns in line (KoCkS, sticks, rags and other items not allowed in the collection system etc.)
What type of debris has been found in the line? Rocks, wire, sticks, rags,
Suspected cause or source of debris: sticks, rocks and wire put in the line and customers flushing rags
Are manholes in the area secure and intact? ® Yes El No [INA
When was the area last checked/cleaned? November-®ecember 2021 pected by collection system ORC
Have cleaning and inspections ever been increased at this location
due to previous problems with debris?
Explain: No previous incidents with debris in line,
".Are appropriate educational materials being developed and distributed
to prevent future similar occurrences?
NC
Comments: Aqua provides bi-annual FOG notifications that educate customers on items that are prohibitied from entering
the wastewater system. The next customer notification will be sent to all Aqua wastewater customers in March 2022,
Form CS-SSO
Page I 1

Other (Pictures and police report as p_licable, must be available upon request.
Describe:
Were adequate equipment and resources available to fix the problem? ® Yes L- No MINA Ij N
If Yes, explain: long handled pole was able to break up blockage. Vac truck was on site within 30 minutes of
notification,
If the problem could not be immediately repaired, what actions
were taken to lessen the impact of the SSO?
Comments:
Form CS-SSO
Page 12

Pips Failure (Hreak)
Pipe size (inches)
What is the pipe material
What is the approximate age of the line/ pipe (years old)
Is this a gravity line? ❑ Yes ❑ No NA ❑ NE
Is this a force main line? El Yes 0 No ❑NA ❑ NE
Is the line a "High Priority" line? ❑Yes No ❑NA ❑ NE
Last inspection date and findings
,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?
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?
When was the line last inspected or videoed?
If line collapsed, what is the condition of the line up and down stream of the failure?
What type of repair was made?
, ��:'•If temporary, when is the permanent repair planned?
Have there been other failures of this line in the past five years? ❑ Yes ❑ No ❑NA ❑ NE
If so, then describe
Form CS-SSO Page 13

System Visitation
Name:
Certification Number:
Date visited:
Time visited:
ORC
Backup
Brandon Cummings
Collections II - #1009299
How was the SSO remediated (iJe, Stopped and cleaned up)?
Yes
®ebris and rag ball was broken up with a long handled pole, rocks, wire, sticks and all other debris were jetted
to the lift station. Lift station was then vac cleaned and debris removed.
As a representative for the responsible part , ly certify that the information contained in this report is true and accurate to the
best of my knowledge.
Person submitting claim: Date; +—
Signature:
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