WQCSD0158_Correspondence_20190808

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Division of Water Re -sources
State of North Carolina
Deparhnent of Environment and Natural Resources
Division of Water Resources
Collection System Sanitary Sewer Overflow Reporting Form
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: Deemed System (WOGS# if active, otherwise use WOCSD#)
Facility: The Preserve Incident #: 214955 Owner: Aqua North Carolina
Region: Raleigh City: Pittsboro County: Chatham
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.): The SSO was at the corner of Mtn. Laurel and The Preserve Trail
Latitude (degrees/minute/second): Longitude (degrees/minute/second):
Incident Started Dt: 08/03/2019 Time: 3:30 PM Incident End Dt: 08/03/2019 Time: 5:10 PM
(mm-dd-yyyy) (hh:mm) AM/PM (mm-dd-yyyy) (hh:mm) AM/PM
Estimated volume of the SSO: 950 gallons Estimated Duration (round to nearest hour): 1 hour(s)
Describe how the volume was determined: Estimate based on flow
Weather conditions during the SSO event: Clear
Did the SSO reach surface waters? ® Yes
Volume reaching surface waters: 200 gallons
❑ No ❑Unknown
Surface water name: Unknown storm water pond
Did the SSO result in a fish kill? El Yes ®No ❑Unknown
If Yes, what is the estimated number of fish killed? N/A
SPECIFIC cause(s) of the SSO:
❑Severe Natural Conditions ❑Grease
❑Roots ❑Inflow &Infiltration
❑Pump Station Equipment Failure El Power Out Vandalism ❑Debris in line ®Pipe Failure (Break)
❑Other (Please explain in Part II)
24-hour verbal notification (name of person contacted): George Bernard
❑DWR ®Emergency Management Date (mm-dd-yyy): 08/04/2019Time: (hh:mm AM/PM): 10:32 AM
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.
Form CS-SSO Page 1

In order to submit a claim for justification of an SSO, you must use Part II of form CS-SSO with additional documentation as
necessary. DWR staff will review the justification claim and determine if enforcement action is appropriate.
PART il:
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: N/A
How much advance warning did you have and what actions were taken in preparation for the event? N/A
Comments: N/A
Form CS-SSO Page 3

Grease 'Documentation such as cleaning inspection enforcement actions past overflow reports educational
material and distribution date etc. should be available upon request.)
When was the last time this specific line (or wet well) was cleaned?
Do you have an enforceable grease ordinance that requires new or retrofit of
grease traps/interceptors? ❑ Yes
Have there been recent inspection and/or enforcement actions taken on near-
by restaurants or other nonresidential grease contributors? ❑ Yes
Explain:
Have there been other SSOs or blockages in this areas that were also caused
by grease ❑ Yes
When?
It yes, describe them:
Have cleaning and inspections ever been done at this location?
Explain.
Have educational material about grease been distributed in the past?
When:
and to whom:
Explain:
Yes
If the SSO occurred at a pump station, when was the wet well and pumps last checked
for grease accumulation:
Were the floats clean?
Comments:
❑ Yes
❑ No
❑ No
❑ No
11 '
❑ NE
❑ NE
®NA ❑ NE
NA ❑ NE
Form CS-SSO Page t

Roots
Do you have an active root control program on the line / area in question? ❑ Yes El No ONA ❑ NE
Describe:
Have cleaning and inspections ever been increased at this location because
of roots? [:1 Yes ❑ No MNA ❑ NE
Explain:
What corrective actions have been accomplished at the SSO location (and
surrounding system if associated with the SSO)?
What corrective actions are planned at the SSO location to reduce root intrusion?
Has the line been smoke tested or videoed within the past year? El Yes ❑ No ®NA [] NE
If Yes, when?
Comments:
Form CS-SSO Page 5

Inflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule ❑ Yes No ❑NA ❑ NE
in any permit that addresses 1/1?
Explain if Yes: N/A
What corrective actions have been taken to reduce or eliminate I & I related overflows this spill location
within the last year? N/A
Has there been any flow studies to determine 1/1 problems in the ❑ Yes ❑ No ®NA ❑ 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 NNA ❑ NE
If Yes, when and what actions are necessary and the status of such actions:
Are there 1/1 related projects in your Capital Improvement Plan? ❑ Yes No NNA ❑ NE
If Yes, explain:
Have there been any grant or loan applications for 1/1 reduction projects? ❑ Yes ❑ No NNA ❑ NE
If Yes, explain:
Do you suspect any major sources of inflow or cross connections ❑ Yes ❑ No ®NA ❑ 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 1/1 related SSOs at this location? Installed new material
Comments:
Form CS-SSO Page 6

Pump Station Equipment Failure (Documentation of testing records etc should be provided upon request
What kind of notification/alarm systems are present?
Auto-dialer/telemetry (one-way communication) ❑ Yes
Audible ❑Yes
Visual ❑ Yes
SCADA (two-way communication) ❑Yes
Emergency Contacgnage ❑Yes
Other ❑Yes
If Yes, explain: N/A
Describe the equipment that failed: Pipe Failure
What kind of situations trigger an alarm condition at this station (i.e. pump failure, power failure, high water, etc.)?
Were notification/alarm systems operable? ❑ Yes ❑ No ®NA ❑ NE
In no, explain: N/A
if a pump failed, when was the last maintenance and/or inspection performed? N/A
What specifically was checked/maintained? N/A
If a valve failed, when was it last exercised? N/A
Were all pumps set to alternate?
Did any pump show above normal run times prior to and during the SSO event? ❑Yes ❑ No
Were adequate spare parts on hand to fix the equipment
Was a spare or portable pump immediately available?
If a float problem, when were the floats last tested? How? N/A
If an auto -dialer or SCADA, when was the system last tested? How? N/A
Comments: N/A
®NA ❑ NE
®NA ❑ NE
/1
❑ NE
❑ NE
Form CS-SSO Page 7

Power outage (Documentation of testing records tec should be provided of alternative power source u on
re uest.
What is your alternate power or pumping source? IN/
Did it function properly? LJ Yes Lj No ®NA L.] NE
Describe? N/A
When was the alternate power or pumping source last tested under load? N/A
If caused by a weather event, how much advance warning did you have and what actions were taken to prepare for the
event? N/A
Comments: N/A
Form CS-SSO Page 8

Vandalism
Provide police report number: N/A
Was the site secured? L] Yes L] No ZJNA Lj NE
If Yes, how? N/A
Have there been previous problems with vandalism at the SSO location? N/A
If Yes, explain: N/A
What security measures have been put in place to prevent similar ®Yes No NA NE
occurrences in the future?
Comments: N/A
Form CS-SSO Fage 9

Debris in line (Rocks sticks rags and other items not allowed in the collection system. etc.)
What type of debris has been found in the line? N/A
Suspected cause or source of debris: N/A
Are manholes in the area secure and intact? ❑ Yes ❑ No 12SINM ❑ NE
When was the area last checked/cleaned? N/A
Have cleaning and inspections ever been increased at this location ❑Yes ❑ No NA ❑ NE
due to previous problems with debris?
Explain: N/A
Are appropriate educational materials being developed and distributed ❑Yes No NA ❑ NE
to prevent future similar occurrences?
Comments: N/A
Form CS-SSO Page 10

Other (Pictures and police report as applicable must be available upon request.)
Describe:
Were adequate equipment and resources available to fix the problem?
If Yes, explain: N/A
If the problem could not be immediately repaired, what actions
were taken to lessen the impact of the SSO?
Comments: N/A
Form CS-SSO Page 1

Pipe Failure (Break)
Pipe size (inches) 2
What is the pipe material PVC
What is the approximate age of the line/ pipe (years old)
Is this a gravity line?
Is this a force main line?
Is the line a "High Priority" line?
Last inspection date and findings N/A
If a force main then,
Was the break on the force main vertical?
Was the break on the force main horizontal?
Was the leak at the joint due to gasket failure ?
Was the leak at the joint due to split bell?
When was the last inspection or test of the nearest air -release value to determine if operable? N/A
When was the last maintenance of the air release performed? N/A
If gravity sewer then,
Does the line receive flow from a force main immediately upstream ❑Yes ®No
of the failed section of pipe?
If yes, what measures are taken to control the hydrogen sulfide production? N/A
When was the line last inspected or videoed? N/A
If line collapsed, what is the condition of the line up and down stream of the failure? N/A
❑NA
r
■
■
❑NA
What type of repair was made? The shut off valve was re -glued to the top of the blow -off pipe on the force main.
If temporary, when is the permanent repair planned? N/A
Have there been other failures of this line in the past five years?
If so, then describe N/A
NE
❑ NE
❑ NE
❑ NE
❑ NE
Form CS-SSO Page 12

Svstem Visitation
ORC Yes
Backup Yes
Name: Alton Ratliff
Certification Number: 1000971
Date visited: 8/3/2019
Time visited: 3:30pm
How was the SSO remediated (i./e. Stopped and cleaned up)?
The pipe failure happened inside of a access box that housed the cleanout for the 2" sewer force main. This
access box was cleaned out using a vacuum truck and the pipe was repaired. The detention storm drain that
feeds the retention pond was also cleaned with the vacuum truck using fresh water and pressure washer.
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: Roger• B. Tupps
Signature:
Telephone Number: 919-653-6966
Date: 08/08/2019
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 l3