WQCSD0287_Five-Day Report - March 2023 SSO_20230329

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Form CS-SSO
Collection System Sanitary Sewer Overflow Reporting Form
PART I
if active, otherwise use WQCSD#)
This form shall be submitted to the appropriate DWQ Regional Office within five days of the first knowledge of
the sanitary sewer overflow (SSO).
Facility:
Owner:
Gity:
Source of SSO (oheck applicable) :IEI{unit ry s"*", n Pump Station I Lift Station
SPECIFIC location of the SSO (be consistent in desqription from past or documentation - i.e. Pump
Manhole at Westall & Bragg Street, etc.) , M4
Manhole# q^Ko\rrl^-
Latitude (degrees/minute/second):
Volume reaching surfacewaters (gallons): ..Y
*
lncident #
-
Reoion: 4<ke-v i (le
coirnt-v: ?"|-lre'rfe"J
Roots
Power outage
Other (Please explain in Part ll)
nn
tr
rncidentstarred or, zf a7/zotE rime-10 !0o ,f*'t
hh:mm AMIPM
l{o o gallons
Describe how the volume was determined:
(mmdd-yyyy)
Estimated volume of the SSO:
Weather conditions during SSO event:OtEr
Did SSO reach surface waters? n Y""Unknown
Surface water name:
DidtheSSoresuIt,n,**ffiffYes,whatistheestimatednumberoffishkilled?
SPECIFIC cause(s) of the SSO:
n S"r"r" Natural Condition
n tnRo* and lnfiltration
[--l Vandalism
[l eip" Failure (Break)
24-hour verbal notification (name of person
Wo*a n Er"rg"ncy Mgmt.
n cr""".
l-l Purp Station Equipment Failure
lIKD"nri" in lin*
lf an SSO is ongoing, please notify Regional Office on a daily basis until SSO can be stopped.
Per G.S. 14G215.1C{b}, the responsible party of a disciarge of 1,000 gallons or more of untreated wastewater to surface
waters shall issue a press release within 48-hours of first knowledge to all print and electronic news media providing general
coverage in the county-whcEthc alischarge occuned. When 15,000 gallons or rnore 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 reErenced statute for further detail.
1) the discharge was caused by severe natural conditions and there were no feasible altematives to the discharge; or
2) the discharge was exceptional, unintentional, temporary and caused by factors beyond the reasonable control of the Permittee
andlor owner, and the discharge could not have been prevented bythe exercise of reasonable control.
Part ll must be completed to provide a justification claim for either of the above situations. This information will be the basis
for the determinalion of any enforcement action. Therefore, it is important to be as complete as possible.
The Director, Division of Water Quality,take enforcenient action for SSOs that are required to be reported to Division unless it
WHETHER OR NOT PART II 1S COMPLETED, A SIGNATURE IS REQUIRED AT THE END OF THIS FORM.
CS-SSO Form Paoe 1
Form CS-SSO
Collection System Sanitary Sewer Overflow Repofting Form
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 SECTIONS PERTAINING TO THE CAUSE OF THE SSO AS CHECKED IN PART ]
(ln the check boxes below, ltlA = Not Applicable and NE = Not Evaluated)
A HARDCOPY OF THIS FORM SHOULD BE SUBMITTED TO THE APPROPRIATE DWQREGIONAL OFFICE
UNLESS IT HAS BEEN SUBMITTED ELECTRONICALLYTHROUGH THE ONLINE REPORTING SYSTEM
CS-SSO Form Paoe 2
7
What type of debris has been found inlhe line?
tlt 'oes
Suspected cause br source-of debris.
a," ruo fl runll r're
When was the area last checkedlcleaned?
Have cleaning and inspections ever been increased atthis location due to previous problems with debris? nr.Ltrdo/n Nn[l r.rr
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6d uLtu"bo{n4:, tde q-re-
ffa 2, B ^,.[l
,>',-. dul(oo' f ra^of
ta nf o,u /n fr of,'V o* fire
Collec*ftx 9y;+o,.r,,- d- U rUT/
,c141 /(
T*"lil(ol-l*=Are appropriate educational materials being developed Snd distributed to preveht
occurrences?
Comments:
wor eX c'OG Ofo
-to
"(.e f, d.ttdb,t-t'< t//if F-oc
Debris in line (Rocks, sticks, rags and other items not allowed in the collection system, etc.)
fept 2o2?
CS-SSO Form Paoe 11
7
Other (Pictures and police report, as applicable, must be available upon request.)
Describe:
Were adequate equipment
tf Yes, explain:
arrailable to fix the problem?NoL r,mn r.re
lf the problem could not be immediately repaired, what actions werc taken to lessen the impact of the
SSO?
Comments:
CS-SSO Form Paoe 12
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System Visitation
ORC
Backup
Name: Do^q.bL E- {+7€
cer,# ct-Lf q7l33f
Datevisired: l{tra,rd_- 27, Z A23
rimevisited: /0;0 O re
How was the SSO remediated (i.e. Stopped and cleaned up)?
le
for the responsible party, I is true and accurate to
person submittins "t^i^, l0 nq.to( P , Pn iCe o,rc, fu;1r/--rlr ZaZ;
Signature:
rerephoneNumber: Bl0 - q t q. -D6 2+
,Any additional information desired to be submitted should be sent to the appropriate Division Regional Office within five days of first
ftnowledge 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).
*e: c?(-ctr{*un
5u^-;TaT
CS-SSO Form Paoe 15