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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. Reporting Facility
1.
Facility Information
Northampton Department of Public Works
Reporting Sewer Authority
2. Authorized Representative Transmitting Form:
Edward Huntley
First Name
Director of Public Works
Tine
B. Phone Notifications:
1. MassDEP staff contacted:
Date/Time contacted:
2. EPA staff contacted:
Date/Time EPA contacted.
3. Board of Health contacted:
Date/Time contacted:
Last Name
MA0101818
Permit*
413-587-1570
Telephone No.
nhuntley @northamptonma.gov
E-mail Address
Paul
first name
10/2/2015
Date
George
first name
10/2/2015
Date
Merrideth
First Name
10/2/2015
Date
4. Others notified(select all that apply):
❑ Harbormaster ❑Shellfish Warden
❑ Downstream Drinking Water Supplier
❑ Beach Resource Manager ❑Other
Nietupski
last name
1:20
Time
Harding
last name
1'25
Time
O'Leary
Last Name
1:30
Time
❑am In pm
❑am 1Y pm
❑Conservation Commission
❑Division of Marine Fisheries
❑ Watershed Association
❑ am Ixlpm
(apedty)
C. SSO Information
1. SSO Discovered:
Visual Observation
By:
2. SSO Stopped:
9/30/2015 9:30
Date Time
am ❑pm
-10:30
Date Time
3. SSO Discharge from: ❑ Sanitary Sewer Manhole ❑ Pump Station
® Backup into Property ❑ Other: (sandy)
4. SSO Discharge to: ❑ Ground Surface(no release to surface water)
❑ Direct to Receiving Water
❑ Catch basin to Receiving Water
® Backup into Property Basement
ssoform-rev.9112013 Wastewater Overflow/Bypass or Sewage Backup Notification•Page 1 of 3
El
am ❑pm
(surface water)
(surface water)
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
C. SSO Information (cont.)
30 Crafts Avenue, Northampton
Location: (Description of discharge site or closest address)
5. Estimated SSO Volume at time of this Report: 5-10 gallons
Method of Estimating Volume:
Visual estimate
6. Cause of SSO Event:
❑ Rain Event ❑ Pump Station Failure ❑ Insufficient Capacity in System
❑ Treatment Unit failure
IA Sewer System Blockage: ❑ Pipe Collapse ❑ Root Intrusion ® Grease Blockage
❑ Other. (Specify)
7. Corrective Actions Taken.
Jet-rod and vac cleaing of manholes and sewer lines in Old South Street and
Rahars Alley.
Impact Area cleaned and/or disinfected: ❑ Yes ❑ No
Corrective Actions Completed: ❑ Yes l] No
D. Comments/Attachments/Follow-uP
I wish to provide(select all that apply):
NI Attachment ❑ Additional comments below: ❑ No additional comments or attachments
Additional comments and planned actions:
The Health Department will investigate status of maintenance of grease trans in
nearby restaurants. The DPW will inspect this area for grease buildup and clean
as necessary,
ssoform•rev.01/2013 Wastewater Overflow/Bypass or Sewage Backup Notification•Page 2 of 3
,
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
E. 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.
/C t+�ga
Signature of Authorized Representative Date Igne�
Please keep a copy of this report for your records.When submitting additional information, include
the MassDEP Incident Number from this report.
MassDEP Regional Office and EPA Telephone and Fax Numbers:
Northeast Region
Southeast Region
Central Region
Western Region
EPA Contact
DEP 24-hour
emergency
Phone: 978-694-3215
Phone: 508-946-2750
Phone: 508-792-7650
Phone: 413-784-1100
Phone: 617-918-1870
Phone: 888-304-1133
Fax: 978-694-3499
Fax: 508-947-6557
Fax: 508-792-7621
Fax: 413-784-1149
Fax: 617-918-0870
30 Crafts Ave SSO Report_201510.docx•rev.0112013 Wastewater Overflow/Bypass or Sewage Backup Notification•Page 3 of 3
Location of SSO to Basemen
al 30 Crafts Avenue
Blockage in Sewer Line
due to grease.
Location of Jet-Rod and
Vector Truck cleaning
City of Northampton
Public Works
Sanitary Sewer Overflow Incident, 9/30/2015
30 Crafts Ave. Northampton. MA