WQCSD0030_Report_20180802 (41)

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
DWR
Collection System Sanitary Sewer Overflow Reporting Form
Division of Water Resources Form CS-SSO
PART I:
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. WQCSD0030 (WQCS#if active, otherwise use WQCSD#)
Facility:Town of Woodland Incident#:4-2018 Owner:Town of Woodland
Region:Raleigh City:Woodland County:Northampton
Source of SSO (check applicable): ® 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#28 Intersection of N.Linden and Peachtree Street
Manhole#:28
Latitude(degrees/minute/second): Longitude(degrees/minute/second):
Incident Started Dt: 07-29-2018 Time: 10:00pm Incident End Dt:07-29-2018 Time: 10:30pm
(mm-dd-yyyy) (hh:mm)AM/PM (mm-dd-yyyy) (hh:mm)AM/PM
Estimated volume of the SSO: 100 gallons Estimated Duration (round to nearest hour): 1 hour(s)
Describe how the volume was determined: Estimated,came from around Manhole cover
Weather conditions during the SSO event. Heavy Rain RECE VED/DENRIDWR
Did the SSO reach surface waters? ® Yes ❑ No ❑ Unknown
AUG 0 2 2018
Volume reaching surface waters: 100 gallons Surface water name: Potecasi Creek
urces
Did the SSO result in a fish kill? ❑Yes ® No ❑ Unknown Water ing Sectio
Permitting Section
If Yes,what is the estimated number of fish killed?
SPECIFIC cause(s)of the SSO:
®Severe Natural Conditions ❑ Grease ❑Roots /1 inflow&Infiltration
❑Pump Station Equipment Failure ❑ Power Outage ❑Vandalism ❑ Debris in line ['Pipe Failure(Break)
❑Other(Please explain in Part II)
24-hour verbal notification (name of person contacted): Vanessa Manuel
®DWR ❑Emergency Management Date(mm-dd-yyy): 07-30-2018Time: (hh:mm AM/PM): 8:58AM
Per G.S. 143-215.1C(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 II IS COMPLETED,A SIGNATURE IS REQUIRED SEE PAGE 13
Form CS-SSO Page 1

Inflow and Infiltration
Are you under an SOC(Special Order by Consent)or do you have a schedule ❑ Yes ® No LINA ❑ NE
in any permit that addresses I/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?
Has there been any flow studies to determine I/I problems in the ® Yes ❑ No [INA ❑ NE
collection system at the SSO location?
If Yes,when was the study completed and what actions did it recommend? .
Has the line been smoke tested or videoed within the past year? ® Yes ❑ No LINA ❑ NE
If Yes,when and what actions are necessary and the status of such actions:
Are there I/I related projects in your Capital Improvement Plan? ❑ Yes ❑ No ®NA ❑ NE
If Yes, explain:
Have there been any grant or loan applications for I/I reduction projects? ® Yes ❑ No LINA ❑ NE
If Yes, explain: Seeking grants.
Do you suspect any major sources of inflow or cross connections ❑ Yes ® No LINA ❑ NE
with storm sewers?
If Yes, explain:
Have all lines contacting surface waters in the SSO location and upstream ❑ Yes ❑ No ®NA ❑ NE
been inspected recently?
If Yes, explain:
What other corrective actions are planned to prevent future I/I related SSOs at this location? Seeking grants for sewer
upgrade.
Comments:
Form CS-SSO Page 6

System Visitation
ORC ® Yes
Backup ❑ Yes
Name: Robert L.Collier
Certification Number: 8969/15595/15987
Date visited. 09-03-2016
Time visited: 0715,0900, 1000
How was the SSO remediated(i./e. Stopped and cleaned up)?
Area at Manhole#28 was washed off by rain. Area at LS#1 was washed with water and lime applied.
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: Robert L.Collier Date: 09-03-2016
Signature: o Title: rp
f‘..(-
Telephone Number: 252-587-7161
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).
Form CS-SSO Page 13