NC0025453_Incident 202401212 - 5 Day Report_20240803

North Carolina Department of Environment and Natural Resources
DWR
Division of Water Resources
WWTP Upset, Spill, or Bypass 5-Day Reporting Form
(Please Print or Type Use Attachments if Needed)
Permittee: T-w.% cy L ,,ice„
Facility Name: ! ,, �s 9 wvt�"-
Incident Started
incident Ended
Level of Treatment:
Date: v? 119 1 Z
Date: u1 lza
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Permit Number: AJL067.s4l5.�,,,,.__
County:
Time: . l
Time: 7: 3 tj a
_None ✓ Primary Treatment ✓Secondary Treatment ✓Chlorination/Disinfection Only
Estimated Volume of,SpiIIlBypass: �� , o 0 (must be given even if it is a rough estimate)
Did the Spill/Bypass reach the Surface Waters? _Yes "No
If yes, please list the following:
Volume Reaching Surface Waters: N /A Surface Water Name: M / k
Did the Spill/Bypass result in a Fish Kill? Yes ✓No
Was WWTP compliant with permit requirements? / Yes No
Were samples taken during event? Yes ✓ No
Source of the Upset/Spill/Bypass Location or Treatment Unit):
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Cause or Reason for the Upset/Spill/Bypass:
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Describe the Repairs Made or Actions Taken:
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Spill/Bypass Reporting Form (August 2014)

WWTP Upset, Spill, or Bypass 5-Day Reporting Form
Page 2
Action Taken to Contain Spill, Clean Up and Remediate the Site (if applicable):
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Action Taken or Proposed r4t�—o be
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rnlnOg ccurcrences�:
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Additional Comments About the Event: !
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24-Hour Report Made To: Division of Water Resources v/ Emergency Management
Contact Name: M i c k -1 HA Date: 0111H r2o?_q Time: '� ; 35 G•,.,
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Other Agencies Notified (Health Dept, etc): ll q A N)
Person Reporting Event: �6,1'j Phone Number: _ (�c5) S5 q, 06/r7
Did DWR Request an Additional Written Report? _Yes ✓ No
If Yes, What Additional Information is Needed:
Spill/Bypass Reporting Form (August 2014)