WQCS00173_BIMS 5-Day Report_20220721

NC Dept of Environmental Quality
State of North Carolina
JUL 21 2022 Department of Environment and Natural Resources
DWRDivision of Water Resources
.Raleigh Regional. o llection System Sanitary Sewer Overflow Reporting Form
Dhrlsian of Water Resourrces 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: WQCS00173 (WQCS# if active, otherwise use WQCSD#)
Facility: Kenly Collection System Incident#: 20220717/05 Owner: Town of Kenly
Region: Raleigh City: Kenly County: Johnston
Source of SSO (check applicable): ® 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.): 300 yards from the Little River pump station on Richardson Rd.
Manhole*
Latitude (degrees/minute/second): Longitude (degrees/minutelsecond):
Incident Started Dt: 07/16/202-2 Time: 03:30 PM Incident End Dt: 07/16/2022 Time: 09:00 PM
(mm-dd-yyyy) (hh:mm) AM/PM (mm-dd-yyyy) (hh:mm) AMIPM
Estimated volume of the SSO: 2500 gallons Estimated Duration (round to nearest hour): 2 hour(s)
Describe how the volume was determined: By the capacity of the pump truck used on site.
Weather conditions during the SSO event: Dry
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 ❑Inflow & Infiltration
❑Pump Station Equipment Failure ❑ Power Outage []Vandalism ❑ Debris in line ®Pipe Failure (Break)
❑Other (Please explain in Part 11)
24-hour verbal notification (name of person contacted): Mary Ann Nicdaysen
❑DWR ®Emergency Management Date (mm-dd-yyy): 07/16/2022Time: (hh:mm AM/PM): l 1:52 AM
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.
WHETHER OF NOT PART II IS COMPLETED, A SIGNATURE IS REQUIRED SEE PAGE 13
Form CS-SSO Page l

In order to submit a claim for justification of an $SO, 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 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 HAS BEEN SUBMITTED ELECTRONICALLY THROUGH THE ONLINE REPORTING SYSTEM
Pomi CS-SSO Page 2

Pii)e Failure (Break)
Pipe size (inches) 6
What is the pipe material pvc
What is the approximate age of the line/ pipe (years old)
Is this a gravity line?
Is this a force main line?
Is the line a "High Priority" line?
Last inspection date and findings
If a force main then,
Was the break on the force main vertical?
Was the break on the force main horizontal?
Was the leak at the joint due to gasket failure ?
Was the leak at the joint due to spilt bell?
25 years
❑ Yes ® No
❑NA
❑ NE
® Yes ❑ No
❑NA
❑ NE
❑ Yes ® No
❑NA
❑ NE
❑ Yes ® No
❑NA
❑ NE
® Yes ❑ No
❑NA
❑ NE
❑ Yes ® No
❑NA
❑ NE
❑ Yes ® No
❑NA
❑ NE
When was the last inspection or test of the nearest air -release valve to determine if operable? unknown
When was the last maintenance of the air release performed? unknown
If gravity sewer then,
Does the tine 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? The broken was removed and replaced using 2 6" Hymax couplings.
If temporary, when is the permanent repair planned?
Have there been other failures of this line in the past rive years? ❑ Yes ® No ❑NA ❑ NE
If so, then describe
Form CS-SSO Page 12

Svstem Visitation
ORC ❑ Yes
Backup ® Yes
NC Dept of Environmental Quality
Name: Josh Williamson Certification Number: 1007379 JUL. 212922
Date visited: 7/16/2022 Ralciph Regional, Oince
Time visited: 04:00 PM
How was the SSO rernediated (i.le. Stopped and cleaned up)?
The ditch was blocked off before the water reached the receiving stream_ All standing water was removed by a pump truck
and hauled to the wastewater plant. Lime was spread in all areas touched by untreated wastewater.
As a representative for the responsible party. Low* that the information contained in this report is true and accurate to the
best of my knowledge.
Person submitting claim: Josh Williamson
Date: 07' 16r 2022
r r
Signature: Title: Q aG t 42
Teleph ne Number: 919-222-8804
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