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Behind 111 SSO 2016 rnt:When it forms Amputee y the tab nove your do not return EP ral Office one and mbers at d of this Massachusetts Department of Environmental Protection NA // Bureau of Resource Protection —Watershed Permitting Program FOR DEP USE ONLY Sanitary Sewer Overflow (SSO)/Bypass Notification Form e Tax Identification Number A. Reporting Facility 1. Facility Information Northampton Department of Public Works Reporting Sewer Authority 2. Authorized Representative Transmitting Form. Donna LaScaleia First Name Last Name Director of Public Works Title MA101818 Permit# (413) 587-1570 Telephone No. Stonm a.gov E-mail Address B. Phone Notifications: 1. MassOEP staff contacted: Date/Time contacted: 2. EPA staff contacted: Date/Time EPA contacted: 3 Board of Health contacted: Date/Time contacted: Paul first name 10-25-2016 Date George first name 10-25-2016 Date Meredith F'rst Name 10-25-2016 Date Nietupski last name 11:25 Time Hardin last name 12:10 lam ❑pm Time O'Leary Last Name 12:20 Time 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 ❑am pm pm (specify) C. SSO Information 1. SSO Discovered: Call from owner. By: 2. SSO Stopped: 3. SSO Discharge from: 13 10/24/2016 10:00 Date Time I] am ❑pm 10-24-2016 10:45 Date Time Sanitary Sewer Manhole ❑ Pump Station ❑ Backup into Property ❑ Other. am ❑Om (specify) 4. SSO Discharge to: ❑ Ground Surface(no release to surface water) ❑ Direct to Receiving Water Catch basin to Receiving Water (surface water) Barrett Street Marsh (surface water) ❑ Backup into Property Basement :oform•rev.01)2013 Wastewater Overflow/Bypass or Sewage Backup Notification•Page 1 of 3 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.) Behind 111 Franklin Street (Description of discharge site or closest address) Location: 5. Estimated SSO Volume at time of this Report: Method of Estimating Volume: 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 unknown ❑ Other: (Specify) 7. Corrective Actions Taken. Franklin St Sewer Main was obstructed with roots. Overflow relieved by Jet rodding. Impact Area cleaned and/or disinfected: ❑ Yes IJ No Impact area is in the process of being cleaned. Corrective Actions Completed: ❑ Yes ® No We are in the process of TV Inspection of sewer conduits to determine system extents and to determine proper course of action. Historic Overflow to be plugged. D. Comments/Attachments/Follow-up I wish to provide(select all that apply): Attachment ❑ Additional comments below: ❑ No additional comments or attachments Additional comments and planned actions: Historic Overflow discovered because of sewer main blockage in Franklin Street. Actual route of wastewater from overfow in sewer main to drainage system unknown. oform•rev.01/2013 Overflow structure to be plugged. Wastewater Overgow/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 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 then-.areSrg cant penalties for submitting false information,including the possibility of fine andir•�(-'•dment •rk wing violations. Please-a re keep p a copy Rofrthis repe Please keep a copy of this report for your records.When submitting additional information, include the MassDEP Incident Number from this report. FOR DEP USE ONLY Tax Identification Number JO )(/ Dae SIg ed MassDEP Regional Office and EPA Telephone and Fax Numbers: Northeast Region Southeast Region Central Region Western Region EPA Contact DEP 24-hour emergency 'sofonn•rev.0112013 Phone: 978-694-3215 Phone; 508-946-2750 Phone: 508-792-7650 Phone: 413 484-1100 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 Wastewater Overttw/BYPass or Sewage Backup Notification•Page 3 of 3 .°Ntg cm, " 9c .. wow • • se • • • 0 • • • • • r t • Oa i 4 • y u • S • ' • • • d 414.414..*0 •• • • Location of overflow entering drainage system Location of Overflow from Sewer Systen Manhole, to be plugged BCity of Northampton Public Works Sanitary Sewer Overflow Incident 10/2412016 Behind 111 Franklin St Northampton, A • era eh by �p 1J4�/s�ij