WQCS00307_5DAY SSO Report_20190226

Form CS-SSO
Collection System Sanitary Sewer Overflow Reporting Form
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Manhole at Westall & Bragg Street, etc):
This form shall be submitted to the appropriate DWQ Regional Office within five days of the first knowledge of the sanitary sewer
overflow (SSO).
Permit Number:(WQCS# if active, otherwise use WQCSD#)
Facility:Incident #:
Owner:
Region:City:County:
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 #:
Latitude (Decimal Degrees):Longitude (Decimal Degrees):
Incident Started Dt:Time:Incident End Dt:Time:
(mm-dd-yyyy)(hh:mm AM/PM)(mm-dd-yyyy)(hh:mm AM/PM)
Estimated Volume of the SSO:gallons Estimated Duration (Round to nearest hour):
Describe how the volume was determined:
Weather conditions during the SSO event:
Did SSO reach surface waters?Yes No Unknown Volume reaching surface waters (gals):
Surface water name:
Did the SSO result in a fish kill?Yes No Unknown If Yes, what is the estimated number of fish killed?
02/22/2019
Town of Canton
Canton Collection System 201900395
AshevilleHaywood
Main St. Manhole- blockage from Park & Sorells St.
2,500 2:30
Pump truck could pump 2500 gallons out of manhole. Take about 2 hours to fill back up.
Rainy
0
2500
WQCS00307
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þ ¨¨
þ¨¨
7:00 am 02/22/2019 09:30 am
PIGEON RIVER
PART I:
SPECIFIC cause(s) of the SSO:
hours
þ Pipe Failure (Break)
24 hour verbal notification (name of person contacted ):
DWR Emergency Mgmt Date (mm-dd-yyy):02/22/2019¨09:58:00 amþTime (hh:mm AM/PM):
Mikal Willmer
If an SSO is ongoing, please notify the appropriate Regional Office on a daily basis until SSO can be stopped.
Per G.S. 143-215.1C(b), the responsible party of a discharge of 1,000 or more of untreated wastewater to surface waters
shall issue a press release within 24-hours of first knowledge to all print and electronic news media providing general
coverage in the county where the discharge occurred. When 15,000 gallons or more of untreated wastewater enters surface
waters, a public notice shall be published within 10 days and proof of publication shall be provided to the Division within 30
days. Refer to the reference statute for further detail.
The Director, Division of Water Resources, may take enforcement action for SSOs that are required to be reported to
Division unless it is demonstrated that:
1) the discharge was cause by sever natural conditions and there were no feasible alternative to the discharge; or
2) the discharge was exceptional, unintentional, temporary and caused by factors beyond the reasonable control of the
Permittee and/or owner, and the discharge could not have been prevented by the exercise of reasonable control.
Part II must be completed to provide a justification claim for either of the above situations. This information will be the basis
WHETHER OR NOT PART III IS COMPLETED, A SIGNATURE IS REQUIRED AT THE END OF THIS FORM
CS-SSO Form Page:1
PART II:
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
Pipe Failure (Break)
Pipe size (inches)
10"
What is the pipe material?
Clay
What is the approximate age of line/pipe? (years old)
40-50
Is this a gravity line?NENANoYesþ¨¨¨
Is this a force main line?NENANoYes¨þ ¨¨
Is the line a "High Priority" line?NENANoYes¨¨¨¨
Last inspection date and findings
If a force main then,
Was the break on the force main veritical?NENANoYes¨¨¨¨
Was the break on the force main horizantal?NENANoYes¨¨¨¨
Was the leak at the joint due to gasket failure?NENANoYes¨¨¨¨
Was the leak at the joint due to split bell?NENANoYes¨¨¨¨
When was the last inspection or test of the nearest air-release valve to determine of
operable?
When was the last maintenace of the air release performed?
If gravity sewer then,
Does the line receive flow from a force main immediately upstream of the failed section
of pipe?
NENANoYes¨þ ¨¨
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If yes, what measures are taken to control the hydrogen sulfide production?
When was the line last inspected or videoed?
within the last 5 years. Exact date not known
If line collapsed, what is the condition of the line up and down stream of the failure?
Unknown
What type of repair was made?
point repair. Replaced section with PVC
Is the repair temporary or permanent?
If temporary, when is the permanent repair planned?
Preparing for line replacement & manhole replacement.
Have there been other failures of this line in the past five years?NENANoYes¨þ ¨¨
If so, then describe
System Visitation
ORC Yesþ
Backup Yes¨
Name:
Richard Hodge
Cert#
25438
Date visited:
02/22/2019
Time visited:
0700
How was the SSO remediated (i.e. Stopped and cleaned up)?
Pump Truck brought onsite and pumped liquid. 2500 gallons went directly into storm drain to River.
CS-SSO Form Page:3
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:Date:02/25/19 08:00 am
Signature:Title:Sewer Superintedent
Telephone Number:
Any addition information desired to be submitted should be sent to the appropriate Division Regional Office within five 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).
Richard Hodge
CS-SSO Form Page:4