24-Hour and Five Days Sanitary Sewer Overflow Report

NPDES Enforcement Section

Water Division

Craig Uyeda, Enforcement Branch Manager - (501) 682-0640

Instructions For Using the 24-Hour and Five Days Sanitary Sewer Overflow Report

After the overflow is detected, the online form below must be submitted within 24 hours.

Note: An * indicates a Required Field.

SSO   Bypass (*You must check at least one of these)      
*Facility Permit Number:     *Facility name:
*Date Overflow Began:
(mm/dd/yyyy)
     *Time:
(hh:mm am/pm)
Date Overflow Ended:
(mm/dd/yyyy)
     Time:
(hh:mm am/pm)
Location:
  (Give address, manhole number-if numbered. Include where the overflow went-yard, ditch, stream, storm sewer, building, other).
  Type of Overflow         Cause of Overflow  
() Manhole Overflow       () I & I – Rainfall  
() Lift Station Overflow       () Roots  
() Main Line Overflow       () Grease  
() Service Line Overflow       () Debris  
() Other Overflow Type:     () Equipment Failure  
    (Enter overflow type if not listed)     () Construction  
    () Vandalism  
Volume:     () Power Failure  
  (Give an estimate in gallons)     () Line Failure/Break  
    () Other Cause:
Impact of SSO Event:         (enter cause if not listed)
               
 
Action Taken – Check all that apply
(Short term and long-term action, including clean-up and any plans to remediate I & I).
() Machine rodded     () Disinfected and Deodorized
() Jet-Vac     () Hydro Cleaned
() Hand rodded     () Spread Lime on Affected Area
() Used Generator To Power Pumps/Equipment     () Public Notification
() Other: Describe      
 
Environmental Damage
() OEHC – Observed or Evidence of Human Contact   () NEAH – No Evidence of Adverse Health/Environmental Impact
() OEEI – Observed or Evidence of Environmental Impact   () EFK – Evidence of Fish Kill
 
Reported By Title Telephone Number xxx xxx-xxxx
Additional Comments
if Needed:

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.

  

NOTE:  Click "Submit Now" only ONCE.
It might take 15-30 Seconds to process your information. Thank you!