ML17279A496

LER 87-024-00:on 870722,limitorque motor-operated open- Direction Torque Switch Bypass Jumper Discovered Missing. Caused by Personnel Error.All Missing Jumpers Installed & Memo Re Top Tier Drawings Issued to personnel.W/870821 Ltr

ML17279A496
Person / Time
Site:	Columbia
Issue date:	08/21/1987
From:	Powers C, Washington S WASHINGTON PUBLIC POWER SUPPLY SYSTEM
To:	NRC OFFICE OF ADMINISTRATION & RESOURCES MANAGEMENT (ARM)
References
IEC-81-13, LER-87-024, LER-87-24, NUDOCS 8708250086
Download: ML17279A496 (9)

Text

ULA INFORMATION DIST TIO YSTEM (RIDS>

ACCESSION NBR:8708250086 DOC. DATE: 87/08/21 NOTARIZED: NO DOCKET FACIL: 50-397 WPPSS Nuclear Pro Ject> Unit 2i Washington Public Poee 05000397 AUTH. NAME AUTHOR AFFILIATION 'k WASHINGTON. B. L. Washington Public Power Supply System POWERSI C. M. Washington Public PoUjer Supply System RECIP. NAME REC1P IENT AFFILIATION

SUBJECT:

LER 87-024-00: on 870722I limitorque motor-operated open-direction torque switch bypass pumper discovered missing.

Caused bg personnel error. *11 missing Jumpers installed memo re top tier drawings issued to -personnel. W/870821 -ltr.

DISTRIBUTION CODE: IESSD COPIES RECEIVED: LTR I ENCL TITLE: 50. 73 Licensee Event Report (LER)i Incident Rpti g etc.SIZE: P NOTES:

RECIPIENT COPIES RECIPIENT COPIES ID CODE/NAME LTTR ENCL ID CODE/NAME LTTR ENCL PD5 L* 1 1 PD5 PD 1 1 SAMWORTH> R 1 INTERNAL: ACRS MICHELSON 1 1 ACRS MOELLER 2 2 AEOD/DOA 1 1 AEOD/DSP/NAS 1 1 AEOD/DSP/RO*B 2 2 AEOD/DSP/TPAB 1 DEDRO 1 NRR/DEBT/ADB 1 0 NRR/DEST/CEB 1 1 NRR/DEBT/ELB 1 1 NRR/DEST/ICSB } 1 NRR/DEBT/MEB 1 1 NRR/DEST/MTB NRR/DEBT/PSB 1 1 NRR/DEST/RSB 1 1 NRR/DEBT/SGB 1 1 NRR/DLPG/HFB 1 1 NRR/DLPG/GAB 1 1 NRR/DOEA/E*B 1 1 NRR/DREP/RAB 1 1

-- REP/RPB 2 2 NRR/PMAS/ ILRB 1 1 REG FIL 02 1 1 RES DEPY GI 1 1 ORDI J 1 1 RES/DE/EIB 1 1 RGN5 FILE 01 1 EXTERNAL: EQ5G QROH M 5 5 H ST LOBBY WARD 1 1 LPDR 1 1 NRC PDR } 1 NSIC HARRIS' 1 1 NSIC MAYSI G 1 1 TOTAL NUMBER OF COPIES REQUIRED: LTTR 43 ENCL 42

NRC Form 358 (843)

~ 0 V.S. NUCLEAR REGULATOAY COMMISSION APPROVED OMB NO. 31600)0e EXPIRES: 8/31/88 LICENSEE EVENT REPORT {LER)

FACILITY NAME (I) DOCKET NUMBER (2I 'PAGE 3 Washin ton Nuclear Plant - Unit 2 o 5 o o o 3 9 OF 07

""'(" M1ss1ng 1mitorque o or pera or pen- 1rec 1on orque 1

Switch Bypass Jumpers Caused hy Personnel Error EVENT DATE I5) LEA NUMBER (6) REPORT DATE {7) OTHER FACILITIES INVOLVE'D (8)

MONTH DAY YEAR YEAR sEQUENTIAL SeeI RS~~ MONTH OAY YEAR FACILITYNAMES DOCKET NUMBER(S)

NUMBER AF: NUM88 R 0 5 0 0 0 0 7 2 2 8 7 8 7 0 2 4 0 00 821 87 0 5 0 0 0 OPERATING THIS REPORT IS SUBMITTED.PURSUANT T 0 THE REQUIREMENTS OF 10 CFR (): /Check One or more ol the follovf/nP/ (11 MODE (8) 20A02(8) 73.7118) 20A05(c) 50.73(e) (2)(lv)

POWER 20A05(el(i)(l) 50.38(cl(l) 50.73(e)(2)(v) 73.71(cl LEYEL 0 0 20A05(s)(l)(8) 50M4)(2) 50,734) (2)(vill (2)(vill)(BI OTHER /Specify /n Ahrtrect tN/ow end /n Text, f/RC Form

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NAME TELEPHONE NUMBER W h'iance En ineer COMPLETE ONE LINE FOR EACH COMPONENT FAILURE DESCRIBED IN THIS REPORT (13)

AREA CODE 50 93 77- 20 0

)N CAUSE SYSTEM COMPONENT MANUFAC.

TVRER REPORTABLE TO NPADS g ' CAUSE SYSTEM COMPONENT MANUFAC.

TUREA EPOATABLE TO NPAOS

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EXPECTED MONTH mM DAY YEAR SUBMISSION DATE (15)

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On July 22, 1987, while the plant was in Cold Shutdown, Plant engineers and electricians discovered a Limitorque motor operator open-direction torque switch bypass .jumper missing. This bypass jumper was required to be installed by a Plant Co(I)1itment in response to IE Circular No. 81-13 "Torque Switch Electrical Bypass Circuit for Safeguard Service Valve Motors.H The missing jumper was discovered by Plant personnel investigating the cause of a motor failure on a Main Steam Isolation Valve Leakage Control System Valve Motor Operator (MSLC-V-lA and MSLC-M0-1A).

A review of Plant documentation led to the field inspection of all MSLC inboard valves. All 12 Inboard MSLC Valves were found with the open-direction torque switch bypass jumpers missing.

Plant Management delayed restart of the Plant and organized a Task Force to further investigate the scope of the problem. The Task Force reviewed all Safeguard Service Valve Motors and identified 66 valves to be field inspected. Only two other valves were found with,jumpers missing. They were Residual Heat Removal Valve RHR-V-GA, a shutdown cooling crosstie isolation valve, and Plant Service Mater Valve SM-V-90, an isolation valve to a Diesel Generator Building Corridor Heating and Ventilation System.

8708250086 870820>97 PDR ADOCK 0500PDR 8

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YEAR 'gK SEOVENTIAL REVISION NVMEER NVMEER Washington Nuclear Plant - Unit 2 0 5 0 0 0 3 87 02 40 0 2 oF0 7 TEXT ///mare E/>>ae /I Iea>>ler/, Iree I//aa'a>>//E/IC Farrrr 3BEI'a/1131 Abstract (continued)

The first Task Force recommended that the Safeguard Service Valve Motor list for WNP-2 be reviewed for completeness. A second Task Force-reviewed this list and determined that six additional valves should be added to the list. Three of these valves should have been included on the original list. They are Main Steam Valve MS-V-146, the main steam supply to auxilaries and Standby Gas Treatment Valves SGT-V-3Al and 382, inlet valves to SGT. secondary fans. The other three valves FPC-V-149 (demineralized effluent to suppression pool water) and AS-V-68A and 8 (auxilary steamline reactor building isolation valves) were installed after Plant startup and the list was not updated.

The cause of the missing jumpers was attributed to either: 1) personnel error on the part of Plant personnel who removed installed jumpers while using non top-tier plant drawings (no documentation could be found that authorized or documented removal of the jumpers), or 2) The jumpers were never installed because of conflicting installation directions from the Plant Architect/

Engineer.

The majorcorrective actions are: 1) all missing jumpers were installed prior to Plant restart, 2) the Plant Manager issued a memorandum to all Plant personnel remi ndi ng them of their responsibility to use top tier drawings, 3) the Safeguard Service Valve Motor list will be formalized and included in the Plant Design data base, 4) the Maintenance Department will undertake an effort to improve documentation. of work performed, and 5) a Engineering effort to upgrade Plant Electrical Wiring Diagrams to top tier status will be expedited.

There are no unacceptable adverse consequences associated with this event because: 1) the missing jumpers do not effect valve operability and 2) each valve/system was backed by redundant systems.

Plant Conditions a) , Power Level - 0'4 b) Plant Mode - 4 (Cold Shutdown)

Event Description On July 22, 1987, while the Plant was in Cold Shutdown, Plant engineers a'nd electricians discovered a Limitorque motor operator open-direction torque switch bypass jumper missing. This bypass jumper was required to be installed by a Plant Commitment in response to IE Circular No. 81-13 "Torque Switch Electrical Bypass Circuit for Safeguard Service Valve Motors". The missing jumper was discovered by Plant personnel investigating the cause of a motor failure on a Main Steam Isolation Valve Leakage Control System Valve Motor Operator (MSLC-V-lA and MSLC-M0-1A).

NIIC SOIINI SEER RU.S GPO'.1088&824 538/455 18 43l

~ O NRC FOIRI 348A U.S. NUCLEAR REGULATORY COMMISSION (94/31 LICENSEE EVENT REPORT ILERI TEXT CONTINUATION APPROVED OMS NO, 3150M(04 EXPIRES; 8/31/88 FACILITYNAME ('ll DOCKET NUMBER (21 LER NUMBER (8) PAGE (31 YEAR SEGVENTIAL ~i'm: REVISION N% NVMOER NVMIER Washin ton Nuclear Plan - Ij i o s o o o q OF TEXT /// mo/4 4Pooo /I IoqooRE IISS mREUosN/ Hl/C %%dmI 3884'4/ (IT(

Plant Engineers, in an effort to determine the cause of the missing bypass jumper, initiated a review of construction documentation and maintenance records for MSLC-V-1A and the other inboard MSLC isolation and bleed valves.

The results of the review were: 1) Construction documentation conclusively showed the jumpers for the inboard isolation valve motor operators were installed (MSLC-MO-1A through 1D); 2) There was no information on bypass jumper removal in any of the Plant maintenance documentation, and; 3) The construction documentation for the inboard bleed valve motor operators (MSLC-MO-2A through 2D and MSLC-MO-3A through 3D) was inconclusive as to whether the jumpers were ever installed. A field inspection of all the inboard MSLC Valves found no open-direction torque switch bypass jumpers installed.

Maintenance Work Requests were prepared and the required bypass jumpers were installed. This. work was completed on July 22, 1987.

As a result of the above findings, Plant Management delayed the planned Plant restart and organized a Task Force to further investigate the scope of the problem.

IE Circular 81-13 requested Plants to install torque switch bypass circuits to prevent a possible faulted condition (torque switch failure or premature actuation) from inhibiting a valve in accomplishing its safety function. In response to IE Circular 81-13 the Plant Architect/Engineer (Burns 8 Roe, Inc.)

prepared a list of valves for WNP-2 which required torque switch bypass circuits. Burns and Roe, Inc., subsequently issued direction to incorporate these bypass circuits into the Plant design. This work was completed prior to Plant Startup pre-operational testing. The bypass circuit requirement was implemented by either; 1) the use of a limit switch in parallel with the to~que switch which prevented the torque switch from being activated until the valve was nearly fully opened or closed; or 2) by hardwiring a jumper around the torque switch.

The Task Force began by reviewing informational as-built sketches of motor operator valve (MOV) wiring made for an equipment qualification walkdown performed 'during the Spring of 1986. This review concluded that a problem may exist in implementation of the open-direction hardwired torque switch bypass circuits (jumpers). The Task Force recommended that MOVs with open-direction hardwired torque switch bypass circuits be field inspected.

The Burns 8 Roe, Inc., list of Safeguard Service Valve Motors included 179 valves of which 116 valves have open or open/close torque switch bypass circuits. Those MOVs which used limit switch bypass circuits were eliminated from the field inspection list because there were no previous plant problems associated with these circuits. Also, some MOVs with hardwired bypass circuits which were known, for various reasons, to have the jumpers installed were also eliminated from the field inspection list. Sixty-six (66)"MOVs were field inspected to verify the installation of the open-direction torque switch bypass jumper. Oply two of the 66 MOVs inspected were found with jumpers missing (RHR-MO-6A and SW-MO-90). It was determined that the jumper in SW-MO-90 was NRC FORM 3444 o U.S.OPO,'1988 0824 538/485 (9831

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NRC Ferro~A U.S. NUCLEAR REGULATORY COMMISSION

)943)

LICENSEE EVENT REPORT {LER) TEXT CONTINUATION APPROVEO OMB NO. 3)50&)04 EXPIRES: 8/31/88 FACILITY NAME Ill OOCKET NUMBER (2) LER NUMBER IS)

YEAR I@ SEOVENTIAL rP> REVISION NUM VRC< NVMBER

- ' 0 s OF Washin ton Nuclear Plan U TEXT ///more e/reee /e rfr/rkerL we //I/oR5/ HRC form 3///)AS I Ill) removed due to personnel error in reading a Plant drawing during the Spring of 1987 outage. No documentation was found which documented the removal of. the jumper in RHR-MO-6A. New jumpers were installed in both of these MOVs. The inspection results also confirmed the valve field inspection criteria as no problems with limit switch bypass circuits were found. This work was completed hy July 24, 1987.

During this investigation it was determined that the original Burns 8 Roe, Inc.

Safeguard Service Valve Motor List should be reviewed for completeness. This led to formation of a second Task Force comprised of Operations, Technical

- Staff and Engineering personnel. This review resulted in the addition of six new MOVs to the Safeguard Service Valve Motor list. Three of the six valves were installed after the original list was made (FPC-V-149 and AS-V-68A/)3), and the other three valves (MS-V-146 and SGT-V-3Al and 3I32) were omitted from the original list. A Plant Modification Request (PMR) was prepared processed, and approved to install jumpers in each of these valves, except for FPC-V-149. The required bypass circuit was included in the original FPC-V-149 Plant Modification package. This work was completed on July 25, 1987.

There are two causes for the missing jumpers; 1) In one case plant records show the bypass jumpers were installed; however, the Electrical Wiring Diagrams (nontop tier drawings) did not show the jumpers and the jumpers were subsequently removed to make valve wiring conform to these non top-tier drawings. Also, documentation of Plant work activities was insufficient to determine when the jumpers were removed. (Cause for MSLC-MO-lA,through 10, RHR-M0-6A, and SW-MO-90.); 2) In the second case it is believed the bypass jumpers were not installed during startup because of conflicting information in the Electrical Elementary Drawings, Connection Diagrams, and Electrical Wiring Diagrams included in the implementing Project Engineering Directives (PED).

Both cases are the result of personnel error in that Plant personnel did not follow Plant directives regardi ng top-tier drawing use and Architect/Engineer personnel prepared and issued incomplete design packages.

There are two reasons for the additions to the original Safeguard Service Valve Motor list: 1) The Plant Architect Engineer Burns 8 Roe, Inc., for reasons unknown, missed three valves that should have been included on the original list, and 2) the Supply System due to an oversight did not maintain the list after the Plant was licensed.

Immediate Corrective Action After the first missing jumpers were found, a Plant Task Force of Engineers and Maintenance personnel was formed to review all selected Safeguard Service Valve Motors to ensure that torque switch bypass jumpers were properly installed.

All missing jumpers were installed by July 25, 1987.

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A second Task Force of Operations, Technical, and Engineering personnel reviewed the Safeguard Service Valve Motor List to ensure its completeness.

Six new valves were added to the Safeguards Service Valve Motor List and Engineering direction was issued to install, where necessary, torque switch bypass .jumpers.

The first Task Force also reviewed Plant top-tier drawings to ensure that the torque switch bypass jumpers were properly shown. Five top-tier plant Electrical Elementary Drawings were identified as needing revision. A Plant Modification request was processed and implemented to revise these drawings.

Further Corrective Action and Evaluation The Plant Manager issued on a memorandum July 28, 1987 reminding Plant personnel of thei r responsibility to use top-tier drawings when performing modifications, maintenance, testing, or troubleshooting plant hardware.'he design criteria for Safeguard Service Valve Motor selection will be formalized. After the design criteria is formalized, WNP-2 valves will be re-reviewed against this criteria and a formal valve safety function list as related to IE Circular 81-13 will be issued. This valve safety function list will be incorporated into the WNP-2 design data base..

Engineering efforts already in progress to upgrade Electrical Wiring Diagrams to top-tier status will be expedited. Electrical Elementary Drawings, Connection Diagrams and Electrical Wiring Diagrams (EWDS) for all Safeguard Service Valve Motors will be cross checked to ensure that each drawing accurately reflects the Plant design with respect to torque switch bypass circuits.

Drawings with known inconsistencies resulting from the field inspection will be revised to reflect as-built status.

The Plant'Maintenance Department will undertake an effort to improve the .

documentation of work activities performed.

Safety Significance There are no unacceptable adverse consequences associated with this event.

First, these valves were designed to perform without the torque switch bypass circuits installed. Periodically, operation of these valves is demonstrated by Plant Surveillance Testing or by operational use. The torque switch bypass circuits were installed only to provide added assurance that a faulted condition would not prevent the valve from performing its safety function. So the chance of one of these valves not performing its safety function because of a missing .torque switch bypass circuit is remote. Secondly, the discussions which follow show that each system 'with a valve found with a missing bypass jumper is adquately protected by redundant components or systems.

NRC FORM 366A o U.S GPO:1988&826 638/46S ISA)

NRC Form 3SSA V.S, NUCLEAR REGULATORY COMMISSION 1943 l LICENSEE EVENT REPORT ILER) TEXT CONTINUATION APPROYEO OMS NO. 3150&IGO EXPIRES: 8/31/88 FACILITYNAME 111 DOCKET NUMBER (2l LER NUMSER LSI PAGE 131 P re SEOVENT/AL ALYrerON NVMSER NVMSTA Washington Nuclear Plant - Unit 2 0 s 0 0 o 3 9 8 7 0 2 4 0 0 O6 oFO TEXT /// more 3/roce II /e//kre/L rree ~ /c/ 'orre/HRC Forrrr 3//SA3/11TI The NSLC system is used to control and direct main steam valve leakage through the SGT system under post accident conditions when the MSIVs are closed and core damage is present. Failure of a single NSLC valve would not jeopordize this function since the system is redundant and can draw off leakage either between or outboard of the redundant MSIVs. (I/ISLC-V-lA through 10, MSLC-V-2A through 20, and MSLC-V-3A through 30 are all part of the inboard-draws off leakage between the inboard and outboard MSIVs-system.)

Similarly, the failure of main steam supply to auxilaries valve (an NSLC outboard boundary valve) NS-V-146 to close would .not disable the NSLC system.

Again, because of MSLC redundancy, a failure of NS-V-146 would not jeopordize NSLC operation since the NSLC could be aligned the Inboard System which draws off leakage between the NSIVs.

The Residual Heat Removal System Valve RHR-V-6A is a crosstie isolation valve used to isolate the RHR Loop A Pump (RHR-P-lA) suction from the Shutdown Cooling Suction Line. The Safety function direction of RHR-V-6A is the open direction. In the event RHR-V-6A failed to open, only the RHR Loop A Shutdown Cooling mode of operation would be affected, and RHR Loop A Shutdown Cooling is backed by the redundant RHR Loop 8 Shutdown Cooling. Only one RHR Shutdown Cooling Loop is requi red to remove core decay heat following a'lant Shutdown.

Further, during non-accident conditions RHR-V-6A is accessible and could he opened manually, and, if neither RHR Shutdown Cooling Loop is available Alternative Shutdown Cooling which provides an alternate flow path would be available. Therefore, the failure of this valve would not cause unacceptable adverse consequences because of system redundancy, component accessibility, and/or alternate availability.

Auxilary Steam System Valves AS-V-68A and B'are Isolation valves for the Auxilary Steamline which is routed through the Reactor Building. These valves are designed to close to isolate a high energy break in the Auxilary steamline in the Reactor Building. Since these are redundant, 'in series, valves a double failure is highly unlikely the missing jumpers in AS-NO-68A and B is not a significant degradation of safety. A .break in these lines has no direct affect on reactor operation, since the Auxilary Steam is supplied from an oil fired steam boiler.

There are two independent Standby Gas Treatment (SGT) Divisions and only one Division is required to operate to meet plant safety requirements. In addition, each Division has a primary fan and a backup fan capable of meeting the Division requirements. SGT-V-3A1 and 3B2 are inlet valves to the backup fans of each SGT Division. These valve are required to open'only if the primary SGT fan in the, Division does not successfully start. The inlet valves for the primary fans had the proper torque switch bypass circuits installed.

Even in the event of a primary valve or fan failure only one of these valves would need to successfully open to meet safety requirements. Therefore there are no unacceptable adverse consequences because multiple failures would have

'to occur before the operability .of this system would be challenged.

NIIC FORM 3eeA e U.S GPO.1988 0.82A 838/ASS 19431

U.S. NUCLEAR REOULATORY COMMISSION NRC FormD08A (943 I LICENSEE EVENT REPORT (L'ERI TEXT CONTINUATION APPROVED OMS NO. 3(50-010e EXPIRES: 8/31/88 FACILITY NAME (11 DOCKET NUMSER (21 LER NUMSER (Sl PACE (31 SSOUENTIAL N~ei REVISION NUMOSR NVMSTR Washington Nuclear Plant TEXT /// more g>>ce ifroeoier/

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Unit (I1l 2 o << o o 3 9 7 8 7 0 2 00 07 OF 0 7 No safety significance is associated with FPC-V-149 since the correct torque switch bypass=circuit was installed. The only problem associated with this valve is it was not included on the original Safeguard Service Valve Motor list.

The Service Water Valve SW-V-90 opens to allow cooling water to the the Diesel Generator (DG) Building Corridor Heating and Ventilation System. SW-V-90 is powered from Division 2 and if it fails to operate is backed by two exhaust fans powered from Division l. These fans will automatically actuate and mai ntain the DG Building corridor within design limits. Therefore, even in the unlikely event of the failure of this valve plant safety is not significantly reduced.

This event posed no threat to the health and safety of the public or Plant personnel.

Similar Events None EIIS Information Text Reference EIIS Reference System , Component Residual Heat Removal (RHR) System BO RHR-V-6A BO ISV RHR-MO-6A BO MO RHR-P-lA I30 P Essential Service Water (SW) System BI SW-V-.90 BI V 9<-MO-90 BI MO Main Steam Leakage Control (MSLC) System SB V SB'S-V-146 MSLC-V-1A-1D, 2A-20 and 3A-30 SB FCV MSLC-M0-1A-10, 2A-2D and 3A-3D SB MO Standby Gas Treatment (SGT) System BH SGT-V-3A1/3B2 BH Fuel Pool Cooling (FPC) System DA FPC-V-149 DA Auxiliary Steam (AS) System AS-V-68A/B ISV AS-MO-68A/B MO NRC fORM SOOA oU.S.OPO:1985 0.824 538/OSS (9431

WASHINGTON.PUBLIC POWER SUPPLY SYSVEM P.O. Box 968 ~ 3000 George Washington Way ~ Richland, Washington 99352 Docket No. 50-397 August 21, 1987 Document Control Desk U.S. Nuclear Regulatory Commission Washington, D.C. 20555 Subiect: NUCLEAR PLANT NO. 2 LICENSEE EVENT REPORT NO.87-024

Dear Sir:

Transmitted herewith is Licensee Event Report No.87-024 for the WNP-2 Plant.

This report is submitted in response to the report requirements of 10CFR50.73 and discusses the items of reportability, corrective action taken, and action taken to preclude recurrence.

Very truly yours, C.M. owers (M/D 927M}

WNP-2 Plant Manager CMP:ac

Enclosure:

L'icensee Event Report No.87-024 cc: Mr. John B. Martin, NRC - Region V Mr. R. T. Dodds, NRC Site (M/D 901A)

INPO Records Center - Atlanta, GA Ms. Dottie Sherman, ANI Mr. D. L. Williams, BPA (M/D 399)