83 SSO 2013 Department of Environmental Protection Program FOR OEP USE ONLY
Bureau ofResoUr PP PermM1hn9 o9
Bureau al Resource Protection-Watershed Tu „ Mavis
Sanitary Sewer Ovel{low lSSO)IBYPass —_-
Notification Form
A.Ge Information
1. Facile InIccnator
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Z. Authorized ReWasenlagve yang N®notification(cml 413-59]-15]0
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3 Event Report Intormgtan x.Anticipated SSO b Bypass
g. Are you reporting i UnantCWated SSO or Bypass
MR B.Phone Noti onfi s Made d any:
K M1 2222- b tan w 1. MaaaoEP_non mnmded rw 52014 Ttme
05 00 �aPn am
nd
>,a patyrme MassOEP contacted by prone: c om bmuad 4 iHartl_g 22
n cpntacted'. a m+ .-- — 2014— a`a"� 0e.a"
2 EPA pane c Date(014_ T'me: Minn sf pn
Date/Time EPA contacted by prone: c pile i,,..,mswn
3 s notified(select all that apply) ❑a Conservation Commission®b Beard oHeyN
Watershed Association ❑e.S¢Nfisn Warden
c Hamotmasa" 0 a Downstream WS 0 •
n-spear
0 p About SSG/Unanticipated Bypass
C.General Information Atw 0345 ❑°"n
o6i2v2014
orw -- Tme: b m:nm ®d tin
> do canna.r_v) _ 42-30-52 Ttd:1 ;
1. When did the avers occurs eMMem �10npMUO°one Sinai re doelatiedes0
2 Location of event .Mancai
volume of overflow discharge at the time of the report_
3 EsEtratbl 13d( g-albns
a Estimated Volume
b Method of esemat g volume:
4, WYete Cd the overflow discharge to?(e 9..
surface water,ground)
3 Mountain s_xtaaexs sso pptaptvnn.data
Wntt*lm Oar bypint
Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Watershed Permitting Program
Sanitary Sewer Overflow (SSO)/Bypass
Notification Form
FOR DEP USE ONLY
Tax S..tt ouww,en
C. General Information About SSOIUnanticipated Bypass(cunt.)
5 Identity causes of/reasons for tie event:(seed ail that apply)
❑a rain ❑u. sncwmelt ❑c high groundwater
❑a Imuffioent capacity ®e. sewer system blockage or collapse
r. pumped station failure ❑g treatnent facity equipment failure
abcksiz in sewer main from gmeu_,_
h.Other i specify
6. Have correctve actions been completed? ®a Yes ❑ e. No ❑c No Action Required
7. Conch ve measures taken(select all that apply,or use Secmn E to attach additional comments)-.
® e.repaired pumpdIt ❑c. repaired service
.. o repaired sewer/cleared ❑ station gpq
blockage
dral drained ❑r backlbw preveMgn
❑a. Onairweo pumped ❑e. doinfection treatment rlevre inflated
sewage out M building
❑v. oter. h Spwd _.._...D.General Information About Anticipated Bypass
1- When will the bypass mar? a 01e G+m'e%Yym Time'.
2. Where will the bypass p5u(4 ; j sites tc+M..+r bd.„)
3 Estenated volume of oveth w discharge at the time of this report:
.. Estimated volume. —
b Method of estimating volume. --. ----..�
4 Identify causes oflreasons for the evert.(select all that apply)
a rain
❑t snawmet ❑c. high groundwate
❑e Lnsufho1ent D e sewer ystem blockage or collapse
capacity
❑r WmMitl 0 treatment holey equipment failure
station failure
g Other
5. Will an SSO occur during the bypass, ❑a Yes
at.Whet'
nere will 550 diuNrge MO "—
A 5-0ay folbw-up report is requ red for to SSO.
p b No
mm
b latitude
d pm
vyN
s50 Ntik.IM.dm w.stMPK o o.JBY W.e or Sewage a W'N No5M1cw'Page x d
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection-Watershed Permitting Program
Sanitary Sewer Overflow(SSOyIBypass
Notification Form
FOR DEP USE ONLY
in meMaolen MCw
D. General Information About Anticipated Bypass(cont.)
Please be advised m t a th Mediated bypass detailed above reruns in an unanticipated
bypass&SSO,MaseDEP must be notified Whin 24 hours and a new form completed.
Pease provide comments In Section E Staging the preventive means to be taken dung the evert.
E.Comments/Attachments/Follow-up
I wish to prow de(select all that apply)
21 t.Attachment El 2 Additions'comments bear. 9 3 No adNeonal comments orathd1wnIs
2e. Additional comments and planned actions
Sewer main jeNOdded by DPW staff and main was Poyang by 5 PM
F. Certification Statement
1 certify under penalty of taw that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that quaffed personnel
progeny who a�gethtle ssdystem evaluate r 01041 peraonsa�respon for my inquiry
Brig the n(orcematim the persons
Information submtted s,to the beer of my knowledge and bellef,the,accurate,and complete lam
aware that there are slgnlgcam penalties for submitting false Infomnaton,Including the posslbftty of
fine and Imprisonment for knowing vibavons.
Me
ase keep Vcopy of this report for your records.When submitting additimel informsion,include
MessOEP Incident Number nom mIS report
MaaOEP Regional Office and EPA Telephone end Fax Numbers:
Northeast Region Phone: 978694-3215 Fax 978694-3499
Southeast Region Pawn. 508-946-2750 Fax 508-947-6557
Central Region Phone 508-792-7650 Fax 508-792-7621
Western Region Phone. 413-784-1100 Fax. 413-784-1149
EPA Contact Phone 617-918-1766
DEP 24-hour Phone. 888304-1133
emergency
83 WunteI 51_20140325 SSO Nd(WO.em
weelewaler OvMOwBY•SI Sews BWn00 Nor Iii-PtS 301
C
33
288
2
Loraeon of SSO at
83 Mountain Steel
a
97
J 8 we mCP
104
73
Approximate location of blockage I
by grease in sewer main.
Cleared with jet-rod.
6r
Sanitary Sewer Overflow Incident-June 25, 2014
83 Mountain Street, Northampton, MA
0 100 200 400 Feet