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Home My WebLink AboutWQCSD0775_5 Day Report_20231023State of North Carolina Department of Environment and Natural Resources Division of Water Resources >"- Collection System Sanitary Sewer Overflow Reporting Form Dlvlsion of Water Resources Form CS-SSO PART 1: This form shall be submitted to the appropriate DW R Regional Office within five business days of the first knowledge of the sanitary sewer overflow (SSO). Permit Number: (WQCS# if active, otherwise use WQCSD#) / C Facility: Incident #: i Owner: dric�Y IL 06 Region: (C�P((I� 1 City: kas County: Source of SSO (check applicable): ❑ Sanitary Sewer ❑ Pu4 Station / Lift Station SPECIFIC location of the SSO (be consistent in description from past reports or documentation - i.e.'Pu`m n (� Station 6, Manhole at Westall & Bragg Street, etc.):7W4Z�ir Manhole #: 1 j Latitude (degrees/minute/second): Longitude (degrees/minute/second): Incident Started Dt: J O I 0 Z Time: IQ:.3 X /Fi�1 Incident End Dt: Time: (mm-dd-yyyy) (hh:mm)AM/PM (mm-dd-yyyy) (hh:mm)AM/PMstimated volume of the SSO: gallons (Estimated Duration (round to nearest hour):hour(s) Describe how the volume was determined: I (()1 I 5 (IA IS ilalf I a)s net' ((nu `` COv 1-e Weather conditions during the SSO event: Did the SSO reach surface waters? Yes ❑ No ❑ unknown (� Volume reaching surface waters: allons Surface water name,��)Nt(� �'Y�111t ICj[� CY(✓e�L Did the SSO result in a fish kill? ❑ Yes No ❑ Unknown 'TOY T) 0-n-) euj On V'Q . If Yes, what is the estimated number of fish killed? SPECIFIC cause(s) of the SSO: ❑Severe Natural Conditions ❑ Grease ❑Pump Station Equipment Failure ❑ Power Outage ❑Other (Please explain in Part II) 24-hour verbal notification (name of person contacted): ❑Emergency Management Date ❑Roots ❑Inflow & Infiltration ❑Vandalism El Debris in line ipe Failure (Break) mm n ✓ 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 it IS COMPLETED A SIGNATURE IS REQUIRED SEE PAGE 13 FormCS-SSO Page 1 In order to submit a claim for justification of an SSO, 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 Form CS-SSO Page 2 Severe Natural Conditions (hurricane tornado etc.) Describe the "severe natural condition" in detail: How much advance warning did you have and what actions were taken in preparation for the event? Comments:- h Q n o i CAL ocL. wn 5 c). \Ne cAI'Iy,J b ns 11Y, StLrvemec1 ��d Ibcctare(A U(c-(A , OetA(ecl P (Pe Caren , '1 r) S-�C u lea Lo i t PVC -fiemOrc � ci4 me (1eQ� biWine L1L0�b. hsfel I�ec1 new iC.Lrn-Qd WcLV.v bccjL Can Cnd CheCVQ-6 teC1LS, r3f (X .. - M e d a� fe c{ e6 al-e-Ce ( &W o-un -k(L LWS GnSlIe aA A", �J n nCi G Gad Cc�n�-C1�n (YLQn4 O<J joakr^ -+u In ,e-6 Whzn dean 1,e,Q `tis Com � i�i-e Form CS-SSO Page 3 When was the last time this specific line (or wet well) was cleaned? 1 V l ), ( 1 I Do you have an enforceable grease ordinance that requires new or retrofit of J grease traps/interceptors? ❑ Yes ❑ No Have there been recent inspection and/or enforcement actions taken on near- by restaurants or other nonresidential grease contributors? ❑ Yes ❑ No Fvnlain- Have there been other SSOs or blockages in this areas that were also caused by grease ❑ Yes ❑ No When? If yes, describe them: Have cleaning and inspections ever been done at this location? Explain. Have educational material about grease been distributed in the past? When: and to whom: ❑NA ❑ NE DNA ❑ NE ❑ Yes ❑ No DNA ❑ NE ❑ Yes ❑ No ❑NA ❑ NE Explain: If the SSO occurred at a pump station, when was the wet well and pumps last checked for grease accumulation: Were the floats clean? Comments: ❑ Yes ❑ No DNA ❑ NE Form CS-SSO Page 4 Roots Do you have an active root control program on the line / area in question? ❑ Yes ❑ No []NA ❑ NE Describe: N C2 cuu--� Have cleaning and inspections ever been increased at this location because Yes ❑ No ❑NA ❑ NE of roots? Explain: What corrective actions have been accomplished at the SSO location (and surrounding system if associated with the SSO)? What corrective actions are planned at the SSO location to reduce root intrusion? H as the fine been smoke tested or videoed within the past year? If Yes, when? Comments: ❑ Yes ❑ No ❑NA ❑ NE Page 5 Form CS-SSO Inflow and Infiltration Are you under an SOC (Special Order by Consent) or do you have a schedule VYes ❑ No ❑NA ❑ NE in any permit that addresses 1/1? Explain if Yes: What corrective actions have been taken to reduce or eliminate I & I related overflows this spill location within the last year? � n Ckre s&l 1 (1 SQP c-t"kbn S aQ 8 Ce 0-ce-epplyyc'� CiU-� SSnc (�p�(� { Cash ilrun ( tPe, A"as ChbeQUrPanyil'ow`au'A s to d4tWMine f/I progerr5s in the El Yes o collection system at the SSO location? If Yes, when was the study completed and what actions did it recommend? ❑NA ❑ NE Has the line been smoke tested or videoed within the past year? ❑ Yes ❑ No ❑NA ❑ NE If Yes, when and what actions are necessary and the status of such actions: Are there 1/1 related projects in your Capital Improvement Plan? If Yes, explain: Yes ❑ No ❑NA ❑ NE (I I)lAw �,T low ana V( Af,o Msoccc-bon ibr Dtbi3i" Have there been any grant or loan applications for 1/1 reduction projects? If Yes, explain: Do you suspect any major sources of inflow or cross connections with storm sewers? If Yes, explain: ❑ Yes No ❑NA ❑ NE ❑ Yes NNo ❑NA ❑ NE Have all lines contacting surface ` rf`acew`a�ters in the SO location and upstream ❑Yes ❑ No ❑NA ❑ V NE been inspected recently? � 1�1 loui If Yes, explain: What other corrective actions are planned to prevent future 1/1 related SSOs at this location? Comments: (n M Form CS-SSO Page 6 Pump Station Equipment Failure (Documentation of testing records etc should be provided upon request) What kind of notification/alarm systems are present? Auto-dialer/telemetry (one-way communication) ❑ Yes Audible ❑ Yes Visual ❑ Yes SCADA (two-way communication) ❑ Yes Emergency Contact Signage ❑ Yes Other If Yes, explain: Describe the equipment that failed: What kind of situations trigger an alarm condition at this station (i.e. pump failure, power failure, high water, etc.)? Were notification/alarm systems operable? ❑ Yes ❑ No ❑NA ❑ NE In no, explain: If a pump failed, when was the last maintenance and/or inspection performed? What specifically was checked/maintained? If a valve failed, when was it last exercised? Were all pumps set to alternate? ❑ Yes ❑ No ❑NA ❑ NE Did any pump show above normal run times prior to and during the SSO event? ❑ Yes ❑ No ❑NA ❑ NE Were adequate spare parts on hand to fix the equipment ❑ Yes ❑ No ❑NA ❑ NE Was a spare or portable pump immediately available? If a float problem, when were the floats last tested? How? If an auto -dialer or SCADA, when was the system last tested? How? Comments: ❑ Yes ❑ No ❑NA ❑ NE Form CS-SSO Page 7 Power outage (Documentation of testing records tec should be provided of alternative power source upon request.) , , , What is your alternate power or pumping source? Did it function properly? ❑ Yes ❑ No ❑NA ❑ NE Describe? When was the alternate power or pumping source last tested under load? If caused by a weather event, how much advance warning did you have and what actions were taken to prepare for the event? Comments: Form CS-SSO Page 8 Vandalism Provide police report number: Was the site secured? If Yes, Have there been previous problems with vandalism at the SSO location? If Yes, explain: What security measures have been put in place to prevent similar occurrences in the future? Comments: ❑ Yes ❑ No ❑NA ❑ NE ❑ Yes ❑ No ❑NA ❑ NE Form CS-SSO Page 9 Debris in line (Rocks sticks rags and other items not allowed in the collection system, etc.) What type of debris has been found in the line? Suspected cause or source of debris: Are manholes In the area secure and intact? When was the area last checked/cleaned? V I 1 (1 \u 7,iQ Yes ❑ No ❑NA ❑ NE Have cleaning and inspections ever been increased at this location ❑ Yes �/ No ❑NA ❑ NE due to previous problems with debris? Explain: Are appropriate educational materials being developed and distributed �es ❑ No ❑NA ❑ NE to prevent future similar occurrences? Comments: FonnCS-SSO Page 10 Other (Pictures and police reportas applicable must be available upon request.) Describe: Were adequate equipment and resources available to fix the problem? If Yes, explain: S _--e-1 `hMe. � 5 ko n ►{'fir ,�, -,�,-t c1�S� q'T( J� r�c� 05 r Q) 6ec If the prob eml could not be immediately repaired, what actions were taken to lessen the impact of the SSO? Comments: 0"y/es ❑ No ❑NA ❑ NE tA& &s PWe Oe-IU✓ee . ❑ Yes ❑ No ❑NA ❑ NE Form CS-SSO Page 11 Pipe Failure (Break) I� Pipe size (inches): (D What is the pipe material: V l , ' n What is the approximate age of the line/ pipe (years old): 'r� l l f-Q r Is this a gravity line? - - Yes ❑ No [_-]NA ❑ NE Is this a force main line? ❑ Yes do ❑NA ❑ NE Is the line a "High Priority" line? ❑ Yes B No ❑ NE ((l�'I S Last inspection date and findings: n ( j Sc v�,Qdoe � r rr\\❑]NaNA 'aV c11 If a force main then, Was the break on the force main vertical? ❑ Yes ❑ NoZINA ❑ NE Was the break on the force main horizontal? ❑ Yes ❑ No [7NA ❑ NE Was the leak at the joint due to gasket failure ? ❑ Yes Q No []NA ❑ NE Was the leak at the joint due to split bell? ❑ Yes q Jo �E]NA ❑ NE When was the last inspection or test of the nearest air -release valve to determine if operable? When was the last maintenance of the air release performed? If gravity sewer then, Does the line receive flow from a force main immediately upstream ❑ Yes VNo ❑NA ❑ NE of the failed section of pipe? If yes, what measures are taken to control the hydrogen sulfide production? d When was the line last inspected or videced? l ) n lii UI.SD n If line collapsed, what is the condition of the lineup and downstream of the failure? What type of repair was made? If temporary, when is the permanent repair planned? Have there been other failures of this line in the past five years? If so, then describe ❑ Yes 11\0 NA ❑ NE ForraCS-SSO Page 12 System Visitation ORC ❑ Yes No Backup ❑ Yes to Name: Certification Number: Date visited: Time visited: How was the SSO remediated (i./e. Stopped and cleaned up)? 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: ( Date: (� 1 V I' -t I Z_i Zr %�� . �'naxl� ; pp�} pp Signature: MAN X Title: {�y� t 1 \ ) (O �Yh1�va I Ibi n j Telephone Number: 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). FormCS-SSO Page 13