NC0025453_WWTP Bypass Summary_20240809

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: 1 J 6y
Facility Name: I��ts Qr-uha, f. tzr,
Incident Started
Incident Ended
Level of Treatment:
Date: 0% 09 1 zozki
Date: b%j c(A I , oZa
Permit Number: Al C.pa
County: JU�A5b+-,\
Time: �: Zn ,,
Time: 9 10 P
_None 2primary Treatment ✓Secondary Treatment /Chlorination/Disinfection Only
Estimated Volume of Spill/Bypass: 6 , 9 J 2 (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: i o ;c Z Surface Water Name: Li+Hp- CruA< /No
Did the Spill/Bypass result in a Fish Kill? Yes
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 to be Taken to Prevent Occurrences:
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Additional Comments About the Event: �C iw,1
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24-Hour Report Made To: Division of Water Resources ✓ Emergency Management ✓
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Contact Name: c..,, ,s Date: a$ o `s 11 20 -�Ll Time: 15
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Other Agencies Notified (Health Dept, etc):
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Person Reporting Event: Dciv"Ll t,. ;,"- Phone Number: (-- S9y- cq17
Did DWR Request an Additional Written Report? _Yes /No
If Yes, What Additional Information is Needed:
Spill/Bypass Reporting Form (August 2014)