text
hAC Perne Egg U.S. 88UCLEha REGULAT30tY -
N APPROVE') Case esO.3190 4 104 LICENSEE EVENT REPORT (LER)
*"'8''**
PAC 8LITY NAase (18 OOCmET NuesBER m PA51s 7 Pilgrim Nuclear Power Station Unit No. 1 0 l5 t o l0 l0l2 l9l 3 i lorl 0 l2 Unplanned Reactor Scram on Low Water Level Due to Operator Error EVENT OATE (54 LER NuesgER (g)
REPOftf OATE (73 OTHER FACILITIES eNVOLVEO IS)
MONTM QAY YEAR YEAR
.- 8Ehu a'
MONTH OAV VEAR PAO uTVusAuss DOCEST psUMGE4dS) 0 15101010 1 I I 0l 1 0l 6 8 6
8l 6 0l 0 l1 0l0 0l 2 0l4 8l6 0 1 510 1 0 1 0 1 1 I TMIG REPORT 88 SugedlTTED PUROUANT TO THE REQUIREasENTS OP 10 CPR 9 (Chece e.e er more.# sne 4aewsasi (11)
OPE RATits0 MOOS m N
mm mw X
se.nwmei.e n.is m 30.asswoHo so.mwm es.nwmw 7:mw y
0i1i0 m wmm
.0.mwm mTa>oH.
=Rg,gg 30.4084aH1HWI 90.73teH2HG 08.73deH2HomHA8 JsEAJ 30.easWf1HM 30.73as)GHal 90.734sH3Hv4Hel s
meesteHilw 30.73tsimim)
SS.73telGHal LICENSEE CO887ACT POR TMt8 LER (13)
NAME TELEPHONE NUMSER Paul.I.
Hamilton - Sr. Plant Engineer AaEA COOE 6llg7 7 g 4; 6; i 7 9;0l0 1
COMPLETE ONE LINE POR EACH COnpOseENT PAILURE OGSCR8DEO tes THIS RSPOftf Ital "A
R U
T DS
CAUSE
$ STEM COMPONENT Ay' f
CALSE SYSTEM CC,MPON E NT yy JM i
l I I I i I i
i i i l i I l
I I I I I I I
I I I I I I M
OUPPLEheENTAL REPORT EXPECTEO 114 asOseTM OAV YgAR su.M, O
G vtS rio P a.,o., uxpecreo svouission oArts
'K] r.O l
l l
As. TRACT ru.o.,.w a.
.-P R
,P, o.>
On 1/6/DF, an unplanned reactor scram occurred during plant startup. The scram ww the result of a low reactor water level which was being controlled
, manually when the event occurred.
Cause of the event was due to licensed operator error.
The error occurred
< when the operator did not take the prompt action required to restore level.
Corrective action was to counsel personnel and submit a request to engineering to evaluate the feasibility of modifying the level control. system.
A previous event is discussed in LER 85-014.
~
l 4
l l
8602130059 860204 PDR ADOCK 05000293 S
PDR I
l 8\\
.RC P._
ILc43)
L
esac form 3964
- JP U S. IsUCLEAT Katut& TORT Cosensissions LICENSEE EVENT REPORT (LER) TEXT CCNTINUATION u*aovEo ove =o siso-oio.
ERP1RES 8/3145 l
FACILITY esAast Hi DOCKtT souhaBER ul PAGE13e gga,sunaean 1e3
.. ov. m.o Pilgrim Nuclear Power Station Unit No, I o l5 lc l0 lo [2 l 9 l3 8l 6 0[0l1 0 l0' 0l2 OF 0 l2 ran n
.p e r asiaw nn On 1/6/86 at 1959 hours0.0227 days <br />0.544 hours <br />0.00324 weeks <br />7.453995e-4 months <br /> an unplanned reactor scram occurred from approximately 10% power during plant startup. The scram was the result of a low reactor water level which was being controlled manually at the time of the event.
When the scram occurred,.the turbine was off line, reactor pressure was approximately 930 psig and the modo switch was in the "run" position.
Cause of this event was utility licensed operator error. - The error occurred
.just prior to placing the feedwater regulating valves in service. -At the time of the event, power level was approximately 10% steady state, water level being controlled with the startup regulating valve, and the water level was L
decreasing. The scram occurred when the operator did not open the downstream block valves and place a feedwater regulating valve in service in the prompt nanner necessary to restore level. During the event water level was fluctuating as it normally does when at reduced steaming rates.
Corrective action was to counsel Operations personnel with regard to the event.
Planned long term corrective action is to consider modifying the startup feedwater regulating system for automatic operation (Ref. ESR 86-013).
In addition, a new plant specific simulator is currently under cc otruction and when completed is expected to contribute to reducing the possibility of a similar occurrence.
l There were no equipment failures associated with this event and the scram sequence was normal. On 1/7/86, at 1027 hours0.0119 days <br />0.285 hours <br />0.0017 weeks <br />3.907735e-4 months <br /> the generator was synchronized to the grid.
j A previous scram that occurred while manually controlling water level is l
discussed in LER 85-014.
33....
m
.=
EOSTON EDISON COMPANY 500 CovLsTON STREET 50sTON, MAssAcMuBKTT5 02199 WILLIAM D. HARR8NGTO N cc.6 4.
February 4, 1986 BECo Ltr. #86- 010 Document Control Desk U. S. Nuclear Regulatory Commission
- - Washington, D.C.
20555 Docket Number-License No. DPR-35
Dear Sir:
The attached-Licensee Event Report 86-001-00, " Unplanned Reactor Scram on Low Water Level Due to Operator Error", is hereby submitted in accordance with the requirements of IOCFR50.73.
If there are any questions on this subject, please do not hesitate to contact me.
Respectfully submitted, W. D. Harrington PJH/keo
- - Enclosure:
LER 86-001 cc:
Dr. Thomas E. Murley Regional Administrator, Region I U.S. Nuclear Regulatory Commission 631 Park Avenue King of Prussia, PA 19406 Standard DECO LER Distribution
|
|---|
|
|
| | | Reporting criterion |
|---|
| 05000293/LER-1986-001, :on 860106,unplanned Reactor Scram Occurred During Plant Startup Due to Low Reactor Water Level Being Controlled Manually.Caused by Operator Error.Personnel Counseled & Evaluation Initiated |
- on 860106,unplanned Reactor Scram Occurred During Plant Startup Due to Low Reactor Water Level Being Controlled Manually.Caused by Operator Error.Personnel Counseled & Evaluation Initiated
| | | 05000293/LER-1986-003, :on 860211,480 Volt safety-related Bus B-20 Inadvertently Deenergized During Electrical Maint on nonsafety-related Cable.Caused by Mgt Deficiency.Cable Repaired.Temporary Mod Procedure Implemented |
- on 860211,480 Volt safety-related Bus B-20 Inadvertently Deenergized During Electrical Maint on nonsafety-related Cable.Caused by Mgt Deficiency.Cable Repaired.Temporary Mod Procedure Implemented
| | | 05000293/LER-1986-004, :on 860220,standby Liquid Control Sys Declared Potentially Inoperable.Caused by Personnel Error When Surveillance Procedure Not Followed.Personnel Counseled |
- on 860220,standby Liquid Control Sys Declared Potentially Inoperable.Caused by Personnel Error When Surveillance Procedure Not Followed.Personnel Counseled
| | | 05000293/LER-1986-005, :on 860307,operator Discovered Water on Floor in Torus Room.Caused by Leak Resulting from Entrapped Air in RHR Sys.Head Spray Piping Cut & Capped.Procedures Revised to Provide Filling & Venting Instructions |
- on 860307,operator Discovered Water on Floor in Torus Room.Caused by Leak Resulting from Entrapped Air in RHR Sys.Head Spray Piping Cut & Capped.Procedures Revised to Provide Filling & Venting Instructions
| | | 05000293/LER-1986-006, :on 860316,reactor Shut Down Due to Increase in Drywell Leakage.Caused by Cracked Weld at Reducing Coupling That Joins Reactor Water Instrument Line to Reactor Vessel Penetration N-16A.Piping Repaired |
- on 860316,reactor Shut Down Due to Increase in Drywell Leakage.Caused by Cracked Weld at Reducing Coupling That Joins Reactor Water Instrument Line to Reactor Vessel Penetration N-16A.Piping Repaired
| | | 05000293/LER-1986-007, :on 860322,unplanned Isolation of Primary Containment Isolation Sys Occurred Resulting in Closure of Eight MSIVs & Main Steam Inboard Drain Valve.Caused by Loose Electrical Neutral Connections on Logic Relays |
- on 860322,unplanned Isolation of Primary Containment Isolation Sys Occurred Resulting in Closure of Eight MSIVs & Main Steam Inboard Drain Valve.Caused by Loose Electrical Neutral Connections on Logic Relays
| 10 CFR 50.73(a)(2)(iv), System Actuation | | 05000293/LER-1986-008, :on 860404,main Steam Line Isolation Automatic Closure Initiated Reactor Scram.Cause Under Investigation. Reactor Shut Down Pending Determination of Cause |
- on 860404,main Steam Line Isolation Automatic Closure Initiated Reactor Scram.Cause Under Investigation. Reactor Shut Down Pending Determination of Cause
| | | 05000293/LER-1986-009, :on 860411,leakage Indicated Through 1001-68B Check Valve & in-series Containment Isolation Valves MO-1001-28B & MO-1001-29B.Caused by Degradation of One Containment Isolation Valve & RHR Seating |
- on 860411,leakage Indicated Through 1001-68B Check Valve & in-series Containment Isolation Valves MO-1001-28B & MO-1001-29B.Caused by Degradation of One Containment Isolation Valve & RHR Seating
| 10 CFR 50.73(a)(2)(i)(A), Completion of TS Shutdown 10 CFR 50.73(a)(2)(1) | | 05000293/LER-1986-010, :on 860415,unplanned Isolation of Primary Containment Isolation Sys Occurred Resulting in Closure of Eight MSIVs & Main Steam Outboard Drain Drive.Root Cause Undetermined.Loose Connections Reworked |
- on 860415,unplanned Isolation of Primary Containment Isolation Sys Occurred Resulting in Closure of Eight MSIVs & Main Steam Outboard Drain Drive.Root Cause Undetermined.Loose Connections Reworked
| 10 CFR 50.73(a)(2)(iv), System Actuation | | 05000293/LER-1986-011, :on 860419,during Local Leak Rate Testing of Msiv,Five Atwood & Morrill Y-Pattern,20-inch,Model 20849-H MSIVs Discovered to Have Leakage in Excess of Tech Spec 4.7.A.2 Requirements |
- on 860419,during Local Leak Rate Testing of Msiv,Five Atwood & Morrill Y-Pattern,20-inch,Model 20849-H MSIVs Discovered to Have Leakage in Excess of Tech Spec 4.7.A.2 Requirements
| | | 05000293/LER-1986-012, :on 860516,determined That Once/Cycle Automatic Actuation Test of HPCI Does Not Meet Full Intent of Tech Spec 4.5.C.1.a.Caused by Insufficient Tech Spec Implementing Procedures.Procedures Will Be Revised |
- on 860516,determined That Once/Cycle Automatic Actuation Test of HPCI Does Not Meet Full Intent of Tech Spec 4.5.C.1.a.Caused by Insufficient Tech Spec Implementing Procedures.Procedures Will Be Revised
| | | 05000239/LER-1986-013, :on 860530,determined That LER Should Have Been Submitted in Mar 1984 Due to Operation W/Ge Nonseismically Qualified Emergency Diesel Generator Differential Protection Relays.Relay Tripped on 860426.Relays Replaced |
- on 860530,determined That LER Should Have Been Submitted in Mar 1984 Due to Operation W/Ge Nonseismically Qualified Emergency Diesel Generator Differential Protection Relays.Relay Tripped on 860426.Relays Replaced
| | | 05000293/LER-1986-013, :on 860530,discovered That LER for 840227 Discovery of Installation of Seismically Unqualified GE Cfd Relays for Diesel Generator Differential Protection Had Not Been Submitted.Relays Tripped on 860426 |
- on 860530,discovered That LER for 840227 Discovery of Installation of Seismically Unqualified GE Cfd Relays for Diesel Generator Differential Protection Had Not Been Submitted.Relays Tripped on 860426
| | | 05000293/LER-1986-014, :on 860610,once/cycle Simulated Automatic Actuation Test of RCIC Sys Found Inadequate.Caused by Insufficient Tech Spec Implementing Procedures.New Procedure Developed to Test Wiring |
- on 860610,once/cycle Simulated Automatic Actuation Test of RCIC Sys Found Inadequate.Caused by Insufficient Tech Spec Implementing Procedures.New Procedure Developed to Test Wiring
| | | 05000293/LER-1986-017, :on 860701,as-found Test Results for 18-inch Anchor Darling Feedwater Check Valves Showed Leakage in Excess of Tech Specs.Caused by Thermal Aging & Erosion of Soft Seat Matl.Hinge Pins Replaced |
- on 860701,as-found Test Results for 18-inch Anchor Darling Feedwater Check Valves Showed Leakage in Excess of Tech Specs.Caused by Thermal Aging & Erosion of Soft Seat Matl.Hinge Pins Replaced
| 10 CFR 50.73(a)(2)(i) | | 05000293/LER-1986-018, :on 860629,GE Akf Model 25 Field Breaker Failed to Trip Automatically.Similar Events Occurred on 830213, 850209 & 0315.Util Investigating for Cause.Corrective Actions Will Be Completed Prior to Startup |
- on 860629,GE Akf Model 25 Field Breaker Failed to Trip Automatically.Similar Events Occurred on 830213, 850209 & 0315.Util Investigating for Cause.Corrective Actions Will Be Completed Prior to Startup
| | | 05000293/LER-1986-019, :on 860715,recirculation Pump Trip Sys & Alternate Rod Insertion Sys Declared Inoperable Due to Insufficient Monthly ATWS Surveillance Procedure.Caused by Tech Spec Change.Tech Spec Revised |
- on 860715,recirculation Pump Trip Sys & Alternate Rod Insertion Sys Declared Inoperable Due to Insufficient Monthly ATWS Surveillance Procedure.Caused by Tech Spec Change.Tech Spec Revised
| | | 05000293/LER-1986-020, :on 860820,identified That South Wall of Switchgear Room Not Listed in Procedure 8.B.16.13.Caused by Failure to Identify Barrier Required to Meet 10CFR50,App R, in Site Surveillance Procedures.Actions Taken |
- on 860820,identified That South Wall of Switchgear Room Not Listed in Procedure 8.B.16.13.Caused by Failure to Identify Barrier Required to Meet 10CFR50,App R, in Site Surveillance Procedures.Actions Taken
| 10 CFR 50.73(a)(2)(1) | | 05000293/LER-1986-022, :on 860829,failure to Leak Check Radioactive Source at Required Interval Discovered.Caused by Failure to Modify Master Surveillance Tracking Program (Mstp) to Note Proper Check Responsibility.Mstp Revised |
- on 860829,failure to Leak Check Radioactive Source at Required Interval Discovered.Caused by Failure to Modify Master Surveillance Tracking Program (Mstp) to Note Proper Check Responsibility.Mstp Revised
| | | 05000293/LER-1986-023, :on 860912,mgt Review of Posted Fire Watches Identified Continuous Fire Watch Not Posted as Ordered on 860905.On 861001,17 Discrepancies Identified Where Hourly Patrols Not Documented |
- on 860912,mgt Review of Posted Fire Watches Identified Continuous Fire Watch Not Posted as Ordered on 860905.On 861001,17 Discrepancies Identified Where Hourly Patrols Not Documented
| | | 05000293/LER-1986-024, :on 861007,nonfire Resistant Coated Structural Steel Observed Embedded in Concrete Wall on North Side of Cable Spreading Room.Fire Watch Established.Options for 3-h Fire Rating Being Evaluated |
- on 861007,nonfire Resistant Coated Structural Steel Observed Embedded in Concrete Wall on North Side of Cable Spreading Room.Fire Watch Established.Options for 3-h Fire Rating Being Evaluated
| | | 05000293/LER-1986-025, :on 861111,fire Water Suppression Sys Found to Be Inoperable.Caused by Misalignment of Fire Pump Suction Valves Due to Diagram,Procedure & Labeling Errors.Fire Pump Restored.Procedures & Diagrams Corrected |
- on 861111,fire Water Suppression Sys Found to Be Inoperable.Caused by Misalignment of Fire Pump Suction Valves Due to Diagram,Procedure & Labeling Errors.Fire Pump Restored.Procedures & Diagrams Corrected
| | | 05000293/LER-1986-026, :on 861029,QA Audit Identified That Surveillances Required by Tech Spec Tables 4.2.D,Note 6 & 4.8-2 Not Procedurally Addressed.Caused by Lack of Verifications in Administrative Controls |
- on 861029,QA Audit Identified That Surveillances Required by Tech Spec Tables 4.2.D,Note 6 & 4.8-2 Not Procedurally Addressed.Caused by Lack of Verifications in Administrative Controls
| | | 05000293/LER-1986-027, :on 861119,plant Experienced Loss of Offsite Power During Severe Winter Storm.Caused by Arcing of High Voltage Lines Due to Heavy Ice & Snow.All Safety Sys Performed as Expected |
- on 861119,plant Experienced Loss of Offsite Power During Severe Winter Storm.Caused by Arcing of High Voltage Lines Due to Heavy Ice & Snow.All Safety Sys Performed as Expected
| |
|