NC0020401_Report_20240926

North Carolina Department of Environmental Quality
Division of Water Resources
WWTP Upset, Spill, or Bypass 5-Day Reporting Form
(Please Print or Type Use Attachments if Needed) , 1
Permittee: �L 1/_,dL'—� � r Permit Number:
�; N C-00 ZO �O l
Facility Name: ND! F►t�05� w wTp County: I=GL+44A)bQ
Incident Started: Date: 'uO-ZEF Time: y • 15P M
Incident Ended: Date: 1-Zy" Time: I Oa IVM
Level of Treatment:
one _Primary Treatment _Secondary Treatment _Chlorination/Disinfection Only
Estimated Volume of Spill/Bypass: I 10 j OO P�(must be given even if it is a rough estimate)
Did the Spill/Bypass reach the Surface Waters? 4L10yes _No
If yes, please list the following:
1� Volume Reaching Surface Waters: f I DT Surface Water Name: f Cl t It, n!) CY eE f L
Did the Spill/Bypass result in a Fish Kill? Yes_ _V-*N o
Was WWTP complian�h permit requirements? Yes _No
Were samples taken during p ent es _ No
Source of the Upset/Spill/Bypass
(Location
or Treatment Unit):
AotC
,n el
-�jooaQ i rL -9re 1
' 1
j�} (ilrYi Gc�)2� jqelene
Cause or Reason for the Upset/Spill/Bypass:
Flo of i rn
the Repairs Made or Actions Taken
r
+b'e- s ys4cpn
K.d . 4 ke areq
Spill/Bypass Reporting Form (August 1997)

WWTP Upset, Spill, or Bypass 5-Day Reporting Form
Page 2
Action Taken to Contain
Spill, Clean Up and Remediate the Site (if applicable):
� �{r► l af
Action Taken or Proposed to be Taken to Prevent Occurrences:
Additional Comments About the Event:
24-Hour Report Made To: Division of Water Resources Y Emergency Management
Contact Name:V b!7 I� Date: �` Z 8�2t7� Time: �`2j 3 (9
c�
Other Agencies Notified (Health Dept, etc):
Person Reporting Event: Phone Number: p112
Did DWR Request an Additional Written Report? _Yes /No
If Yes, What Additional Information is Needed:
$S 8 — 03(�$
Spill/Bypa s""Reporting Form (August 1997)
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