WQCS00191_Renewal (Application)_20220401

DW R
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0400 — SYSTEM -WIDE WASTEWATER COLLECTION SYSTEMS
INSTRUCTIONS FOR FORM CSA 04-16 & SUPPORTING DOCUMENTATION
Documents shall be prepared in accordance with 15A NCAC 02T .0100, 15A NCAC 02T .0400, and all relevant
Division Policies. Failure to submit all required items will necessitate additional processing and review time.
For more information, visit the System -wide Collection System Permitting website:
General — When submitting an application to the Municipal Permitting Unit, please use the following instructions as a
checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided
boxes will help produce a quicker review time and reduce the amount of requested additional information.
The Applicant shall submit one original and one copy of the application and supnortinz documentation.
The copy may be submitted in digital format.
A. Cover Letter
f: Submit a cover letter listing all items and attachments included in the permit application package
B. No Application Fee Required
e No application fee is necessary. The permittee will be billed an annual fee upon issuance of the permit
e The appropriate annual fee for systemwide wastewater collection system permits may be found at:
e Annual Non -Discharge Fees
C. System -Wide Wastewater Collection System (FORM: CSA 04-16) Application:
P Submit the completed and appropriately executed System -wide Wastewater Collection System (FORM: CSA 04-
16) application. Any unauthorized content changes to this form shall result in the application package being
returned. If necessary for clarity or due to space restrictions, attachments to the application may be made, as long
as the attachments are numbered to correspond to the section and item to which they refer.
If the Applicant Type in Section 1.3 is a Privately -Owned Public Utility, provide the Certificate of Public
Convenience and Necessity (CPCN) from the North Carolina Utilities Commission demonstrating the Applicant
is authorized to hold the utility franchise for the area to be served by the wastewater collection system, or
Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area
or that franchise approval is expected.
ID If the Applicant Type in Section 1.3 is a corporation or company, provide documentation if it is registered for
business with the North Carolina Secretary of State.
D. General Information:
e The Authorized signing official listed in Section 1.4 should match with that of the Applicant certification page in
accordance with 15A NCAC 02T .0 I 06(b). Per 15A NCAC 02T .0106(c), an alternate person may be designated
as the signing official if a delegation letter is provided from a person who meets the criteria in 15A NCAC 02T
.0106(b).
NOTE - Public Works Directors are not authorized to sign this permit application, according to the rule,
unless they are formally delegated.
INSTRUCTIONS FOR APPLICATION CSA 04-16 & SUPPORTING DOCUMENTATION Pago. 1 of 5

Town of Walnut Cove
February 15, 2022
Office of Board of Town Commissioners
To: North Carolina Department of Environment and Natural Resources Division of Water
Resources Percs Unit
From: Town of Walnut Cove
Enclosed is the infon-nation requested from the form CSA-0813 for the Collection System of
\Nralnut Cove
Thank you,
Mark A. Bowman (ORC)

Information Regarding Application CSA08-13
I. Applicant Information
a. Town of Walnut Cove
b. Town of Walnut Cove collection system p CS00191
c. Municipal
d. Town Manger Signature (Kim reerm
i. Town Manger's email: townmanger crvnofwa1nutcove.org
e. P.O Box 130 Walnut Cove, NC 27052
f. [phone] (Office) and [phone] (Fax)
II. Contact/ Consultant Information
a. Mark A. Bowman
b. Collection System (ORC) Certg 988483
c. 5623 NC Hwy 8 South, Germanton, NC 27019
d. [phone] (cell) and [phone] (fax)
III. General Requirements
a. Renewal
b. Stokes County
c. Town of Walnut Cove (NliWTP)
d. WWTP Permit g NC0025526
e. 90% Domestic- 10% Industrial (No Pre -Treatment)
f .2193
s. .5M6D
h. Representative Data
i. Population served- 1730
IV. Line Length
a. Gravity Sewer- 21 miles
b. Force Main- 5 miles
c. Vacuum Sewer- 0 miles
d. Pressure Sewer- 0 miles

Town of Walnut Cove Pump Station List
I) Telemetry Pump Stations
a. Hwy 311-65
b. Hwy 311- Plant Street
. N1ontgomery Court
d. Spring Street
e. Marshall Street
f. Lions Park
2) Audio Alarm Only
a. Walnut Tree
b. Circle Drive
c. Walnut Cove Elementary School
d. Parkdale Plant
e. Oak Street
I', Waste Water Treatment Plant

Aerial Lines
Ductile Iron line crossing Town Fork Creek Hwy 311
High Priority Lines
Ductile Iron (In casing) crossing creek at Ninth St, outfall Line_
Ductile Iron (in casing) crossing creek at Depot St,
4" sewer service crossing creek at W/Cove Elementary School
Ductile Iron (in casing) crossing creek at Fourth St. outfall line
Sub Water way sewer lines •
Sewer outfall line at Town Fork Creek in Mitchell's field
Sewer outfall line at Ninth St.- Oldtown Rd.
Sewer outfall line at 311-Ninth St.
Sewer outfall line at Adams Ridge Rd.-311

VI. COLLECTION SYSTEM COMPLIANCE:
1. Is a Response Action Plan currently in place IVIYIes or No
2. If Yes, submit a copy of the Response Action Plan or see table 6 below.
3. Is a pump station contingency plan currently in place? KKes or No
4. If Yes, submit a copy of the pump station contingency plan or see table 6 below.
5. Is a comprehensive collection system map currently in place? Yes or El No
6. Submit a submit a copy of the collection system map (CD or hardcopy) or indicate a schedule for completion
7. Thoroughly read and review the System -Wide Collection System Permit Conditions. Typically compliance schedules
are only offered to NEW permit applicants and NOT permit renewals. Any compliance dates must be included within
the permit prior to issuance or the permit holder will be found in violation upon inspection.
Permit Condition
Current
Compliance?
If no, Indicate a
Compliance
Date
Typical
Compliance
Schedule
1(4) - Grease ordinance with legal authority to inspect/enforce
gces No
12 - 18 mo.
1(5) - Grease inspection and enforcement program
gcesEl No
12 - 18 mo.
I(6) - Three to five year current Capital Improvement Plan,
VYes No
12- 18 mo,
1(8) -Pump station contingency plan
Ri'{es El No
3 mo.
1(9) - Pump station identification signs.
R(Yes No
3 mo.
1(11) - Functional and conspicuous audible and visual alarms.
&dices No
3 - 6 mo.
II(5) - Spare pumps for any station where one pump cannot
handle peak flows alone (in a duplex station, the 2nd pump is
the spare if pump reliability is met).
Yes No
6 - 9 mo.
II(7)- Accessible right-of-ways and easements.
iYesD No
6 - 12 mo.
II(9) - Response action plan with Items 9 (a - h).
g")'e4-.El No
3 mo.
III(3)- Comprehensive collection system map
"Yes El No
10% per year
For conditions not listed, compliance dates are not typically offered. List any permit conditions that may be difficult for the
applicant to meet (attach clarification if needed):
VII. APPLICANT'S CERTIFICATION per 15A NCAC 02T .0106(b):
I, C-4-N -ct=„z„ ct\c,v‘z.g1 attest that this application for "row of 141,j14 ve
(Signature Authority's Name az:Title from Item 1.4) (Facility name from Item 1.1)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
Note: In accordance with NC General Statutes 143-215.6A and I 43-215.6B, any person who knowingly makes any false statement,
representatio r certific tion in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
$10,000 as well i enalties up to $25,000 per violatio
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Da: 07 /5' 43(3C7C9---

Town of Walnut Cove Collection System
General Information
Town of 'Walnut Cove collection is located at 208 West Third Street, Walnut Cove, NC 27052.
The Collection System is currently operated by five full time employees. All five employees are
on 24-hour call. Each employee is furnished with a cell phone. An five employees live within a
10-mile radius of the Town. Response time is less than an hour. The certified electrician for the
Town is Bobby Moore. The Town also has Jeff Lawson with Lawson Plumbing and Hauling on
24-hour call.
Employees:
• Mark Bowman: PWD Grade II Collections (ORC)- 23 years of service
• William Shirley: Back Up Grade I Collections (ORC) and Backhoe Operator- 6 years of
service
• Jackson Willard- 2 years of service
• Austin Willard- 1 year of service
• Brooks Blalock- 1 year of service
List of Collection System Equipment
• 700 Gallon Sewer Jet of America
• High Pressure Jet Rooter
• 1991 dump truck
• Trailer mounted generator
• 2020 Kubota tractor
• 200 JCB rubber -tired Backhoe
• 2012 Ford F350 truck
• 2012 Ford F250 truck
• 2014 Ford F250 truck
• 2010 Ford F150 truck
• 2015 Ford F350 dump truck
All mapping of entire Collection System updated in December 2016.

Town of Walnut Cove, North Carolina
AN ORDINANCE ESTABLISHING REVENUES AND AUTHORIZING
EXPENDITURES
FOR
Annual Budget for FY 2021-2022
WHEREAS, the Board of Commissioners of the Town of Walnut Cove have prepared an
operating budget for the town of Walnut Cove in compliance with Chapter 159 of the General
Statues of North Carolina, otherwise title "Local Government and Fiscal Control Act"; and
WHEREAS, after a public hearing on said budget held on June 8, 2021 and receiving public
comment, it is now the desire of the Mayor and Board of Commissioners to adopt said budget;
NOW, THEREFORE, be it ordained by the Board of Commissioners of the Town of Walnut
Cove, County of Stokes, State of North Carolina;
ANNUAL BUDGET ORDINANCE
SECTION 1-REVENUES AND EXPENDITURES BUDGET
REVENUE:
General Fund S985,110
Water and Sewer Fund 999,631
License Plate Agency 187,731
TOTAL REVENUE S2,172,472
EXPENDITURES:
General Fund S935,110
Water and Sewer Fund 999,631
License Plate Agency 187,731
TOTAL EXPENDITURES S2,I72,472

General Fund
The following amounts are hereby appropriated in the General fund for the operation of the
town government and its activities for the fiscal year beginning July 1, 2021 and ending June
30, 2022, in accordance with the chart of accounts established by the Town:
Expenditures by department:
10-4110-000 Public Officials $51,656
10-4120-000 AdminiFinance S282,821
10-4200-000 Town Maint./Lights $141,023
10-4310-499 Law, Fire Protection $306,210
10-0000-000 General Services $203,400
TOTAL: S985 110
Water and Sewer Fund
The following amounts are hereby appropriated in the Water and Sewer for the operation of the
water and sewer utilities for the fiscal year beginning July 1, 2021 and ending June 30, 2022, in
accordance with the chart of accounts heretofore established by the Town:
Expenditures by department:
6 1 -0000-000 'Water and Sewer $999,631
TOTAL: S999,631
License Plate Agency
The following amounts are hereby appropriated in License Plate Agency Fund for the operation
of the license plate agency for the fiscal year beginning July 1, 2021, and ending June 30, 2022,
in accordance with the chart of accounts heretofore established by the Town:

Expenditures by department:
67-0000-000 License Plate Agency S187,731
TOTAL: $187,731
Total Expenditures all Funds $2,172,472
SECTION II. AD VALOREM TAX RATE ESTABLISHED
An ad valorem rate of forty cents ($.40) per one hundred dollars ($100) valuation is hereby
confirmed as the official tax rate of the Town of Walnut Cove for the fiscal year 2021-2022.
The tax rate is based on a total estimated valuation of property for the purpose of taxation of
$9,999,999 and an estimated collection rate of 97.40 percent. The estimated rate of collection is
based on the fiscal 2020-2021 collection rate.
SECTION III. WATER/SEWER/GARBAGE RATES ESTABLISHED
The following rates are hereby established for the provision of services for the fiscal year
beginning July 1, 2021.
MINIMUM WATER BILL
(5,000 GALLONS PER 2 MONTHS)
EACH ADDITIONAL 1,000 GALLONS
WATER TAP FEE
INSPECTION FEE
RE -CONNECT FEE (M-F 7A-3P)
RE -CONNECT FEE (OTHER TIMES)
RE-INSERT METER
MINIMUM SEWER BILL
(5,000 GALLONS PER 2 MONTHS)
EACH ADDITIONAL 1,000 GALLONS
SEWER TAP FEE
INSPECTION FEE
WATER DEPOSIT REQUIRED
MONTHLV GARBAGE FEE
\NATE [-?, S:`‘LESIpER 1,0o0 GALLONS)
IN -TOWN OUTSIDE TOWN
S32.24 S55.81
5.43
COST PLUS 10%
30.00
60.00
75.00
100.00
9.38
COST PLUS 10%
30.00
60.00
75.00
100.00
534.49 562.94
6.38
COST PLUS 10°,-/o
30.00
100.00
11.18
COST PLUS 10%
30.00
150.00
11.50 N 'A

SECTION IV. AUTHORIZATION AND LIMITATIONS
The Tol,vn Manager is hereby authorized to transfer appropriations within a fund as contained
herein under the following conditions:
a. Transfers between line -item expenditures within a department without limitation and
without a report being required.
b. Transfer up to a total of S3,000 between departments within the same fund for each of
the first three quarters of the fiscal year and up to S12,000 between departments of the
same fund for the 4th quarter of the fiscal year. The Town Manager may make an
official report on such transfers at the next regular meeting of the Board of
Commissioners.
c. All transfers between funds require prior approval by the Board of Commissioners.
SECTION 'V. COPIES
Copies of this Budget Ordinance shall be furnished to the Clerk of the Board of Commissioners,
the Town Manager, and the Finance Officer to be kept on file by them for their direction in
disbursements of funds.
_
Adopted this c:1) day of 2021.
Mayor Nellie Brown
Attest:
Town Clerk

WALNUT COVE
Sanitary Sewer Overflow
Response Procedures
July 15, 2005
Jensen Environmental Consultants, P.A.
PO Box 2245
Jamestown, NC 27282
336-889-5650

,L(4-c( 77-1=Le Vc9 02 bovr.‹
pv, (At -e.5 vt •?/-
WALNUT COVE
Water and Wastewater System
DATE: Fc.kyrim.vri i6, Lon.
Memorandum
FROM: Wyk ex,,mai, Public Works Director
TO: All Walnut Cove Maintenance Personnel
SUBJECT: Sanitary Sewer Overflow (S.S.O.) Response Procedures
Purpose
The purpose of this document is to protect the citizens and environment of Walnut Cove,
North Carolina by establishing written procedures for responding to Sanitary Sewer
Overflows (S.S.0.). These procedures apply to all Maintenance Personnel, who in the
course of their work may deal with S.S.O.'s. These procedures will be reviewed at least
semiannually or whenever revised guidance from County, State or Federal authorities
dictate modifications are necessary.
Response Summary
1. Sanitary Sewer Overflows endanger our environment and the health of any citizens or
employees that come into contact with an S.S.O. Unchecked S.S.O.'s can result in
significant penalties from State and Federal environmental regulatory agencies as well.
The procedures below were designed to protect our environment, citizens, and
employees from an S.S.O. event. These procedures pertain to Walnut Cove
Maintenance Personnel.
2. Upon discovery of an S.S.O., an initial response will be made by the Collection System
ORC (Operator in Responsible Charge). Upon arrival, the foreman will make an
immediate assessment to determine if a S.S.O. event has taken place. If an event has
taken place or is in progress, the maintenance crew will attempt to eliminate the source
of the S.S.O. and notify the Tovvn's S.S.O. Contact Person, the Collection System
ORC.
3. The S.S.O. Contact Person or his alternate will respond to the event location without
delay. Upon arrival, the S.S.O Contact Person will make an assessment of the S.S.O,
determine what is required to mitigate the event, and establish a course of action for
clean up and restoration of the S.S.O. site.

4. If a blockage has occurred and an overflow is in progress, the S.S.O. Contact Person
will:
• Call the Collection System ORC to mobilize additional manpower resources, if
assistance is needed.
• Arrange for a Sewer JetNacuum Truck crew.
• Contact the on -call Operator for mobilintion of personnel and equipment.
5. The S.S.O. Contact Person will record all events as NC Division of Environmental
Management regulations require and will serve as the primary contact with State of
North Carolina authorities.
Caution
Rapid reaction is critical in the event of a S.S.O., but employees are cautioned to
maintain proper safety precautions, especially as they pertain to confined space
entry and hazardous material handling.
2

SPILL ON ASPHALT OR CONCRETE
1. Set up containment at or near the storm drainage system. Do not allow the spill enter
the storm drainage system.
2. Cordon off the area around the sanitary sewer overflow (S.S.O.) area with a "Caution
Do Not Enter" tape.
3. Spread lime over the spillage, then sand (or equivalent material) to a depth of 1 inch.
Let this stand for 1 hour before sweeping into piles for transfer to a truck for hauling.
If moisture or grease is still present, repeat the procedure.
4. After removing the contaminated material, wash down the area with high water
pressure and sodium hypochlorite bleach (such as Clorox, etc.). Pump the wash water
back into the sewer system for treatment. Transport the wet sand to the Town's
Wastewater Treatment Plant Drying Area.
5. If the spill gets into the storm drainage system, refer to the SPILL IN A STREAM
procedure.
SPILL IN A STREAM
1. Take conductivity readings of the creek to determine the proper placement of a
containment dam. The dam needs to be constructed near a manhole or a location that
is accessible to the Sewer Jet/Vacuum Truck. Placement of the dam should be at the
point where the lowest conductivity reading is measured, if possible. Build the dam
with dirt that is capable of handling creek and hydrant water without dam failure. At
the dam, station a pump capable of handling the creek flow. At all times, have extra
dirt and a backhoe at the site, so the dam can be rebuilt if a breach occurs. Also, there
must always be two workers at the pump site during pumping operations. Pump the
containment water from the dam into a sanitary sewer manhole for treatment.
2. Put up "Caution Do Not Enter" warning tape from the S.S.O. site to the pump site on
both sides of the creek in populated areas. Use the same method to restrict access in
unpopulated areas, if there is any chance of people coming in contact with the S.S.O.
3. Take Fecal Coliform samples at the S.S.O. site, 100 feet upstream from the site (for a
background count), and at 400 foot downstream intervals from the pump site. Bring
the samples to the Director's office.
4. Flush the stream with water from a sufficient number of hydrants to remove the waste
product from the creek. Continue flushing and sample every 24 hours until the results
are less than or equal to 400 colonies/ml or the background count from the upstream
sample, if it is greater than 400 colonies/ml.
3

5. If rip rap is in the creek, wash it down with high pressure water until there is no waste
residue remaining on or within the rip rap structure.
6. If sludge is in the creek, sweep the creek bottom and sides with a broom until there is
no waste residue remaining.
7. If creek flows into a body of water used for recreation or drinking, notify the affected
County and Local officials as soon as the problem is discovered. Also, refer to the
SPILL IN A POND OR LAKE Procedure.
SPILL IN A POND OR LAKE
1. Put up warning tape, "Caution Do Not Enter", on the shoreline at the contaminated
area.
2. In a pond, collect Fecal Coliform samples and Dissolved Oxygen (D.0.) readings
around the entire circumference. Set up pumping operations below the dam as
described above in the SPILL IN A STREAM procedure.
3. In a large lake, sample Fecal Coliforms two feet off the bottom. D.0 readings are to
be taken one foot under the surface of the water. Take equal samples around the
circumference of the lake.
4. If the Fecal Coliform counts are greater than 8,000 colonies/ml from the first sampling
results, contact the Director for appropriate action.
5. Continue pumping until Fecal Coliforms of 400 colonies/ml or less are obtained at the
pumping impoundment site.
6. Keep monitoring Fecal Coliform counts until the North Carolina Department of Water
Quality or the County Public Health Department determines that monitoring is no
longer required.
SPILL ALONG AN OUTFALL
I. Put up warning tape, "Caution Do Not Enter" around the S.S.O. site.
2. In an open area, lime (powder) heavily and till thoroughly. Repeat the procedure, then
seed and put down straw.
3. In an area where there is undergrowth or small trees, wash the area with large amounts
of water. Push into a creek towards the pumping impoundment site. Do this until no
waste remains. Wait for 12 to 24 hours, and then lime the area heavily. Do not get
lime in the creek. Also, do not lime when the weather forecast is predicting rainfall.
4

SPILL ON A RESIDENT'S YARD
1. Till the area whenever possible. Apply lime, seed, and straw.
2. If unable to till, apply lime and two inches of topsoil, then mix thoroughly. Lime again
lightly, seed, and cover with straw.
5

11.2 WALNUT COVE SANITARY SEWER OVERFLOW RESPONSE
PROCEDURES
The following appendix is a copy of the Walnut Cove Sanitary Sewer
Overflow Response Procedures dated June 1, 2005.
63

S.S.O. REPORTING PROCEDURES
1. During normal business hours if a S.S.O. is discovered, notify the Director Public
Works or Collection System ORC at the telephone numbers below:
Mr. Kevin Webb, Director of Public Works
OR
Mr. Mark Bowman, Collection System ORC
336-591-4809
336-591-4809
2. After normal business hours, contact County Communications, 800-672-2851 to
dispatch the person on -call.
3. The S.S.O. Contact Person will be the primary interface between the County, the State
of North Carolina Department of Water Quality, and the Stokes County Health
Department on all S.S.O. matters.
4. The Contact Person will report the bypass of any wastewater treatment component or
system and/or overflow from any sewer line or pump station. This requirement applies
in the following cases:
• Any spill of 1000 gallons or more.
• Any spill regardless of the volume, if any waste reaches the surface waters of the
State. Please note that conveyances such as drainage ditches and storm sewers are
considered waters of the State.
• S.S.O. Contact Person is required to provide oral notificatimregarding reportable
spills to the Winston-Salem Regional Office, 336-774600eas soon as possible,
but in no case later than 24 hours following the spill event. '7'7 G q Pc:1)0
• Additionally, if a spill occurs after normal business hours, the event must be
reported during the next working day. Should a spill occur after hours, that
reaches surface waters and/or may be considered as either an environmental or
health hamrd, the report must be made immediately to the Division of Emergency
Management, 800-858-0368, 800-662-7956, or 919-733-3300. Their office will
contact the appropriate staff of the Division of Water Quality.
• A written report (see attached form) must be submitted to the appropriate regional
office within five (5) days of the time that the County becomes aware of the spill
occurrence. All parts of the form must be completed in detail. It is highly
recommended that the form be faxed to the Regional Office, then followed up by a
telephone call to confirm the fax has been received and to provide any additional
information that may be needed.
• Within 48 hours of the determination that a discharge of 1000 gallons or more of
untreated wastewater has reached the surface waters of the State, a press release
must be issued to all print and electronic news media that provide general coverage
to the area. A copy of the press release and a list of the news media to which it
6

was distributed must be kept for at least one year after the discharge and be
provided to any person upon request.
• In the event of a discharge of 15,000 gallons or more of untreated wastewater to
the surface waters of the State, a notice must be published in a newspaper having
general circulation in the county where the discharge is located and in each
significantly affected county downstream from the point of discharge. The
Secretary shall have sole discretion to determine which counties are affected by the
discharge and shall approve the form and content of the notice and the newspapers
in which it is published. The notice shall be captioned "NOTICE OF
DISCHARGE OF UNTREATED SEWAGE". The notice must be published
within 10 days after the Secretary has determined the counties that are significantly
affected by the discharge, approved the form and content of the notice, and
selected the newspapers in which it will be published. A copy of the notice and
proof of publication must be filed with the Department within 30 days after the
notice is published. The publication of a notice of discharge is in addition to the
issuance of the press release described in the section above.
5. The owner or operator of any wastewater collection or treatment works, operated
primarily to collect or treat municipal or domestic wastewater and which has a permit
issued by the State, must provide the users or customers and the Department an annual
report which summarizes the performance of the collection system or treatment works.
In addition, the report must specify the extent that the collection system or treatment
works has violated the permit or Federal or State laws, regulations, or rules related to
the protection of water quality. The report must be prepared and provided within 60
days after the end of the calendar or fiscal year.
7

Permittee
Sewage Spill Response Evaluation:
(page 1 of 2)
Permit Number County
Incident Ended: (Date/Time) Estimated Duration (Time)
First knowledge of incident: (Date/Time)
Estimated volume of spill/bypass gallons. Show rational for volume.
If spill is ongoing, please notify Regional Office on a daily basis until spill can be stopped.
Reported to: (Date/time)
Name of person
Weather conditions:
Source of spill/bypass (check one): Sanitary Sewer Pump Station VVVVTP
Level of treatment (check one):
None Primary Treatment
Secondary Treatment Chlorination Only
Did spill/bypass reach surface waters? Yes No (If Yes, please list the following)
Volume reaching surface waters? gallons
Name of surface water
Did spill/bypass result in a fish kill? Yes No
If Yes, what is the estimated number of fish killed?
Please provide the following information:
1. Location of spill/bypass:
2. Cause of spill/bypass:
3. Did you have personnel available to perform initial assessment 24 hours/day (including weekends and
holidays)?
Yes No
4. How long did it take to make an initial assessment of the spill/overflow after first knowledge?
Hours Minutes
How long did it take to get a repair crew onsite?
Hours Minutes
Please explain the time taken to make initial assessment:
Revision #1 6/11/99