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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
MA0101818
First Name Last Name
Director of Public Works
Title
Permit*
413-587-1570
Telephone No.
nhuntley @northamptonma.gov
E-mail Address
B. Phone Notifications:
1. MassDEP staff contaded:
Date/Time contacted:
2. EPA staff contacted:
Date/Time EPA contacted:
3 Board of Health contacted:
Date/Time contacted:
Kurt
first name
12/18/2014
Date
George
first name
12/18/2014
Date
Merridith
First Name
12/19/2014
Date
4. Others notified (select all that apply);
❑ Harbormaster ❑ Shellfish Warden
Boisjolie
last name
5:00
Time
Harding
last name
5:00
Time
O'Leary
Last Name
4:00
Time
❑am ®pm
❑am ®pm
❑Conservation Commission
❑ Division of Marine Fisheries
❑ Downstream Drinking Water Supplier ❑ Watershed Association
❑ Beach Resource Manager ❑ Other:
❑am ®pm
(specify)
C. SSO Information
1. SSO Discovered:
By
Reported by store
12/18/2014
Date
4:00
Tine
2. 550 Stopped:
3. SSO Discharge from:
12/18/2014 4:40
Date
Time
❑ Sanitary Sewer Manhole ❑ Pump Station
❑ Backup into Property ❑ Other: (sceay)
4. SSO Discharge to: ❑ Ground Surface(no release to surface water)
❑ Direct to Receiving Water
❑ Catch basin to Receiving Water
Z Backup into Property Basement
33 Main St S5Q20141213 docx•rev.01/2013
(surface water)
(surface water)
Wastewater Overflow/Bypass or Sewage Backup Notification•Page 1 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
C. SSO Information (cont.)
Basement of 233 Main Street, Northampton
Location:
(Description of discharge site or closest address)
5 Estimated SSO Volume at time of this Report: 15 gallons
Method of Estimating Volume: Visual inspection
6. Cause of SSO Event:
❑ Rain Event ❑ Pump Station Failure ❑ Insufficient Capacity in System
❑ Treatment Unit failure
® Sewer System Blockage: ❑ Pipe Collapse ❑ Root Intrusion ❑ Grease Blockage
❑ Other: (Specify)
7. Corrective Actions Taken:
Sewer Main along the north side of Main Street building cleared with jet-rod
Impact Area cleaned and/or disinfected: ❑ Yes ❑ No
Corrective Actions Completed. ® Yes ❑ No
Sewer Main cleared and flowing
D. Comments/Attachments/Follow-up
I wisn to provide(select all that apply):
M Aliochment ❑ Additional comments below: ❑ No additional comments or attachments
Additional comments and planned actions:
33 Main St_8$0_20141213 do: •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.
$a'17/�i'u� (zdws R. Loar.1.� tzizzify
rnalufe of A I Date Signed
Prase 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
233 Main St_SSO_20141218.docx•rev.01/2013
Phone: 978-694-3215
Phone: 508-946-2750
Phone: 508-792-7650
Phone: 413-784-1100
Phone: 617-918-1870
Phone: 888-3041133
Fax: 978-694-3499
Fax: 508-947-6557
Fax: 508-792-7621
Fax: 413-784-1149
Fax:617-918-0870
Wastewater Overflow/Bypass or Sewage Backup Notification•Page 3 of 3
4.
Approximate location of blockage
by rags and grease
in 8 inch VC sewer main.
Cleared with jet-rod
Sanitary Sewer Overflow Incident, 12/1812014
233 Main Street, Northampton, MA
0
25 50
i l l l
100 Feet