IR 05000245/1977033

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IE Insp Rept 50-245/77-33 on 771213-16 & 22-23.No Noncompliance Noted.Major Areas inspected:771213 Offgas Explosions,Including Probable Cause,Corrective Actions, Emergency Plan Implementation & Radiological Assessments
ML20028C444
Person / Time
Site: 05000000, Millstone
Issue date: 01/16/1978
From: Kottan J, Mccabe E, Shedlosky J
NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I)
To:
Shared Package
ML20027A594 List: ... further results
References
FOIA-82-545 50-245-77-33, NUDOCS 8301100169
Download: ML20028C444 (34)


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'U.S.' NUCLEAR REGULATORY COMMISSION

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OFFICE OF INSPECTION AND ENFORCEMENT.

Region.I-

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Report No.

50-245/77-33

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Docket No.

50-245 a

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License No..

DPR-21 Priority

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Category C

Licensee:

Northeast Nuclear Enerav Comnany i

P. O. Box 270

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Hartford,- Connecticut 06101

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Facil.ity Name:

- Millstone Nuclear Power Station, Unit 1 -

Inspection at:

Waterford, Connecticut Inspection conducted:

De ember 13-6 'and' 22-23,1977 i

Inspectors: N

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[T. Shedipygeact[ Inspector date signed

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J. J. Kott'an', Iadiation Specialist fa td/ signed

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McCaho.

.h-. Chiof. Roactnr Projects

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tions N. 2, R0&NS Branch date signed 16 [7 R

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Approved by:

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E. C. McCabe, Jr., Ch'i'ef, Reactor Projects

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/ date signed Section No. 2, RO&NS Branch

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l Inspection Summary:

Inspection on December 13-16 and 22-23,1977 (Report No. 50-245/77-33)_

Areas Inspected:

Special, unannounced inspection concerning two off gas ex-plosions on December 13, 1977, including: the probable cause of the explosions; the corrective actions following the explosions; independent inspections of equipment, structures, piping and instrumentation; emergency plan implementa-tion; radiological as~sessments; and measures to prevent reoccurrence.

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inspection involved 78 man-hours on site by two NRC inspectors and a supervisor Resul ts : No items of noncompliance were identified in the 6 areas inspected.

A letter to Northeast Nuclear Energy Company, dated December 14, 1977, docu-

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mented an understanding with the NRC that limits would be placed upon plant operation. - Following review and inspection of ' modifications and repairs,

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an NRC letter. concurring with resumption of power operations was issued the licensee on December 23, 1977.

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4 Region -I Form 12 (Rev. April-77)

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1 8301100169 821207 POR FOIA

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HIATT82-545 PDR

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OETAILS

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1.

Persons Contacted The below listed technical and supervisory level licensee personnel were contacted:

Mr. P. Callaghan, Maintenance Supervisor Mr. P. Collopy, Health Physics Supervisor Mr. E. C. Farrell, Unit 2 Superintendent

  • Mr. E. J. Ferland, Plant Superintendent
  • Mr. E.. R. Foster, Unit 1 Superintendent Mr. J. Franks, Plant Equipment Operator Mr. L. Gray, Radiation Physicist, Lawrence and Memorial Hospital Mr. R. Herbert, Operations Supervisor Mr. R. Johnson, Day Shift Supervisor Mr. G. A. Kanakaris, Assistant Chief Engineer, Civil Engineering, Ebasce Services, Inc.

Mr. R. Kramer, Shift Supervisor Dr'. R. Lapp, Consultant Mr. J. McHugh, Chemistry Supervisor Mr. E. J. Mroczka, Station Services Superintendent Mr. J. Howell, Shift Supervisor Mr. J. F. Opeka, Assistant Station Superintendent

Mr. P. Przekop, Engineer

  • Mr. W. Romberg, Senior Engineer Mr. W. Rotherfort, Senior Civil Engineer, NUSCO Mr. C. Shine, Shift Supervisor

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Mr. R. Smart, Generation Civil Engineer, NUSCO Mr. F. Teeple, Instrument and Control Supervisor

  • present at exit interview.

Other Persons Contacted Mr. D. Cook, Chief Investigator, Environment, Energy and Natural Resources Subcommittee, Government Operations Committee, U.S.

House of Representatives Mr. H. Levin, Staff Engineer, Engineering Branch Of fice of Muclear Reactor Regulation, USNRC

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Mr. D. H. Jaffe, Licensing Project Manager, Office of Nuclear j

Reactor Regulation, USNRC

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2.

Event Summary

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The following seq'uence of events on December 13, 1977 was con-structed from NRC and licensee records and information.

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0930 At 89% power, a minor explosion occurred in the Off Gas System.

This blew the sealing water out of the system's drain line loop seals.

A Local Emergency was declared because of airborne radiation in the reactor and turbine buildings.

1000 The Off Gas System Loop Seals (which act as system gas traps) were refilled in the reactor building and the plant vent stack.

1200 NUSCO Systems Communications Office began calling local and state officials to notify them of the minor explosion.

1220 Stack radiation monitors were declared in.perable due to high background levels.

Normal plant shutdown (

began in accordance with Technical Specification 3.8.A.4.

1255 Licensee informed NRC Region I about the initial explosion.

1300 With reactor power reducdd to about 30%, a second and disruptive off gas explosion occurred in the base of the plant vent stack, which damaged the stack structure.

One man was injured.

1301 The reactor was manually scrammed.

1308 A Site Emergency was declared.

1323 Injured man departed site in an ambulance.

i 1330 NRC Region I placed a phone call to the site and was informed about the second and disruptive explosion.

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1345 NRC Region I informed the State of Connecticut

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Director of Radiation Control about the explosions.

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Licensee informed the Waterford, Connecticut Emergency Center about the Site Emergency.

1400 All personnel on site were accounted for.

1405 Licensee site personnel informed the State of Con-necticut about the Site Emergency.

1611 Decontamination of the injured man was reported complete.

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1635 Radiation hazard area identification and roping off was completed.

1645 Decontamination of personnel on site was completed.

1755 Site Emergency downgraded to local Emergency.

All radiological samples, environmental samples, doses and dose rates were below federal and license limits.

(Sam ling and surveys continued through December 14, 1977.

1835 NRC inspector arrived on site.

1900 Local Emergency secured.

3.

Probable Cause of the Off-Gos Expjosions a.

Initial Explosion

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The Of f Gas System is designed to withstand internal detona-tion of the explosive mixtures of hydrogen and oxygen off gases which it contains.

An improved Off Gas System is under construction consisting primarily of the addition of hydrogen recombiners and charcoal hold-up filters to the present system.

Welding work installing a service air line for the improved Of f Gas System was taking place within several inches of instrument lines of the present Off Gas System.

An arc strike found on those instrument lines was evaluated by the licensee as sufficient to raise an explosive hydrogen and oxygen mixture in the Off Gas System to above its auto-ignition temperature.

The inspector concurred that an arc strike or improperly a

grounded welding equipment could have caused the first explosion.

No other initiating mechanism was identified by the licensee, or by the inspector's physical examination of the Off Gas

System af ter the incident.

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b.

Second and Disruptive Explosion Loop seals in the Off Gas System drain lines serve as barriers

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In the space at the base of the plant vent stack where the second, disruptive explosion occurred, there are two Off Gas Particulate Filters with drains having loop seals.

After the first explosion, personnel were dispatched to refill the loop seals.

A frozan water line impeded that operation, necessitating use of a hose and yard water fixture as a water source.

Off Gas particulate filter differential pressure gages in the Stack Instrument Building, constructed adjacent to the stack, were damaged by the first explosion. The instrument building became a high airborne radiation area due to leakage of off gases from the damaged gages, this further complicated the refilling of loopseal tanks. The source of the airborne radiation was not known until the damaged gages were found on December 14, 1977.

The second and disruptive explosion, which occurred at 1300 hours0.015 days <br />0.361 hours <br />0.00215 weeks <br />4.9465e-4 months <br />, was attributed to leakage of the off gases through the loop seals into the closed space at the base of the plant vent stack, due to failure to re-establish an adequate water seal ('

after the first explosion.

fio other probable cause was identified by the licensee or by flRC inspection and evaluation.

The two level Stack Base Space was a fully enclosed, unventilated space with no installed instrumentation to provide warning of leakage of explosive gases from the Off Gas System.

The probable ignition source for the second and disruptive explosion was i.dentified as electrical ignition by the stack sump pump level switch which was located in the area of the explosion.

4.

Radiological Assessments a.

Individual Injury and Radiation Exposure The individual injured by the blast was walking in the stack area during the course of his duties when the second and disruptive explosion occurred at 1300 hours0.015 days <br />0.361 hours <br />0.00215 weeks <br />4.9465e-4 months <br />.

He was knocked to the ground and suffered a concussion, multiple skin abrasions, and radioactive contamination (primarily Cesium 138).

Decontami-nation and medical treatment were accomplished at Lawrence and Memorial Hospital.

Licensee and hospital procedures for

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contaminated personnel were followed.

Decontamination of the ambulance was accomplished by licensee personnel.

Hospi tal equipment decontamination was accomplished by hospital perscanel.

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The licensee estimate of dose received by the injured man was less than 60 mrem whole body and less than 323 mrem to the skin.

Inspector review of the individual's radiation exposure history confirmed that federal radiation exposure limits for the individual were not exceeded.

Because of the concussion, the injured man was retained for observation by the hospital and released on December 17, 1977.

He was temporarily released from the hospital on December 14

for whole body counting by the licensee.

That analysis showed that he had retained no contamination from the incident.

No noncompliances or unsatisfactory conditions were identified in the evaluation and treatment of the injured man.

b.

Other Radiation Exposures

The licensee estimated a maximum radiation exposure to the ambulance driver and attendant.

That exposure was due to contamination on the injured man and his clothing.

Radiation readings indicated a dose rate of about 60 mrem /hr one foot from the individual's trunk.

Although it took only 22 minutes

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to deliver the man to the hospital and return, the licensee estimated the maximum exposure to ambulance personnel to be 60 mrem whole body.

Maximum exposure of hospital personnel was 40 mrem.

This was based on TLD (Thermo - Luminescent Dosimeter)

readings performed for Lawrence and Memorial Hospital by the

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Electric Boat Division of General Dy'namics.

Dose to other site personnel was evaluated as being between 2 and 100 mrem.

This was primarily due to exposure to radioactive gases and decay products released of the second explosion.

Those people exposed included those aiding the injured man.

These values are all well within federal limits.

No noncompliance or unsatisfactory conditions were identified i

in the. licensee's determination and evaluation of doses to other individuals exposed during the incident.

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c.

. Release Magnitude and local Contamination

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The licensee calculated that the maximum ground level release

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which could have occurred was 54 curies.

That release consisted of a normal mixture of radioactive noble gases and iodine which would otherwise have been discharged from the top of the

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The magnitude of the release was determined by assuming that following the first explosion at 0930 bcurs one half of i

the radioactive off, gases did not go up the stack.

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gases were assumed to have leaked from the Off Gas System-Filter through the filter drain'line and the unfilled loop _ seal

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tank. The off gases were assumed to have remained in the Stack Base Space until released by the'second explosion at 1300 hours0.015 days <br />0.361 hours <br />0.00215 weeks <br />4.9465e-4 months <br />. Measured contamination around the base of the stack ranged from 2000 to 20,000 dpm/100 cm2 about 1 hour1.157407e-5 days <br />2.777778e-4 hours <br />1.653439e-6 weeks <br />3.805e-7 months <br /> af ter the disruptive explosion, with the area near the door exhibiting about a 13 mrem /hr dose rate.

Cesium 138, having a half-life.of 32 minutes, was identified as the contaminant.

The licensee roped off the contaminated area and the con-tamination decayed to below normal background within 6 hours6.944444e-5 days <br />0.00167 hours <br />9.920635e-6 weeks <br />2.283e-6 months <br />.

No noncompliances or unsatisfactory conditions were identified in licensee determination and evaluation of the release magni-tude or local contamination.

d.

Offsite Dosages The licensee calculated the maximum potential radiation ex-posure to an individual at the downwind site boundary to be 0.94 mrem whole body and 6 mrem to the thyroid.

These levels'

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are below federal radiation exposure limits for unrestricted areas.

An environmental TLD (Thermo-Luminescent Dosimeter)

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located onsite in the downwind direction from the stack was retrieved and indicated no exposure above normal background.

That TLD previously was unexposed as it had been changed the morning of December 13, 1977 as part of the routine site environmental monitoring program.' The actual point at which the maximum potential radiation exposure could have occurred was identified ae being in Long Island Sound.

No noncompliances or unsatisfactory conditions were identified in the licensee's determination and evaluation of potential offsite dosages.

5.

Equipment Damage The disruptive explosion at 1300 hours0.015 days <br />0.361 hours <br />0.00215 weeks <br />4.9465e-4 months <br /> caused damage to the enclosed space at the base of the stack.

No reactor protection, core cooling or other safety related equipment is located near the site of the

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explosion.

No safety related equipment was endangered.

The blast i

blew the Stack Base Space door off and into the southeast corner of a warehouse about 200' away.

The door was stopped by a 12" high structural beam which was bent approximately 8" by the impact.

Two ton shield plugs in the Stack Base Space ground level floor above

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the Off Gas System particulate filters were blown out of the floor.

The reinforced concrete ceiling which separated the Stack Base Space from the Stack Chimney was breached and severely damaged, with support beams dislodged and concrete fragments scattered about the Stack Base Space. That rubble caused minor damage to the 4" Off Gas System discharge line. -system isolation valve, and to the filter isolation valve extension rod operators.

Additional minor damage was caused to the 10" gland seal exhaust discharge line, the 12" Standby Gas Treatment System exhaust line, and to a 2" improved Off Gas System return line.

The minor damage did not impair operations of the systems involved.

Slight damage was caused to Plant Exhaust System ductwork and to the exhaust fan.

The Stack Gas Radiation Monitor probe supporting beam was damaged by the blast or by concrete from the ruptured ceiling.

Four vertical hair line cracks were found on the outside of the stack at ground level. They were about 15' to 20' in length.

The licensee evaluated the stack's structural integrity to be adequate.

NRC inspection concurred in that evaluation.

(See Inspection Report 50-245/77-35 for the December 20-21, 1977 period).

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Repairs and Modifications Licensee corrective and preventive actions are described in his December 22, 1977 letter of response to the December 14, 1977 letter from NRC Region I, and in Licensee Event Report LER 77-40/lT dated December 27, 1977.

The inspector verified completion of below listed repairs and modifications, hnd imposition of additional aaministrative controls.

On December 23, 1977 an NRC Region I letter was issued concurring in the resumption of power operations.

a.

Off Gas System particulate filter drain lines in the stack I

base were isolated by removing the drain line isolation valves and installation of blank flanges.

b.

The enclosed space condition was eliminated by removal of the ceiling in the Stack Base Space, establishing an opening to

,I the stack chimney.

c.

A second Stack Base Space door was installed by bolting an

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aluminium plate to an angle iron jamb.

Both doors were sealed.

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The Stack Base doors, stack penetrations, and cracks were leak tested satisfactorily using leak detection fluid.

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Unit i ventilation exhaust ducts to the stack were modified to-discharge a portion of, their flow to the lower level of the Stack Base Space.

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The Off Gas System delay pipe drain in the reactor building was modified by installation of a normally shut valve in the

. loop seal below the normal water level.

(That valve is to be opened periodically to perform the draining' function).

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Off Gas System flow instrument piping in the condensate pump area and particulate filter differential pressure (dP) in-strument piping in the Stack Instrument Building have been color coded and labelled.

(The filter dP instruments will

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normally be~ valved out of service).

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A ventilation blower was installed in the Stack Instrument Building.

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Piping cross ties between the present and improved Off Gas System installations are shut.

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Instrument air is being used to keep the noble gas delay bed in the improved Off Gas System under greater pressure than the present Off Gas System.

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Off Gas flow elements were removed, found satisfactory, and

reinstalled.

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The Steam Jet Air Ejector (SJAE) "A" After-condenser rupture disc was replaced.

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The SJAE "B" After-condenser relief valve was replaced with a sealed bonnet relief valve.

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Pressure drop testing and helium leak testing were used to verify leak tightness of the Off Gas System following repairs and modifications.

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Operating Procedure (0P) 324 A, " Condenser Air Removal System

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(SJAE's)", was' revised (Rev. 7 dated December 23, 1977) to

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address filling of Off Gas and mechanical vacuum pump drain

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line' loop seals and draining of the Off Gas System delay pipe.

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- OP 522, " Detonation in-the Off Gas System", Rev. O dated December 22, 1977, was issued to c~over detonation symptoms, effects, and the procedure for extinquishing combustion of gases in the Off Gas System.

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Other procedures were modified to reflect installation and positioning of modified Off Gas System components.

, No noncompliances or unsatisfactory conditions were identified in t!,e area of repairs, modiffcations, and additional administrative controls.

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Procedure Review The inspector reviewed the following procedures to verify that the

. licensee adhered to them during the incident.

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Health Physics Procedures HPP:924/2924, Rev. 1, dated April 17, 1974 Hospitalization of

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Contaminated Personnel.

HPP:931/2931, Rev. 1, dated April 5, 1974, Monitoring for

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Personnel Contamination.

HPP:932/2932, Rev. 2 dated April 30, 1975, Personnel Decontamination.

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Emergenc_y Plan Procedures

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Appendix B OP501/2501, Rev. 6, dated September 8, 1977, local

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Emergency.

Appendix C OP501/2501, Rev. 6, dated September 8, 1977, Site

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Emergency.

Appendix X OP501/2501, Rev. 6, dated December 30, 1976, First

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Aid, Decontamination, and Evacuation of Exposed and/or Contaminated

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Casualties.

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No noncompliances or unsatisfactory conditions were identified with i

respect to procedure adherence.

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Expanded Ev'ent__ Summary.

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On December 13, 1977, with the reactor operating at 89% power, activities in progress included backwashing of main condensers from

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about 0810 to 0920.

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0930 The west refuel floor radiation monitor alarmed,

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causing reactor. building ventilation isolation'and

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automatic initiation of the Standby Gas Treatment System (SGTS) on the refueling floor.

This was due to work being performed on the refueling floor in the fuel storage pool and was not related to the off-gas detonations.

It did cause a shift from

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normal to emergency exhaust ventilation.

The following alarms and indications led plant staff to the con-clusion that a hydrogen detonation had occurred within the Off Gas System.

Off Gas radiation monitors spiked high (approximately doubled

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from 1.5E+3 mR/hr to 3E+3 mR/hr) and within 20 minutes had returned to their original level.

Stack gas radiation monitors spiked (from 6E+2 cps to lE+3

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cps) and decreased to a lower level (2.3E+2 cps) for 30 minutes before beginning to increase.

They then ramped up to a high

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level (lE+4 cps) and then slowly decreased.

SJAE flow dropped downscale.

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Torus area radiation monitor annunciated on high radiation at 50 mrem /hr.

0935 A local emergency was' declared due to the reactor building radiation alarm.

The reactor building was evacuated and a guard posted at the acces; point.

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Operators, with health physics. personnel assisting, refilled the off gas delay pipe drain line loop seals located in the reactor building.

Personnel were dispatched to refill the off gas filter drain line loop seal tanks located in the plant vent stack. Gas trap loop seals in the reactor building were refilled without problems.

However, upon attempting to refill loop seal tanks in the stack from the. Stack Instrument Building, water did not flow from a fill line.

The line was found frozen


due to failed heat tracing tape.

Operations to fill the loop seal tanks continued using a yard water supply ^and hose originally provided for that purpose.

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1019 The Emergency Control Center was manned.

'1021 The Emergency Duty Officer p'reliminarily classified this occurrence as a Site Emergency.

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1027 Health Physics personnel reported abnormal radiation levels in the reactor building northeast corner room and in the stack instrument room.

1027 Radiation level readings at the site boundary were background.

1030 High airborne radiation on turbine deck.

This was due to a release from a relief valve which was in-stalled on the "B" SJAE after. condenser.

This valve was not a sealed bonnet type.

The valve vents to the off gas delay line.

It had previously been bagged to contain leakage of radioactive gas.

The detonation ruptured the bag.

Conditions were reclassified as a Local Emergency.

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1036 Meterological data - wind blowing from Northeast.

1042 Power reduction to 50% reactor power was begun.

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~1045 Air sample results taken near the meterological tower were 8.8E-6 microcuries per milliliter; with no detectable iodine levdis.

No high airborne levels existed within the reactor building.

1047 Restricted access to the stack area pending radiation survey results.

High background radiation was believed to be causing the high stack radiation readings.

1118 Reactor power at 50%

1130 Control room operators observed that stack radiation levels were returning to nonnal levels.

A temporary seal was placed on the "B" SJAE af ter condenser relief valve.

The Local Emergency and Emergency Control Center were secured.

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1145" Operations personnel entered the Stack Base Space using air breathing units and valved in the standby

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off gas particulate filters and valved out the filter in service.

This was done because it was thought that the 0930 detonation ~may have damaged that filter.

Prior to entering the stack room, radiation levels and hydrogen gas concentrations

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were monitored.

Radiation levels were 8 mrem / hour, but checks resulted in no hydrogen being detected.

After shifting-of Off Gas filters, an increase in stack gas radiation was observed.

1200 The NUSCO Systems Communication Office began noti-fying local and state officials about the first ex-plosion.

1215 Stack gas monitors were purged with little effect on the increasing levels.

1220 Stack Gas monitors were evaluated as inoperable.

Commenced power reduction and reactor shutdown to (

comply with Technical Specification 3.3.A.4 which requires that the reactor be in hot shutdc.in within 10 hours1.157407e-4 days <br />0.00278 hours <br />1.653439e-5 weeks <br />3.805e-6 months <br /> after both stack gas radiation monitors become iroperable.

1255 NRC Region I was notified by the licensee of these

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1300 A second and disruptive explosion occurred in a room I

in the base of the plant vent stack.

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blown from the stack, and a man was knocked down by

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the force of the blast.

i 1301 The reactor was manually scrammed and isolated.

i Cooldown was begun using the isolation condenser.

1303 Waterford police were called for an ambulance.

1304 The Emergency Control Center was manned.

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'1308 Incident classified as a Site Emergency.

1317 Health physics supervisor in charge at the plant s tack.

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1320 Started counting air samples.

1323 Ambulance departed site with injured man.

1323 Monitoring teams started taking downwind surveys.

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1329 Southwest corner of stack reading less than 1.0 mrem /hr.

1330 NRC Region I notified of the second explosion.

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Meterological data: wind 10 mph from 045 (North-east).

1344 Emergency Control Center data plotter started to make notifications specified on call list.

1345 NRC Region I notified the Director of Radiation Con-trol, State of Connecticut, of these events.

1345 Ambulance returned to site for decontamination.

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Doorway at Stack Base Room reading 16 millirem per

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hour.

1359 Licensee informed Waterford Emergency Center about the disruptive explosion.

1400 All personnel at site wer'e accounted for.

1405 Licensee notified State of Connecticut about the disruptive explosion.

1432 Meterological data: wind 12 mph from 050'.

1524 State police representative at site Emergency Con-trol Center.

1536 Ambulance decontaminated and released.

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1611 Injured man decontaminated at Lawrence and Memorial Hospital.

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1635 Doorway of stack boarded up.

1645 All personnel contaminated during incident were de-u-

contaminated.

-1755 Downgraded conditions to Local Emergency.

1835 First NRC inspector arrived on site.

1900 Secured Local Emergency.

9.

Exit Interview At the end of the inspection, the inspector met with the licensee and summarized the inspection scope, purpose and findings (see Detail 1 for attendees).

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