WQ0002829_Incident Report_20060704

Incident Report
Report Number: 200602105
Incident Type: Non -Compliance Reporting
Category: Non -Discharge
Incident Started: 07/04/2006
County: Dare
City:
Farm #:
Responsible Party:
Owner.
Permit:
Facility:
First Name:
Middle Name:
Last Name:
Address
City/State/Zip:
Phone:
Material Category: Estimated Qty: UOM
DD:MM:SS Decimal
Latitude:
Longitude:
Location of Incident: Kill Devil Hills
Address:
City/StateOp
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On -Site Contact:
First/Mid/Last Name:
Company Name:
Phone:
Pager/Mobile Phone: /
Reported By:
Flrst/Mid/Last Name: William G Freed
Company Name:
Address:
City/State/Zip:
Phone: [phone]
Pager/Mobile Phone: /
Chemical Name Reportable Qty. lbs. Reportable Qty. kgs.
Position Method:
Position Accuracy:
Position Datum:
Report Created 07/05/06 01:59 PM Page 1

Cause/Observation:
Power failure at lift station caused raw wastewater to overflow
manhole. Less than 500 gallons overflowed into an unnamed
stream that flows into the Atlantic Ocean. Volume of water Is
contained behind a culvert with Invert above water surface level.
Power was out for approximately one hour.
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Action Taken:
Mr. Freed will follow up with letter.
Incident Questions:
Did the Material reach the Surface Water? Unknown
Surface Water Name?
Did the Spill result in a Fish Kill? Unknown
If the Spill was from a storage tank indicate type.
Containment? Unknown
Cleanup Complete? Unknown
Directions:
Comments:
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Conveyance:
Water Supply Wells within 1500ft : Unknown
Access to Farm Power outage
■ Spray Availability ■ Structure Questions
Estimated Number of fish?
(Above Ground or Under Ground)
Groundwater Impacted : Unknown
0 Animal Population
Report Created 07/05/06 01:59 PM Page 2

Access to Farm
Farm accessible from the main road? ❑ Yes ❑ No ❑ NA ❑ NE
Animal PODulation
Confined? ❑ Yes ❑ No ❑ NA ❑ NE
Depop? ❑ Yes ❑ No ❑ NA ❑ NE
Feed Available?
❑ Yes ❑ No ❑ NA ❑ NE
Mortality? ❑ Yes ❑ No ❑ NA ❑ NE
Spray Availability
Pumping equipment?
❑ Yes ❑ No D NA D NE
Available Fields?
❑ Yes ❑ No ❑ NA NE
Structure Questions
Breached?
Inundated?
Overtopped?
Water on outside wall?
Poor dike conditions?
Event Type
Event Date Due Date
Report Entered
2006-07-05 01:50:32
Report Received
2006-07-05 12:00:00
Referred to Regional Office - Primary Contact
2006-07-05 12:00:00
Incident Start
2006-07-04 09:30:00
Standard Agencies Notified:
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Comment
Report Created 07/05/06 01:59 PM Page 3

Agency Name Phone First Name M.I. Last Name Contact Date
Other Agencies Notified:
Agency Name Phone First Name M.I. Last Name Contact Date
DWQ Information:
Report Taken By: Report Entered By: Regional Contact:
Buster Thompson Buster Thompson Buster Thompson
Phone:
Date/Tlme: 2006-07-05 12:00:00 AM 2006-07-05 01:50:32 PM 2006-07-05 12:00:00 AM
Referred Via: Phone Phone
Did DWQ request an additional written report?
If yes, What additional Information Is needed?
Report Created . 07/05/06 01:59 PM Page 4