05000423/FIN-2014008-02
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Finding | |
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Title | Failure to Identify and Promptly Correct a Condition Adverse to Quality |
Description | The inspection team identified a self-revealing apparent violation of Title 10 of the Code of Federal Regulations (10 CFR) 50, Appendix B, Criterion XVI, Corrective Action, involving Dominions failure to promptly identify and correct a condition adverse to quality. Specifically, the Unit 3 turbine-driven auxiliary feedwater (TDAFW) pump was operated from May 2013 through February 2014 in an adverse configuration due to the installation of an incorrect cam follower bearing. As a result of this adverse configuration, the pump experienced three overspeed trips during the subject timeframe. As a consequence, Dominion violated Technical Specification (TS) 3.7.1.2, since TDAFW was determined to be either failed or unreliable for greater than the TS allowed outage time. Dominion installed the correct cam follower, entered this issue in their corrective action program (CAP) as condition report (CR) 538743 and CR 531536, and completed a root cause evaluation (RCE) (RCE 001111). The issue was determined to be more than minor since it was associated with the equipment performance attribute of the Mitigating Systems cornerstone and adversely affected its objective to ensure the availability, reliability, and capability of systems that respond to initiating events to prevent undesirable consequences. Specifically, operation of the TDAFW pump with the incorrect spherical bearing reduced the reliability of a risksignificant, safety-related mitigating system. The issue was evaluated in accordance with IMC 0609, Appendix A, Exhibit 2, and was determined to require a detailed risk evaluation based on the finding representing an actual loss of function of a single train for greater than its TS allowed outage time. The detailed risk evaluation concluded that the increase in core damage frequency of this issue is in the mid to high E-6 range, or White (low to moderate safety significance). The dominant core damage sequences involved fire scenarios resulting in control room abandonment that rely upon the TDAFW pump as the primary source of make-up to the steam generators and decay heat removal. This finding had a cross-cutting aspect in Human Performance, Consistent Process, where individuals use a consistent, systematic approach to make decisions and risk insights are incorporated as appropriate. Specifically, Dominion did not implement consistent, systematic approaches to resolve the condition as evidenced by their inadequate and inconsistent use of CAP and troubleshooting. |
Site: | Millstone |
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Report | IR 05000423/2014008 Section 4OA5 |
Date counted | Sep 30, 2014 (2014Q3) |
Type: | AV: White |
cornerstone | Mitigating Systems |
Identified by: | Self-revealing |
Inspection Procedure: | IP 93812 |
Inspectors (proximate) | F Arner H Nieh M Chambers P Finney W Cook |
Violation of: | Pending |
CCA | H.13, Consistent Process |
INPO aspect | DM.1 |
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Finding - Millstone - IR 05000423/2014008 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Millstone) @ 2014Q3
Self-Identified List (Millstone)
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