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Sewer Man Hole North of Bradford St Pumping Station SSO 2014 Important:when filling out forms on the canquror. use only the tab key to move your cursor-do not use the return key. 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 Authonly 2. Authorized Representative Transmitting Form: Edward Huntley First Name Last Name Director of Public Works Title B. Phone Notifications: See DEP 1. Regional Office takphone and fax numbers at the end of hire form. 2. 3. MassDEP staff contacted: Date/Time contacted: EPA staff contacted: Date/Time EPA contacted: Board of Health contacted. Date/Time contacted: Kurt Are name 12/18/2014 Dab G�eo/ e first manna 12/182014 Dab Merridith First Nana 12/19/2014 Deb MA0101818 Pam*a 413-587-1570 Telephone N0. nhuntley©northamptonma.gov E-mail Address Boisjolie last name 4:15 Time Harding lest name 4:19 Time O'Leary Last Nana 4:00 Time ❑am Ei pm ❑am ®Prn 4. Others notified(select all that apply); ❑Conservation Commission ❑ Harbormaster ❑ Shellfish Warden ❑ Division of Marine Fisheries ❑ Downstream Drinking Water Supplier ❑ Watershed Association ❑ Beach Resource Manager ❑Other: ❑am 21 pm (Nisch) ❑ C. SSO Information 55O Discovered: By: Passerby 2. SSO Stopped: 12/18/2014 Dab 1:10 Time 0 a El pm 12/182014 2:03 Date Tine 3. SSO Discharge from: ® Sanitary Sewer Manhole ❑ Pump Station ❑ Backup into Property Other. (wry) ❑am pm 4. SSO Discharge to: ❑ Ground Surface(no release to surface water) ❑ Direct to Receiving Water ❑ Catch basin to Receiving Water ❑ Backup into Property Basement Bradford St Pump SSO_20141218 docx•rev.01/2013 (surface water) Market Street Brook, Historic MN River (surface water) Wastewater Overfoweypass or Sewage Backup Notification•Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Watershed Permitting Program Sanitary Sewer Overflow (SSO)IBypass Notification Form FOR DEP USE ONLY Tax Identlfxation Number C. SSO Information (cont.) Sewer Manhole north of the Bradford Street Pumping Station(42-19-46, 72-37-55) Location: (Description of discharge sits or closest address) 5. Estimated SSO Volume at time of this Report 200-500 gallons Visual inspection and estimation of flow and Method of Estimating Volume: timing of pump station failure 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 (SWAM 7. Corrective Actions Taken: Pump Station switched to direct power and pumps started Impact Area cleaned and/or disinfected: ® Yes ❑ No Surface area treated with tyme Corrective Actions Completed: ® Yes ❑ No Pump Station batteries replaced D. Comments/Attachments/Follow-up I wish to provide(select all that apply): ® Attachment ❑ Additional comments Sax: ❑ No additional comments or attachments Additional comments and planned actions: Bradford St Purtp_SSO_20141218.doa•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)IBypass Notification Form FOR DEP USE ONLY Tax kbntifxabon 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. ..,.s �� ravres R• �IVsr'sL►l rs fr_I'J -nature of A etl ReprasentaWa ab 4� lease kee 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 Bradford St Pump_SSO 20141218.docx•rev.01 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 013 Wastewater Overflow/Bypass or Sewage Backup Notification•Page 3 of