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<br />Part 4: v'/ERFLOI•!S ni~0 QYP„SS~S <br /> <br />~+. !1) List the number of tines in the last year there -•~as an overflow, <br />bypass, or unperr~itted discharge of untreated or incompletely <br />treated wastewater due to heavy rain or snowmelt: 21 <br />(Circle One} 0 = 0 points; 1 = 5 poin s• 2 = 10 points; <br />3 = 15 points; 4 = 30 points; ~ or more_ 50 points <br />(2} List the number of bypasses, overflows, or unpermitted discharges <br />shown in A (1} that were within the collection system and the <br />number at the treatment plant. <br />Collection System 21 Treatment Plant n <br />B. (1) List the number of times in the last year there was a bypass or <br />overflow of untreated or incompletely treated wastewater due to <br />equipment failure, either at the treatment plant or due to pumping <br />problems in the collection system: O <br />(Circle One) _ 1 = 5 points; 2 = 10 points; <br />3 = 15 points; 4 = 30 points; 5 or more = 50 points <br />(2) List the number of bypasses or overflows shown in 6 (1) that were <br />within the collection system and the number at the treatment <br />plant. <br />Collection System 0 Treatment Plant O <br />C. Specify whether the bypasses came from the city or village sewer system <br />or from contract or tributary communities/sanitary districts, etc. <br />CITY <br />D. Add the point values circled for A and~6 and place the •t tal=in•the box <br />below. <br />TOTAL POINT VALUE FOR PART 4 I SO <br />Enter this value on the point calculation table on the list page. <br />E. List the person responsible for reporting overflows, bypasses or <br />unpermitted discharges to State and Federal authorities: <br />CURTIS HERROD tITT1.rTY SiTPFRTNTFNDFl`T X713) 471-965n <br />Flame Title Telephone Number <br />Describe the procedure for gathering, compiling, and reporting: <br />3IISTiAT. nRSRRVATTnN FRnM FTFTn PERSONNEL AND REPORTS FROM THE PUBLIC <br />9 <br />