WQCSD0185_DV-2022-0035 enforcement file_20220505

DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT
Violator: Aqua North Carolina Inc.
Facility Name: Neuse River Village Collection System
Permit Number: WQCSD0185
County: Wake
Case Number: DV-2022-0035
ASSESSMENT FACTORS
1) The degree and extent of harm to the natural resources of the State, to the public health, or to private
property resulting from the violation;
A total of 35,000 gallons of sewage surcharged from a manhole due to a blockage in the line from grease. None of the
35,000 gallons reached surface waters. Discharge to the land without a permit.
2) The duration and gravity of the violation;
The SSO started 12.10.2021 at 4:00 PM and ended 12.13.2021 at 1:30 PM (69:30). 35,000 gallons of sewage to the ground.
3) The effect on ground or surface water quantity or quality or on air quality;
Nutrients and pathogens to the ground. Co." Cc. �yL gw54-•0„a( ( V
4) The cost of rectifying the damage;
The cost of rectifying the damage is not given.
5) The amount of money saved by noncompliance;
It is believed that no money was saved by the noncompliance.
6) Whether the violation was committed willfully or intentionally;
It does not appear that the violation was not committed willfully or intentionally.
7) The prior record of the violator in complying or failing to comply with programs over which the
Environmental Management Commission has regulatory authority;
There have been zero enforcements against the violator within the past 12 months.
8) The cost to the State of the enforcement procedures.
$36.57
Date
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ

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Find Permit
Reviewers ' Related Permits ' Comments
History
Inspections Incidents Enforcemenls
` Violations
Details 1 Details 2
Permit
IWQCSD0185
ClassiDesig.
Events Reg, Adlvilles
Version: [1.0
Status:
Permit Type: Deemed permitted collection system management and operation
Permit Classification: llndividual
Program Category:
Facility:
Non -discharge
Neuse River Village Collection System
'Active
Primary Related Permit
�LDetails
Owner, Aqua North Carolina Inc
— Dates —
Issued:
Effective:
Expire:
SOC:
Last Updated By:
r310112000
0310112000
Orig Issued 0310112000
Statutory [ 3012000
Inactive:
Details...
barry.herzberg
Details,..
Adman Region: Raleigh
County: lake
Projed Type: New Project
❑ Major Permit
❑ Has Subsurface Drains
0 New Farm 0 Existing Farm
Farm
❑ Innovative Avail. Acre
❑ Rainbreaker Device
❑ OIC Present
Last Updated On: 1121712006 1:19 Pl4
<Back
Next >
Finish

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ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Certified Mail # 7020 3160 0000 4109 5787
Return Receipt Requested
Shannon V Becker, President
Aqua North Carolina Inc.
202 Mackenan Dr.
Cary, NC 27511-6447
NORTH CAROLINA
Environmental Quality
May 05, 2022
SUBJECT: Notice of Violation and Assessment of Civil Penalty
for Violations of North Carolina General Statute (G.S.) 143-215.1(a)(6)
and Collection System Permit No. WQCSD0185
Aqua North Carolina Inc.
Neuse River Village Collection System
Case No. DV-2022-0035
Wake County
Dear Mr. Becker:
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $786.57 ($750.00 civil penalty +
$36.57 enforcement costs) against Aqua North Carolina Inc.
This assessment is based upon the following facts: a review has been conducted of the Sanitary Sewer Overflow (SSO)
5-Day Report submitted by Aqua North Carolina Inc. This review has shown the subject facility to be in violation of the
requirements found in Collection System Permit No. WQCSD0185 and G.S. 143-215.1(a)(1). The violation(s) that
occurred are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that Aqua North Carolina Inc violated the terms, conditions or
requirements of Collection System Permit No. WQCSD0185 and G.S. 143-215.1(a)(1) in the manner and extent shown in
Attachment A. In accordance with the maximums established by G.S. 143-215.6A(a)(2), a civil penalty may be assessed
against any person who violates the terms, conditions or requirements of a permit required by G.S. 143-215.1(a).
North Carolina Department of Environmental Qu&lty I Division of Water Resources
RaklphRegional Office 1 MOO Barren Drive I Raleigh North Carolina 27609
919.79U200

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Based upon the above findings of fact and conclusions of law, and in accordance with authority provided by the
Secretary of the Department of Environmental Quality and the Director of the Division of Water Resources, I, Scott
Vinson, Regional Supervisor, Raleigh Regional Office hereby make the following civil penalty assessment against Aqua
North Carolina Inc.:
$750.00 For I of the 1 violations of Collection System Permit No. WQCSD0185 and G.S. 143-215.1(a)(1) for
Sanitary Sewer Overflow(s) resulting in a discharge without a valid permit.
$750.00 TOTAL CIVIL PENALTY
$36.57 Enforcement Costs
$786.57 TOTAL AMOUNT DUE
Pursuant to G.S. 143-215.6A(c), in determining the amount of the penalty I have taken into account the Findings of Fact and
Conclusions of Law and the factors set forth at G.S. 143B-282.1(b), which are:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
The degree and extent of harm to the natural resources of the State, to the public health, or to private property
resulting from the violation;
The duration and gravity of the violation;
The effect on ground or surface water quantity or quality or on air quality;
The cost of rectifying the damage;
The amount of money saved by noncompliance;
Whether the violation was committed willfully or intentionally;
The prior record of the violator in complying or failing to comply with programs over which the Environmental
Management Commission has regulatory authority; and
The cost to the State of the enforcement procedures.
Within thirty (30) days of receipt of this notice, you must do one of the following:
(1) Submit payment of the penalty, OR
(2) Submit a written request for remission, OR
(3) Submit a written request for an administrative hearing
Option 1: Submit payment of the penalty:
Payment should be made directly to the order of the Department of Environmental Quality (do not include waiver
form). Payment of the penalty will not foreclose further enforcement action for any continuing or new violation(s).
Please submit payment to the attention of:
Attn: PERCS Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

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Option 2: Submit a written request for remission or mitigation including a detailed justification for such
request:
Please be aware that a request for remission is limited to consideration of the five factors listed below as they may
relate to the reasonableness of the amount of the civil penalty assessed. Requesting remission is not the proper
procedure for contesting whether the violation(s) occurred or the accuracy of any of the factual statements contained in
the civil penalty assessment document. Because a remission request forecloses the option of an administrative hearing,
such a request must be accompanied by a waiver of your right to an administrative hearing and a stipulation and
agreement that no factual or legal issues are in dispute. Please prepare a detailed statement that establishes why you
believe the civil penalty should be remitted, and submit it to the Division of Water Resources at the address listed below.
In determining whether a remission request will be approved, the following factors shall be considered:
(1) whether one or more of the civil penalty assessment factors in NCGS 143B-282.1(b) was wrongfully
applied to the detriment of the petitioner;
(2) whether the violator promptly abated continuing environmental damage resulting from the violation;
(3) whether the violation was inadvertent or a result of an accident;
(4) whether the violator had been assessed civil penalties for any previous violations; or
(5) whether payment of the civil penalty will prevent payment for the remaining necessary remedial actions.
Please note that all evidence presented in support of your request for remission must be submitted in writing. The
Director of the Division of Water Resources will review your evidence and inform you of his decision in the matter of
your remission request. The response will provide details regarding the case status, directions for payment, and
provision for further appeal of the penalty to the Environmental Management Commission's Committee on Civil Penalty
Remissions (Committee). Please be advised that the Committee cannot consider information that was not part of the
original remission request considered by the Director. Therefore, it is very important that you prepare a complete and
thorough statement in support of your request for remission.
In order to request remission, y u must complete and submit the enclosed "Request for Remission of Civil Penalties,
Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form within thirty(30) day, of receipt of this
notice. The Division of Water Resources also requests that you complete and submit the enclosed "Justification for
Remission Request."
Both forms should be submitted to the following address:
Attn: PERCS Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
AND
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
1628 Mail Service Center, Raleigh
Raleigh, NC 27699-1628

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Option 3: File a petition for an administrative hearing with the Office of Administrative Hearings:
If you wish to contest any statement in the attached assessment document, you must file a petition for an administrative
hearing. You may obtain the petition form from the Office of Administrative Hearings. You must file the petition with
the Office of Administrative Hearings within thirty (30) days of receipt of this notice. A petition is considered filed
when it is received in the Office of Administrative Hearings during normal office hours. The Office of Administrative
Hearings accepts filings Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m., except for official state
holidays. The petition may be filed by facsimile (fax) or electronic mail by an attached file (with restrictions) - provided
the signed original, one (1) copy and a filing fee (if a filing fee is required by NCGS §150B-23.2) is received in the
Office of Administrative Hearings within seven (7) business days following the faxed or electronic transmission. You
should contact the Office of Administrative Hearings with all questions regarding the filing fee and/or the details of the
filing process.
The mailing address and telephone and fax numbers for the Office of Administrative Hearings are as follows:
6714 Mail Service Center
Raleigh, NC 27699 6714
Tel: [phone]
Fax: [phone]
One (1) copy of the petition must also be served on DEQ as follows:
Mr. William F. Lane, General Counsel
Department of Environmental Quality
1601 Mail Service Center
Raleigh, North Carolina 27699-1601
Please indicate the case number (as found on page one of this letter) on the petition.
Failure to exercise one of the options above within thirty (30) days of receipt of this letter, as evidenced by an internal
date/time received stamp (not a postmark), will result in this matter being referred to the Attorney General's Office for
collection of the penalty through a civil action. Please be advised that additional penalties may be assessed for violations
that occur after the review period of this assessment.
If you have any questions, please contact Mitchell Hayes with the Division of Water Resources staff of the Raleigh
Regional Office at [phone] or via email at [e-mail].
Sincerely,
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
ATTACHMENTS
Cc: WQS Raleigh Regional Office - Enforcement File
Laserfiche

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JUSTIFICATION FOR REMISSION REQUEST
Case Number: DV-2022-0035
Assessed Party: Aqua North Carolina Inc.
Permit No.: WQCSDOI 85
County: Wake
Amount Assessed: $786.57
Please use this form when requesting remission of this civil penalty. You must also complete the "Request For Remission,
Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form to request remission of this civil penalty.
You should attach any documents that you believe support your request and are necessary for the Director to consider in
evaluating your request for remission. Please be aware that a request for remission is limited to consideration of the five
factors listed below as they may relate to the reasonableness of the amount of the civil penalty assessed. Requesting
remission is not the proper procedure for contesting whether the violation(s) occurred or the accuracy of any of the factual
statements contained in the civil penalty assessment document. Pursuant to N.C.G.S. § 143B-282.1(c), remission of a civil
penalty may be granted only when one or more of the following five factors apply. Please check each factor that you
believe applies to your case and provide a detailed explanation, including copies of supporting documents, as to why the
factor applies (attach additional pages as needed).
(a) one or more of the civil penalty assessment factors in N.C.G.S. 143B-282.1(b) were wrongfully applied to the
detriment of the petitioner (the assessment factors are listed in the civil penalty assessment document);
(b) the violator promptly abated continuing environmental damage resulting from the violation (i.e., explain the
steps that you took to correct the violation and prevent future occurrences);
(c) the violation was inadvertent or a result of an accident (i.e., explain why the violation was unavoidable or
something you could not prevent or prepare for);
(d) the violator had not been assessed civil penalties for any previous violations;
(e) payment of the civil penalty will prevent payment for the remaining necessary remedial actions (i.e., explain
how payment of the civil penalty will prevent you from performing the activities necessary to achieve
compliance).
EXPLANATION:

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STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
COUNTY OF WAKE
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST
Aqua North Carolina Inc.
Neuse River Village Collection System
PERMIT NO. WQCSD0185
WAIVER OF RIGHT TO AN
ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
CASE NO. DV-2022-0035
Having been assessed civil penalties totaling $786.57 for violation(s) as set forth in the assessment document of the Division
of Water Resources dated May 05, 2022, the undersigned, desiring to seek remission of the civil penalty, does hereby waive
the right to an administrative hearing in the above -stated matter and does stipulate that the facts are as alleged in the
assessment document. The undersigned further understands that all evidence presented in support of remission of this civil
penalty must be submitted to the Director of the Division of Water Resources within thirty (30) days of receipt of the notice
of assessment. No new evidence in support of a remission request will be allowed after (30) days from the receipt of the
notice of assessment.
This the day of , 20
SIGNATURE
ADDRESS
TELEPHONE

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ATTACHMENT A
Aqua North Carolina Inc.
CASE NUMBER: DV-2022-0035
PERMIT NO: WQCSDO185
FACILITY: Neuse River Village Collection System
Other Violations
INCIDENT VIOLATION
NUMBER DATE VIOLATION TYPE
VIOLATION DESCRIPTION
REGION: Raleigh
COUNTY: Wake
TOTAL VOLUME PENALTY
(GALLONS) AMOUNT
202102261 12/10/2021 CSO/SSO(Sewer Overflow) Discharge without valid permit 35,000 $750.00

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AQUA
4Essenthi Uiilities Company
February 10, 2022
Mr. Scott Vinson, Regional Supervisor
Water Quality Regional Operations
Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699-1628
Re: Notice of Violation and Intent to Issue Civil Penalty
Neuse River Village Collection System, Wake County
Permit No. WQCSD0185
NOV-2022-DV-0021
Dear Mr. Vinson:
yC Dope of 14, vfr
i'tft onntent8l Quail
kakiBft
Region
el Otto.
Aqua North Carolina, Inc. (Aqua) offers the following response to the above -referenced Notice of
Violation which was issued for a self -reported Sanitary Sewer Overflow (SSO) 5-Day report on December
10, 2021.
Aaua's Response:
Investigative efforts show an excessive amount of grease entering the collection system. Grease
created a clog in the sewer main and caused ma caused to overflow. Aqua is putting this collection
system on a biannual Jetting schedule instead of a yearly schedule while we investigate longer term
solutions. The sewer main was last cleaned in March of 2021. The appropriate FOG educational
notice is distributed to all customers in March and September of each year.
If you have any questions or comments, please do not hesitate to contact me at [phone].
Sincerely,
Ramat X-fruegez
Area Manager
cc: Joseph Pearce
Amanda Berger
Shannon Becker

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ROY COOPER
Gmrrn&
E.IZABETH S. BJSER
seartury
S. DANIEL SMITH
Director
Clunfied Mall # 7020, Q 0000 43142122
Reim Recalat Raqu
Shannon V Becker
Aqua North Carolina Inc.
202 Mackenan Dr.
Cary, NC 27511-6447
NORTH CAROUNA
Enstronmeittaletanty
January 24, 2022
SUBJECT: NOTICE OF VIOLATION & INTENT TO ISSUE CIVIL PENALTY
Tracking No.: NOV-2022-DV-0021
Sanitary Sewer Overflows - December 2021
Collection System Permit No. WQCSD0185
Neuse River Village Collection System
Wake County
Dear Mr. Becker:
A review has been conducted of the self -reported Sanitary Sewer Overflows (SSO's) 5-Day Report/s submitted by
Aqua North Carolina Inc. The Division's Raleigh Regional Office concludes that the Aqua North Carolina Inc. violated
Permit Condition I (2) of Permit No. WQCSD0185 by failing to effectively manage, maintain, and operate their
collection system so that there is no SSO (Sanitary Sewer Overflow) to the land or surface waters and the SSO
constituted making an outlet to waters of the State for purposes of G.S. 143-215.1(a)(1), for which a permit is
required by G.S. 143-215.1.
The Raleigh Regional Office is providing the Aqua North Carolina Inc. an opportunity to provide evidence and
justification as to why the Aqua North Carolina Inc. should not be assessed a civil penalty for the violation(s) that
are summarized below:
Inddent Start Duration
Number Date (Mins) Location Cause
202102261 12/10/2021 4,170 Near Misty River Drive Grease
and Bubbling Brook
Court, Raleigh
Total Vol
Total Surface
Vol Water
(Gals) (Gals) DWR Action
35,000 0 Notke of Violation -
Nottice of Intent
Nadi Caroline Doormen atrrodret nalqueryi =Monotwft« lottessoes
Raklgh Pagbr.dOft, 1 moORar.n Drive 1 RAWLNorth Craft* 77609
11467111.4200

This Notice of Violation / Notice of Intent to Enforce (NOV/NOI) Is being issued for the noted violation. Pursuant
to G.S. 143-215.6A, a cMI penalty of not more than twenty-five thousand dollars ($25,000.00) may be assessed
against any person who violates or fails to act in accordance with the terms, conditions, or requirements of any
permit issued pursuant to G.S. 143-215.1.
This office requests that you respond to this Notice, in writing, within 10 business days of its
receipt. In your response, you should address the causes of non-compliance, remedial actions, and all other
actions taken to prevent the recurrence of similar situations. The response to this correspondence will be
considered in this process. Enforcement decisions will also be based on volume spilled, volume reaching surface
waters, duration and gravity, impacts to public health, fish kills or recreational area dosures. Other factors
considered in determining the amount of the civil penalty are the violator's history of non-compliance, the cost of
rectifying the damage, whether the spill was intentional and whether money was saved by non-compliance.
If you have any questions, please do not hesitate to contact Mitchell Hayes with the Water Quality Section in
the Raleigh Regional Office at 919-791-4200 or via email at [e-mail].
Sincerely,
lirtaat
f..kez Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Cc: Raleigh Regional Office - WQS File
Laserfiche
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lisleishlteglondOffiar 13eooeunteDO* :waj►Hertheoneurna

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• Complete Items 1, Z and 9.
A Print your name and address on the reverse
so that we Gan return the nand to you.
• Attach this card to the back of the mallpleoe,
or on the *ant if tome pennite.
1.
SHANNON V BECYKER, PRESIDENT
AQUA NORTH CAROUNA, INC.
202 MACKENAN COURT
CAR'..NC 27511-6447
NOV-2022-DV-0021 / NOV-INTENT TO ISSUE CP / 20220128
HENDERSON COLL SYS. / WQCS00185 / WAXE COUNTY
REC: 7020 3160 0000 4115 6822 / en 01/24/2022
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SHANNON V. BECKER, PRESIDENT
AQUA NORTH CAROUNA, INC.
202 MACKENAN COURT
CARY, NC 27511-6447
NOV-2022-DV-0021/ NOV-INTENT TO ISSUE CP/ 2022012E
NEUSE RIVER VILLAGE CS / WQCS00185 / WAKE COUNTY
REC: 7020 3160 0000 4115 6822 / Rr 01/24/2022
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Permit No. G-10
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NCDEQ DIVISION OF WATER QUALITY
RALEIGH REGIONAL OFFICE
3800 BARRETT DRIVE
RALEIGH, NC 27609
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Shannon V Becker
Aqua North Carolina Inc.
202 Madkenan Dr.
Cary, NC 27511-6447
NORTH CAROLINA
Sivitmeasidatenality
January 24, 2022
SUBJECT: NOTICE OF VIOLATION & INTENT TO ISSUE CIVIL PENALTY
Traddn0 Na: NOV-2022-DV-0021
Sanitary Sewer Overflows - December 2021
Collection System Permit No. WQCSD0185
Neuse River Village Collection System
Wake County
Dear Mr. Becker
A review has been conducted of the self -reported Sanitary Sewer Overflows (SSO's) 5-Day Report/s submitted by
Aqua North Carolina Inc. The Division's Raleigh Regional Office concludes that the Aqua North Carolina Inc. violated
Permit Condition I (2) of Permit No. WQCSD0185 by failing to effectively manage, maintain, and operate their
collection system so that there is no SSO (Sanitary Sewer Overflow) to the land or surface waters and the SSO
constituted making an outlet to waters of the State for purposes of G.S. 143-215.1(a)(1), for which a permit is
required by GS. 143-215.1.
The Raleigh Regional Office is providing the Aqua North Carolina Inc. an opportunity to provide evidence and
justification as to why the Aqua North Carolina Inc. should not be assessed a civil penalty for the violation(s) that
are summarized below:
Incident Sort Duration
Number Date (Mint) Location
Total Vol
Total Su fece
Vol Water
Cause (Gals) (Gan) DWR Action
202102261 12/10/2021 4,170 Near Misty River Drive Grease
and Bubbling Court, Raley
35,000 0 Notice of Violation -
Notice of Intent
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DWR
DWlslon of Water Resources
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 is
This form shall be submitted to the appropriate DWQ Regional Office within five business days of the first knowledge of the
sanitary sewer overflow (SSO).
Permit Number: WQCSD0185 (WQCS# if active, otherwise use WQCSD#)
Facility: Neuse River Village Collection System Incident #: 202102261
Owner: Aqua North Carolina Inc
City: County: Wake Region: Raleigh
Source of SSO (check applicable): [l 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): Near Misty River Drive and Bubbling Brook Court, Raleigh
Manhole #:
Latitude (Decimal Degrees): Longitude (Decimal Degrees):
Incident Started Dt: 12/10/2021 Time: 4:00 pm Incident End Dt: 12/13/2021 Time: 01:30 pm
(mm-dd-yyyy) (hh:mm AMIPM) (mm-dd-yyyy) (hh:mm AMIPM)
Estimated Volume of the SSO: 35,000 gallons Estimated Duration (Round to nearest hour): 69:30 hours
Describe how the volume was determined: estimated based on avg flow and duration
Weather conditions during the SSO event: cold, dry
Did SSO reach surface waters? ❑ Yes No Unknown Volume reaching surface waters (gals): 0
Surface water name:
Did the SSO result in a fish kill? ❑ Yes [INo Unknown If Yes, what is the estimated number of fish killed? 0
SPECIFIC cause(s) of the SSO:
Q Grease
24 hour verbal notification (name of person contacted }: Colleen Cohn
▪ DWR Emergency Mgmt Date (mm-dd-yyy): 12/14/2021 Time (hh:mm AM/PM): 11:30:00 am
If an SSO is ongoing, please notify the appropriate Regional Office on a daily basis until SSO can be stopped.
Per G.S. 143-215.1C(b), the responsible party of a discharge of 1,000 or more of untreated wastewater to surface waters
shall issue a press release within 24-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 reference statute for further detail.
The Director, Division of Water Resources. may take enforcement action for SSOs that are required to be reported to
Division unless it is demonstrated that:
1) the discharge was cause by sever natural conditions and there were no feasible alternative 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
WHETHER OR NOT PART III IS COMPLETED, A SIGNATURE IS REQUIRED AT THE END OF THIS FORM
CS-SSO Form
Page: 1

PART II:
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
Grease
When was the last time this specific line (or wet well) was cleaned?
March 2021
Do you have an enforceable grease ordinance that requires new or retrofit of grease ❑ Yes ❑ No [ NA ❑ NE
traps/interceptors?
Have there been recent inspections and/or enforcement actions taken on nearby ❑ Yes [] No RI NA ❑ NE
restaurants or other nonresidential grease contributors?
Explain.
The customers are all residential.
Have there been other SSOs or blockages in this area that were also caused by ❑ Yes ❑ No RI NA ❑ NE
grease?
When?
If yes, describe them:
Have cleaning and inspections ever been increased at this location? 171 Yes [] No ❑ NA ❑ NE
Explain,
Have educational materials about grease been distributed in the past? 17 Yes ❑ No ❑ NA ❑ NE
When?
BI-annually in March and September
and to whom?
All Aqua WWW Customers
Explain?
Bi-annuallv Aqua distribuas FOG notices to all ww customers. The notice contains language about the materials,
chemical, and subances that should NOT be placed in a WW CS.
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 p NA ❑ NE
CS-SSO Form Page: 2

Comments:
System Visitation
ORC F1 Yes
Backup ❑ Yes
Name:
Andy Stevens
Cert#
1005680
Date visited:
12/13/2021
Time visited:
12:30 pm
How was the SSO remediated (Le. Stopped and cleaned up)?
The spill was contained to a 50' radius of the MH be leaves. Once the spill was stopped, lime was put down.
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: Matthew R Costner
Signature:
Telephone Number:
Date:
Title:
Any addition information desired to be submitted should be sent to the appropriate Division Regional Office within five days of 1
knowledge of the SSO with reference to the incident number (the incident number is only generated when electronic entry of th
form is completed, if used).
CS-SSO Form Page: 3

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Total Balance Due :
Sum Of Total Paid:
Total Enforcement Cost:
Total Penalty Amount:
Total Penalties After Remiss'ons •
Sum of Total Case Penalties: