WQCS00002_BIMS Report_20220318

24 Hour Reporting: DWR number for spill reporting is State of North Carolina
919-791-4200, ask for a representative of "Surface Waters" Department of Environment and Natural Resources
and explain that you are reporting a spill event. After hours Division of Water Resources
reporting is made by contacting State
emergency management at 1-800-858-0368.
SSO WORKSHEET

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; WQCS00002 (WQCS+# if active, otherwise use WQCSD#)
Facility: SFMN11012 Incident #: Owner:
Region: City: Garner County: Wake
Source of SSO (check applicable): [ll] Sanitary Sewer [1 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.): 1202 NEW BETHEL CHURCH RD, GARNER, NC
Manhole #: SFMN11012 30-inch Force Main

Latitude (degrees/minute/second): Longitude (degrees/minute/second):
Incident Started Dt; 02/14/2022 Time: 97:30AM incident End Dt; 92/14/2022 time, 11:30 AM
(mm-dd-yyyy) (hh:mm) AM/PM (mm-dd-yyyy) (hh:mm) AM/PM
Estimated volume of the SSO; 83,000 gallons gallons Estimated Duration (round to nearest hour): 4 hour(s)
Describe how the volume was determined: duration and flow
Weather conditions during the SSO event: Clear
Did the SSO reach surface waters? [fl] Yes [] No [-] Unknown
Volume reaching surface waters: 63,000 gallons Surface water name: Mahlers Creek
Did the SSO result ina fish kill? [] Yes [Bl No [J Unknown
If Yes, what is the estimated number of fish killed?
SPECIFIC cause(s) of the SSO:
[ ]Severe Natural Conditions OO Grease []Roots [inflow & Infiltration
L_]Pump Station Equipment Failure [_] Power Outage []Vandalism [_] Debris inline [_]Pipe Failure (Break)
[Bl] Other (Please explain in Part II)
24-hour verbal notification (name of person contacted): NCDOT Chris Smith, Assistant Resident Engineer Div 5.

[B|DWR [Emergency Management Date (mm-dd-yyy): Time: (hh:mm AM/PM):

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 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.

WHETHER OF NOT PART ILIS COMPLETED, A SIGNATURE IS REQUIRED SEE PAGE 13
Form CS-SSO Page |
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 II:
ANSWER THE FOLLOWING QUESTIONS FOR EACH RELATED CAUSE CHECKED IN PART | 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 |
(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 2
Other (Pictures and police report, as applicable, must be available upon request.)
Describe:
Were adequate equipment and resources available to fix the problem? [lM Yes L]No LINA L] NE
. Raleigh Water deployed vac-trucks and tankers to assist in containment and collection of untretaed wastewater. If Yes, explain:

If the problem could not be immediately repaired, what actions L] Yes [] No (BINA L] NE
were taken to lessen the impact of the SSO?
Comments:
This incident was the direct result of a failed sewer by-pass attributed to an NCDOT bridge construction project. The sewer by-pass, established by independent contractors

working on behalf of NCDOT, failed causing untreated wastewater to reach. The incident was mitigated and controlled by Raleigh Water Utility Responders. The incident was

mitigated and controlled by Raleigh Water Utility Responders. Responders established immediate containment and collection equipment downstream of the affected asset.

The containment and collection effort was able to recover approximately 7,000 gallons of untreated wastewater that did not reach surface waters.

Form CS-SSO Page 11
System Visitation

ORC WH Yes Aine
Backup Ces Ne
Ramer Carlos M Perez
Certification Number, 1903875
Date vicited: 2/14/2022
Time visited: 10:00 AM
How was the SSO remediated (i./e. Stopped and cleaned up)?
NCDOT contractors shut off the by-pass by closing the valve thus restricting wastewater flow.

Utility Responders from Raleigh Water utilized vac-trucks and a 6,000 gal. tanker to assist in the containment and collection efforts.

Contractors working on behalf of the NCDOT bridge relocation project were summoned to repair the failed by-pass.

Raleigh Water conducted an area assessment on Mahlers Creek and Swift Creek and did not observe wastewater debris or fish kill.

The engineer working on behalf of the NCDOT bridge relocation project took the lead in reporting the event to DEQ.

As a representative for the responsible party, | certify that the information contained in this report is true and accurate to the
best of my knowledge.
Person i Carlos MyPerez Date: 03/18/2022
Signature: Le Title: ORC Raleigh Water Collection System
Telephone Number:

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 13