WQCS00056_202401551_Bypass_20241007

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
DWR Collection System Sanitary Sewer Overflow Reporting Form
Formi CS-SSO
PART 1:
This form shall be submitted to the appropriate DWR Regional Office within five business days of the first knowledge of the
sanitary sewer overflow(SSO).
Permit Number: WQCS00056 (WQCS#if active, otherwise use WQCSD#)
Facility: Siler City Collection System Incident#:202401551 Owner: Town of Siler Cit�
Region: Raleigh City: Siler City County: Chatham
Source of SSO(check applicable): E Sanitary Sewer Pump Station/Lift Station
SPECIFIC location of the SSO(be consistent in description from past reports or documentation-i.e. Pump
Station 6, Manhole at Westall&Bragg Street, etc.):
Manhole#: A301
Latitude (degrees/minute/secand): Longitude(degrees/minute/second):
Incident Started Dt: 08/08,2024 Time: 7:50a Incident End Dt:08,08,'2024 Time: 10:45a
(mm-dd-yyyy) (hh:mm)AM/PM (mm-dd-yyyy) (hh:mm)AM/PM
Estimated volume of the SSO: 875 gallons Estimated Duration (round to nearest hour): 2.35 hour(s)
Describe how the volume was determined: estimate based on visual
Weather conditions during the SSO event: heavy rain(Troical Storm Debby)
Did the SSO reach surface waters? 0 Yes F] No 7 Unknown
Volume reaching surface waters: 875 gallons Surface water name: Loves Creek
Did the SSO result in a fish kill? El Yes H No F Unknown
If Yes,what is the estimated number of fish killed?
SPECIFIC cause(s)of the SSO:
XSevere Natural Conditions E] Grease E]Roots Olnflow&Infiltration
FPump Station Equipment Failure El Power Outage [—]vandalism Debris in line E]Pipe Failure (Break)
FOther(Please explain in Part 11)
24-hour verbal notification (name of person contacted): Cheng Zhang
DCDWR [:]Emergency Management Date(mm-dd-yyy): 08 09/2024Time: (hh:mm AM/PM): 10:12am
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 11 IS COMPLETED,A SIGNATURE IS REQUIRED SEE PAGE 13
Form CS-SSO Page I

In order to submit a claim for justification of an SSO,you must use Part I I of form CS-SSO with additional documentation as
necessary. DWR staff will review the justification claim and determine if enforcement action is appropriate.
PART 11L.
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: Tropical Storm Debby
How much advance warning did you have and what actions were taken in preparation for the event?around 24 hours,high
prioritylines where inspected.
Comments:
Form CS-SSO Page 3

System Visitation
ORC Z Yes
Backup Yes
Name: Chris McCorquodale
Certification Number: 992764
Date visited: 08/09:2024
Time visited: 8:14a
How was the SSO remediated (i./e. Stopped and cleaned up)?
area was flooded from high creek levels, once creek went down so that we could get to the area,there was nothing to clean
up. straw was placed around manhole and picked up 2 days later
As a representative for the responsible party, I certify that the i0formation contained in this report is true and accurate to the
best of my knowledge.
Person submitting claim: Chris McCorquopdale Date: W!04.�2024
Signature: Title:
Telephone Number: 919-726-8614
Any additional information desired to be submitted should be sent to the appropdate 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).
Form CS-SSO Page 13