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Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Watershed Permitting Program
Sanitary Sewer Overflow (SSO)/Bypass
Notification Form
FOR DEP USE ONLY
Tax Identification Number
A. General Information
1. Facility Information
MA0101818
a. Reporting Facility Permit Number
Northampton Department of Public Works
b. Name of Collection System/Treatment Woks
2. Authorized Representative filing
Edward
a. First Name
Director of Public Works
d. Title of Authorized Representative
3. Event Report Information
this notification form:
Huntley 413-587-1570
b. Last Name c. Telephone(10)
nhuntley@northamptonma.gov
e. E-mail Address of Authorized Representative
a. Are you reporting: ® 1. Unanticipated SSO or Bypass ❑2.Anticipated SSO or Bypass
B. Phone Notifications Made, if any:
1. MassDEP person contacted:
Kurt
a. first name
Date/Time MassDEP contacted by phone:
George
a. first name
2. EPA person contacted:
Date/Time EPA contacted by phone:
3. Others notified (select all that apply):
Boisjolie
b. last name
05/0112014 Tim 01:13
e
c. Date (mm/ddyyyy) d.hhmm
Harding
b. last name
05/01/2014 Time. 01:16 ❑e.an
c. Date(mmlddryyyy) d. hh:mm ®f.pm
® a Conservation Commission n b.Board of Health
❑e.am
f.pm
❑c.Harbormaster ❑ d.Downstream WS ❑ e.Watershed Association ❑r.Shellfish Warden
Sarah LaValley and Meredith O'Leary
❑g.Other: h.Specify
C. General Information About SSO/Unanticipated Bypass
1
When did the event occur? 451012014 Time:
a. Date(mm(dd yyyy)
09:45 ®c.am
b. hh:mm ❑d.Pa
2. Location of event: College Lane-near Smith College Boathouse 42-19-5 72-38-26
a.Number and Street(or closest address) b.latitude c.longitude
3. Estimated volume of overflow discharge at the time of this report:
Unknown-flow out of manhole for approximately
2 hours
Estimated Volume:
b. Method of estimating volume:
4. Where did the overflow discharge to?(e.g., Surface water(Paradise Pond-Mill River)
surface water, ground)
College Lane SSO Nobfcabon_20140501 SSO Notification.docx• Wastewater Overflow/Bypass or Sewage Backup Notification•Page 1 of 4
rev.072010
Massachusetts Department of Environmental Protection
Bureau of Resource Protection —Watershed Permitting Program
Sanitary Sewer Overflow (SSO)/Bypass
Notification Form
FOR DEP USE ONLY
Tax Idenbficabon Number
C. General Information About SSO/Unanticipated Bypass (cont.)
5. Identify causes of/reasons for the event: (select all that apply)
❑a. rain ❑ b. snowmelt ❑c. high groundwater
❑a. insufficient capacity ®e. sewer system blockage or collapse
❑r pump/lift station failure ❑ g. treatment facility equipment failure
15 inch sewer main blocked with grease
❑h.Other i.Speclly
6. Have corrective actions been completed? ®a. Yes ❑ b. No ❑c.No Action Required
7. Corrective measures taken (select all that apply,or use Section E to attach additional comments):
a.repaired sewer/cleared ❑ b.repaired pump/lift ❑c. repaired service
blockage station connection
❑d. drained or pumped ❑f. backflow prevention
sewage out of building ❑e. disinfection treatment device installed
Sewer main cleared with jet rod
❑B Other: h. Specify
D. General Information About Anticipated Bypass
1. When will the bypass occur?
2. Where will the bypass occur?
a. Date(mm/ddyyyy)
Time.
b. hh:mm
a.Number and Street(or closest address) b.latitude
3. Estimated volume of overflow discharge at the time of this report:
a. Estimated volume:
b Method of estimating volume:
4. Identify causes of/reasons for the event: (select all that apply)
❑a. rain
❑d. insufficient
capacity
f. pump/lift
station failure
❑g.Other.
❑b. snowmelt
❑e. sewer system blockage or collapse
❑g. treatment facility equipment failure
c.am
❑d.pm
c longitude
❑c. high groundwater
i. Seemly
5. Will an SSO occur during the bypass? ❑a. Yes
a.1. Where will SSO discharge to?
A 5-day follow-up report is required for the SSO.
College Lane SSO Nobficabon_20140501_SSO NoMicatbn.docx• Wastewater Overflow/Bypass or Sewage Backup Notification•Page 2 of 3
rev.07/2010
Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Watershed Permitting Program
Sanitary Sewer Overflow (SSO)/Bypass
Notification Form
❑b.No
FOR DEP USE ONLY
Tax Identification Number
D. General Information About Anticipated Bypass (cont.)
Please be advised that if the anticipated bypass detailed above results in an unanticipated
bypass&SSO, MassDEP must be notified within 24 hours and a new form completed.
Please provide comments in Section E detailing the preventive measures to be taken during the event.
E. Comments/Attachments/Follow-up
I wish to provide(select all that apply):
la 1.Attachment❑ 2. Additional comments below: ❑ 3.No additional comments or attachments
2a. Additional comments and planned actions:
F. Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or persons
who manage the system,or those persons directly responsible for gathering the information, the
information submitted is,to the best of my knowledge and belief,true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of
fine and imprisonment for knowing violations.
I.Signature of Auth rized pro 2.
Please keep a copy of this report for your records.When submitting additional information, include
the MassDEP Incident Number from this report.
Re senb -
MassDEP Regional Office and EPA Telephone and Fax Numbers:
Northeast Region Phone: 978-694-3215 Fax 978-694-3499
Southeast Region Phone: 508-946-2750 Fax 508-947-6557
Central Region Phone: 508-792-7650 Fax 508-792-7621
Westem Region Phone: 413-784-1100 Fax 413-784-1149
EPA Contact Phone: 617-918-1766
College Lana SSO Notifcation_20140501_SSO NotifWion.doex• Wastewater Overflow/Bypass or Sewage Backup Notification•Page 3 of 3
rev.07/2010
Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Watershed Permitting Program
Sanitary Sewer Overflow (SSO)/Bypass
Notification Form
FOR DEP USE ONLY
Tax Identification Number
DEP 24-hour
emergency
Phone: 888-304-1133
College Lane S50 Notification 20140501_530 Notification.docx• Wastewater Overflow/Bypass or Sewage Backup Notification•Pape d old
rev.07/2010
•
Smith College • •
SSO Location
Smith College
College Lane
•
Approximate location
of grease blockage
eCity of Northampton
Public Works
Sanitary Sewer Overflow Incident
May 1, 2014
College Lane, Smith College
0 90 180
360 Feet
It I