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Category:LICENSEE EVENT REPORT (SEE ALSO AO
MONTHYEARML17335A5641999-10-18018 October 1999 LER 99-024-00:on 990708,literal TS Requirements Were Not Met by Accumlator Valve Surveillance.Caused by Misjudgement Made in Conversion from Initial DC Cook TS to W Std Ts.Submitted License Amend Request.With 991018 Ltr ML17335A5531999-10-0707 October 1999 LER 99-023-00:on 990907,inadequate TS Surveillance Testing of ESW Pump ESF Response Time Noted.Caused by Inadequate Understanding of Plant Design Basis.Surveillance Tests Will Be Revised & Implemented ML17326A1291999-09-17017 September 1999 LER 99-022-00:on 990609,electrical Bus Degraded Voltage Setpoints Too Low for Safety Related Loads,Was Discovered. Caused by Lack of Understanding of Design of Plant.No Immediate Corrective Actions Necessary ML17326A1121999-08-27027 August 1999 LER 99-021-00:on 990728,determined That GL 96-01 Test Requirements Were Not Met in Surveillance Tests.Caused by Failure to Understand Full Extent of GL Requirements. Surveillance Procedures Will Be Revised or Developed ML17326A1011999-08-26026 August 1999 LER 99-020-00:on 990727,EDGs Were Declared Inoperable.Caused by Inadequate Protection of Air Intake,Exhaust & Room Ventilation Structures from Tornado Missile Hazards. Implemented Compensatory Measures in Form of ACs ML17326A0911999-08-16016 August 1999 LER 99-019-00:on 990716,noted Victoreen Containment Hrrms Not Environmentally Qualified to Withstand post-LOCA Conditions.Caused by Inadequate Design Control.Reviewing Options to Support Hrrms Operability in Modes 1-4 ML17326A0771999-08-0404 August 1999 LER 98-029-01:on 980422,noted That Fuel Handling Area Ventilation Sys Was Inoperable.Caused by Original Design Deficiency.Radiological Analysis for Spent Fuel Handling Accidents in Auxiliary Bldg Will Be Redone by 990830 ML17326A0741999-07-29029 July 1999 LER 99-018-00:on 990629,determined That Valve Yokes May Yield Under Combined Stress of Seismic Event & Static,Valve Closed,Stem Thrust.Caused by Inadequate Design of Associated Movs.Operability Determinations Were Performed for Valves ML17326A0661999-07-26026 July 1999 LER 99-017-00:on 990625,noted That Improperly Installed Fuel Oil Return Relief Valve Rendered EDG Inoperable.Caused by Personnel Error.Fuel Oil Return Valve Was Replaced with Valve in Correct Orientation.With 990722 Ltr ML17326A0651999-07-22022 July 1999 LER 98-014-03:on 980310,noted That Response to high-high Containment Pressure Procedure Was Not Consistent with Analysis of Record.Caused by Inadequate Interface with W. FRZ-1 Will Be Revised to Be Consistent with New Analysis ML17326A0491999-07-13013 July 1999 LER 99-016-00:on 990615,TS Requirements for Source Range Neutron Flux Monitors Not Met.Caused by Failure to Understand Design Basis of Plant.Procedures Revised.With 990713 Ltr ML17326A0331999-07-0101 July 1999 LER 99-004-01:on 971030,failure to Perform TS Surveillance Analyses of Reactor Coolant Chemistry with Fuel Removed Was Noted.Caused by Ineffective Mgt of Tss.Chemistry Personnel Have Been Instructed on Requirement to Follow TS as Written ML17326A0151999-06-18018 June 1999 LER 99-014-00:on 990521,determined That Boron Injection Tank Manway Bolts Were Not Included in ISI Program,Creating Missed Exam for Previous ISI Interval.Caused by Programmatic Weakness.Isi Program & Associated ISI Database Modified ML17325B6311999-06-0101 June 1999 LER 99-S03-00:on 990430,vital Area Barrier Degradation Was Noted.Caused by Inadequate Insp & Maint of Vital Area Barrier.Repairs & Mods Were Made to Barriers to Eliminate Degraded & Nonconforming Conditions ML17325B6421999-06-0101 June 1999 LER 99-013-00:on 990327,safety Injection & Centrifugal Charging Throttle Valve Cavitation During LOCA Could Have Led to ECCS Pump Failure.Caused by Inadequate Original Design Application of Si.Throttle Valves Will Be Developed ML17325B6351999-05-28028 May 1999 LER 99-S02-00:on 990428,vulnerability in Safeguard Sys That Could Allow Unauthorized Access to Protected Area Was Noted. Caused by Inadequate Original Plant Design.Mods Were Made to Wall Opening to Eliminate Nonconforming Conditions ML17265A8231999-05-24024 May 1999 LER 98-037-01:on 990422,determined That Ice Condenser Bypass Leakage Exceeds Design Basis Limit.Caused by Pressure Seal Required by Revised W Design Not Incorporated Into Aep Design.Numerous Matl Condition Walkdowns & Assessments Made ML17325B6001999-05-20020 May 1999 LER 99-012-00:on 990420,concluded That Auxiliary Bldg ESF Ventilation Sys Not Capable of Maintaining ESF Room Temps post-accident.Caused by Inadequate Control of Sys Design Inputs.Comprehensive Action Plan Being Developed ML17325B5861999-05-10010 May 1999 LER 99-002-00:on 990415,discovered That TS 4.0.5 Requirements Were Not Met Due to Improperly Performed Test. Caused by Incorrect Interpretation of ASME Code.App J Testing Will Be Completed & Procedures Will Be Revised ML17325B5811999-05-0404 May 1999 LER 99-011-00:on 990407,air Sys for EDG Will Not Support Long Operability.Caused by Original Design Error.Temporary Mod to Supply Makeup Air Capability in Modes 5 & 6 Was Prepared ML17325B5771999-05-0303 May 1999 LER 99-010-00:on 990401,RCS Leak Detection Sys Sensitivity Not in Accordance with Design Requirements Occurred.Caused by Inadequate Original Design of Containment Sump Level. Evaluation Will Be Performed to Clearly Define Design ML17325B5581999-04-16016 April 1999 LER 99-006-00:on 990115,personnel Identified Discrepancy Between TS 3.9.7 Impact Energy Limit & Procedure 12 Ohp 4030.STP.046.Caused by Lack of Design Basis Control.Placed Procedure 12 Ohp 4030.STP.046 on Administrative Hold ML17325B5471999-04-12012 April 1999 LER 99-009-00:on 990304,as-found RHR Safety Relief Valve Lift Setpoint Greater than TS Limit Occurred.Cause Investigation for Condition Has Not Been Completed.Update to LER Will Be Submitted,Upon Completion of Investigation ML17325B5321999-04-0707 April 1999 LER 99-S01-00:on 990308,discovered That Lock for Vital Gate Leading to Plant 4KV Switchgear Area Was Nonconforming & Vulnerable to Unauthorized Access.Caused by Inadequate Gate Design & Inadequate Procedures.Mods Are Being Made to Gate ML17325B5161999-04-0101 April 1999 LER 99-007-00:on 981020,calculations Showed That Divider Barrier Between Upper & Lower Containment Vols Were Overstressed.Engineers Are Currently Working on Analyses of Loads & Stress on Enclosures ML17325B5221999-03-29029 March 1999 LER 99-001-00:on 960610,degraded Component Cooling Water Flow to Containment Main Steam Line Penetrations,Identified on 990226.Caused by Inadequate Understanding of Design Basis.Additional Investigations Ongoing ML17325B4801999-03-18018 March 1999 LER 99-004-00:on 971030,failure to Perform TS Surveillance Analyses of Rc Chemistry with Fuel Removed Was Noted.Cause of Event Is Under Investigation.Corrected Written Job Order Activities Used to Control SD Chemistry Sampling ML17325B4741999-03-18018 March 1999 LER 99-005-00:on 940512,determined That Rt Breaker Manual Actuations During Rod Drop Testing Were Not Previously Reported.Caused by Lack of Training.Addl Corrective Actions,Including Preventative Actions May Be Developed ML17325B4571999-02-24024 February 1999 LER 99-003-00:on 990107,CR Pressurization Sys Surveillance Test Did Not Test Sys in Normal Operating Condition.Caused by Failure to Recognize Door 12DR-AUX415 as Part of CR Pressure Boundary.Performed Walkdown of Other Doors ML17335A5171999-02-11011 February 1999 LER 99-002-00:on 990112,determined That RCS Pressurizer PORVs Had Not Been Tested,Per Ts.Caused by Inadequate Scheduling Controls Allowing Personnel Error.Surveillance Procedure Was Completed & Updated LER Will Be Submitted ML17335A5141999-02-10010 February 1999 LER 99-001-00:on 990106,noted That GE Hfa Relays Installed in EDGs May Not Meet Seismic Qualification.Caused by Operating Experience Info Incorrectly Dispositioned in 1985. Updated LER Will Be Submitted by 990405 ML17335A5011999-02-0101 February 1999 LER 98-060-00:on 981231,identified That Rt Sys Response Time Testing Did Not Comply with TS Definition.Caused by Inadequate Procedures.Corrective Actions Will Be Developed & Update to LER Will Be Submitted by 990415.With 990201 Ltr ML17335A4951999-01-29029 January 1999 LER 98-059-00:on 981230,interim LER -single Failure in Containment Spray Sys Could Result in Containment Spray Ph Outside Design Occurred.Investigation Into Condition Continuing.Update Will Be Submitted by 990514 Ltr ML17335A4961999-01-27027 January 1999 LER 98-057-00:on 981228,discovered That AFW Valves Were Not Tested IAW Inservice Testing Program.Caused by Failure to Recognize Design Bases Features Re Afws by Personnel. Updated LER Will Be Submittted by 990415.With 990127 Ltr ML17335A4921999-01-19019 January 1999 LER 98-052-01:on 981128,no Analysis for NSR Sc Manual Loader for Tdafwp Could Be Found in Original Design.Cause Due to All Failure Modes Not Considered When Compressed Air Sys Originally Designed.Performed Review of Components ML17335A4721999-01-0606 January 1999 LER 98-055-00:on 981207,potential for Condition Outside of Design Bases for Rod Control Sys Was Noted.Caused by Calibration Error Coupled with Single Rod Failure.Condition Rept Investigation Is Ongoing ML17335A4691999-01-0606 January 1999 LER 98-056-00:on 981211,hot Leg Nozzle Gaps Resulted in Plant Being in Unanalyzed Condition.Analyses Are Being Performed by W to Resolve Problem.Updated LER Will Be Submitted by 990211.With 990106 Ltr ML17335A4661999-01-0505 January 1999 LER 98-049-00:on 981020,emergency Boron Injection Flow Path Was Inoperable.Caused by Original Design Deficiency. Engineering Evaluation of Event Is Continuing ML17335A4631999-01-0404 January 1999 LER 98-054-00:on 981202,discovered That at Least One MSSV Had Not Been Reset as Required by Ts.Engineering Is Continuing Review of Extent of Condition for Event.Updated LER Will Be Submitted by 990129.With 990104 Ltr ML17335A4481998-12-30030 December 1998 LER 98-053-00:on 981130,discovered Use of Inoperable Substitute Subcooling Margin Monitor.Caused by Condition Existing Since Installation of Plant Process Computer in 1992.Updated LER Will Be Submitted.With 981230 Ltr ML17335A4581998-12-28028 December 1998 LER 98-052-00:on 981128,turbine Driven AFW Pump Speed Controller Failure Mode Occurred.Caused Because Not All Failure Modes Were Considered When Compressed Air Sys Was Originally Designed.Verified Current Design Change Process ML17335A4281998-12-22022 December 1998 LER 98-051-00:on 981122,reactor Trip Signal from Manual Safety Injection Not Verified as Required by TS Surveillance,Was Discovered.Maintenance Currently Evaluating Significance & Cause of Event ML17335A4111998-12-17017 December 1998 LER 98-047-00:on 981117,potential for Increase Leakage from Reactor Coolant Pump Seals Was Identified.Util Is Working with W to Resolve Issue.Current Expectations Are to Submit Update to LER by 990215.With 981217 Ltr ML17335A4141998-12-16016 December 1998 LER 98-058-00:on 981216,postulated High Line Break Could Result in Condition Outside Design Bases for AF Occurred. Caused by Deficiencies Associated with Administration of HELB Program.Analysis of AF Will Be Completed by 990122 ML17335A4181998-12-16016 December 1998 LER 98-050-00:on 980814,ancillary Equipment Installed in Ice Condenser Was Not Designed to Withstand Design Basis Accident/Earthquake Loads.Caused by Lack of Established Design Criteria.Developed Design Criteria ML17335A3871998-12-11011 December 1998 LER 98-031-01:on 980610,potential Common Mode Failure of RHR Pumps Were Noted.Caused by Inaccurate Values.Accurate Miniflow Numbers Have Been Determined by Flow Testing ML17335A3821998-12-0808 December 1998 LER 98-039-01 Re EOP Step Conflicts with Small Break LOCA Analysis.Ler 98-039-00 Has Been Canceled.With 981208 Ltr ML17335A3781998-12-0707 December 1998 LER 98-007-00:on 981106,high Energy Line Break Effects in Auxiliary FW Sys Was Noted.Cause of Event Is Under Investigation & Will Be Completed by 990220.Updated LER Will Be Submitted by 990310.With 981207 Ltr ML17335A3771998-12-0303 December 1998 LER 98-046-00:on 981103,determined That Afs Was Unable to Meet Design Flow Requirements During Special Test.Caused by Failure to Consider All Aspects of Sys Operation in Design of Suction Basket Strainers.Sys Will Be Redesigned ML17335A3741998-12-0202 December 1998 LER 97-011-02:on 970822,operation Was Noted Outside Design Bases for ECCS & CSP for Switchover to Recirculation Sump Suction.Caused by Ineffective Change Mgt.Revised Procedure for Switchover 01(02) Ohp 4023.ES-1.3 1999-09-17
[Table view] Category:RO)
MONTHYEARML17335A5641999-10-18018 October 1999 LER 99-024-00:on 990708,literal TS Requirements Were Not Met by Accumlator Valve Surveillance.Caused by Misjudgement Made in Conversion from Initial DC Cook TS to W Std Ts.Submitted License Amend Request.With 991018 Ltr ML17335A5531999-10-0707 October 1999 LER 99-023-00:on 990907,inadequate TS Surveillance Testing of ESW Pump ESF Response Time Noted.Caused by Inadequate Understanding of Plant Design Basis.Surveillance Tests Will Be Revised & Implemented ML17326A1291999-09-17017 September 1999 LER 99-022-00:on 990609,electrical Bus Degraded Voltage Setpoints Too Low for Safety Related Loads,Was Discovered. Caused by Lack of Understanding of Design of Plant.No Immediate Corrective Actions Necessary ML17326A1121999-08-27027 August 1999 LER 99-021-00:on 990728,determined That GL 96-01 Test Requirements Were Not Met in Surveillance Tests.Caused by Failure to Understand Full Extent of GL Requirements. Surveillance Procedures Will Be Revised or Developed ML17326A1011999-08-26026 August 1999 LER 99-020-00:on 990727,EDGs Were Declared Inoperable.Caused by Inadequate Protection of Air Intake,Exhaust & Room Ventilation Structures from Tornado Missile Hazards. Implemented Compensatory Measures in Form of ACs ML17326A0911999-08-16016 August 1999 LER 99-019-00:on 990716,noted Victoreen Containment Hrrms Not Environmentally Qualified to Withstand post-LOCA Conditions.Caused by Inadequate Design Control.Reviewing Options to Support Hrrms Operability in Modes 1-4 ML17326A0771999-08-0404 August 1999 LER 98-029-01:on 980422,noted That Fuel Handling Area Ventilation Sys Was Inoperable.Caused by Original Design Deficiency.Radiological Analysis for Spent Fuel Handling Accidents in Auxiliary Bldg Will Be Redone by 990830 ML17326A0741999-07-29029 July 1999 LER 99-018-00:on 990629,determined That Valve Yokes May Yield Under Combined Stress of Seismic Event & Static,Valve Closed,Stem Thrust.Caused by Inadequate Design of Associated Movs.Operability Determinations Were Performed for Valves ML17326A0661999-07-26026 July 1999 LER 99-017-00:on 990625,noted That Improperly Installed Fuel Oil Return Relief Valve Rendered EDG Inoperable.Caused by Personnel Error.Fuel Oil Return Valve Was Replaced with Valve in Correct Orientation.With 990722 Ltr ML17326A0651999-07-22022 July 1999 LER 98-014-03:on 980310,noted That Response to high-high Containment Pressure Procedure Was Not Consistent with Analysis of Record.Caused by Inadequate Interface with W. FRZ-1 Will Be Revised to Be Consistent with New Analysis ML17326A0491999-07-13013 July 1999 LER 99-016-00:on 990615,TS Requirements for Source Range Neutron Flux Monitors Not Met.Caused by Failure to Understand Design Basis of Plant.Procedures Revised.With 990713 Ltr ML17326A0331999-07-0101 July 1999 LER 99-004-01:on 971030,failure to Perform TS Surveillance Analyses of Reactor Coolant Chemistry with Fuel Removed Was Noted.Caused by Ineffective Mgt of Tss.Chemistry Personnel Have Been Instructed on Requirement to Follow TS as Written ML17326A0151999-06-18018 June 1999 LER 99-014-00:on 990521,determined That Boron Injection Tank Manway Bolts Were Not Included in ISI Program,Creating Missed Exam for Previous ISI Interval.Caused by Programmatic Weakness.Isi Program & Associated ISI Database Modified ML17325B6311999-06-0101 June 1999 LER 99-S03-00:on 990430,vital Area Barrier Degradation Was Noted.Caused by Inadequate Insp & Maint of Vital Area Barrier.Repairs & Mods Were Made to Barriers to Eliminate Degraded & Nonconforming Conditions ML17325B6421999-06-0101 June 1999 LER 99-013-00:on 990327,safety Injection & Centrifugal Charging Throttle Valve Cavitation During LOCA Could Have Led to ECCS Pump Failure.Caused by Inadequate Original Design Application of Si.Throttle Valves Will Be Developed ML17325B6351999-05-28028 May 1999 LER 99-S02-00:on 990428,vulnerability in Safeguard Sys That Could Allow Unauthorized Access to Protected Area Was Noted. Caused by Inadequate Original Plant Design.Mods Were Made to Wall Opening to Eliminate Nonconforming Conditions ML17265A8231999-05-24024 May 1999 LER 98-037-01:on 990422,determined That Ice Condenser Bypass Leakage Exceeds Design Basis Limit.Caused by Pressure Seal Required by Revised W Design Not Incorporated Into Aep Design.Numerous Matl Condition Walkdowns & Assessments Made ML17325B6001999-05-20020 May 1999 LER 99-012-00:on 990420,concluded That Auxiliary Bldg ESF Ventilation Sys Not Capable of Maintaining ESF Room Temps post-accident.Caused by Inadequate Control of Sys Design Inputs.Comprehensive Action Plan Being Developed ML17325B5861999-05-10010 May 1999 LER 99-002-00:on 990415,discovered That TS 4.0.5 Requirements Were Not Met Due to Improperly Performed Test. Caused by Incorrect Interpretation of ASME Code.App J Testing Will Be Completed & Procedures Will Be Revised ML17325B5811999-05-0404 May 1999 LER 99-011-00:on 990407,air Sys for EDG Will Not Support Long Operability.Caused by Original Design Error.Temporary Mod to Supply Makeup Air Capability in Modes 5 & 6 Was Prepared ML17325B5771999-05-0303 May 1999 LER 99-010-00:on 990401,RCS Leak Detection Sys Sensitivity Not in Accordance with Design Requirements Occurred.Caused by Inadequate Original Design of Containment Sump Level. Evaluation Will Be Performed to Clearly Define Design ML17325B5581999-04-16016 April 1999 LER 99-006-00:on 990115,personnel Identified Discrepancy Between TS 3.9.7 Impact Energy Limit & Procedure 12 Ohp 4030.STP.046.Caused by Lack of Design Basis Control.Placed Procedure 12 Ohp 4030.STP.046 on Administrative Hold ML17325B5471999-04-12012 April 1999 LER 99-009-00:on 990304,as-found RHR Safety Relief Valve Lift Setpoint Greater than TS Limit Occurred.Cause Investigation for Condition Has Not Been Completed.Update to LER Will Be Submitted,Upon Completion of Investigation ML17325B5321999-04-0707 April 1999 LER 99-S01-00:on 990308,discovered That Lock for Vital Gate Leading to Plant 4KV Switchgear Area Was Nonconforming & Vulnerable to Unauthorized Access.Caused by Inadequate Gate Design & Inadequate Procedures.Mods Are Being Made to Gate ML17325B5161999-04-0101 April 1999 LER 99-007-00:on 981020,calculations Showed That Divider Barrier Between Upper & Lower Containment Vols Were Overstressed.Engineers Are Currently Working on Analyses of Loads & Stress on Enclosures ML17325B5221999-03-29029 March 1999 LER 99-001-00:on 960610,degraded Component Cooling Water Flow to Containment Main Steam Line Penetrations,Identified on 990226.Caused by Inadequate Understanding of Design Basis.Additional Investigations Ongoing ML17325B4801999-03-18018 March 1999 LER 99-004-00:on 971030,failure to Perform TS Surveillance Analyses of Rc Chemistry with Fuel Removed Was Noted.Cause of Event Is Under Investigation.Corrected Written Job Order Activities Used to Control SD Chemistry Sampling ML17325B4741999-03-18018 March 1999 LER 99-005-00:on 940512,determined That Rt Breaker Manual Actuations During Rod Drop Testing Were Not Previously Reported.Caused by Lack of Training.Addl Corrective Actions,Including Preventative Actions May Be Developed ML17325B4571999-02-24024 February 1999 LER 99-003-00:on 990107,CR Pressurization Sys Surveillance Test Did Not Test Sys in Normal Operating Condition.Caused by Failure to Recognize Door 12DR-AUX415 as Part of CR Pressure Boundary.Performed Walkdown of Other Doors ML17335A5171999-02-11011 February 1999 LER 99-002-00:on 990112,determined That RCS Pressurizer PORVs Had Not Been Tested,Per Ts.Caused by Inadequate Scheduling Controls Allowing Personnel Error.Surveillance Procedure Was Completed & Updated LER Will Be Submitted ML17335A5141999-02-10010 February 1999 LER 99-001-00:on 990106,noted That GE Hfa Relays Installed in EDGs May Not Meet Seismic Qualification.Caused by Operating Experience Info Incorrectly Dispositioned in 1985. Updated LER Will Be Submitted by 990405 ML17335A5011999-02-0101 February 1999 LER 98-060-00:on 981231,identified That Rt Sys Response Time Testing Did Not Comply with TS Definition.Caused by Inadequate Procedures.Corrective Actions Will Be Developed & Update to LER Will Be Submitted by 990415.With 990201 Ltr ML17335A4951999-01-29029 January 1999 LER 98-059-00:on 981230,interim LER -single Failure in Containment Spray Sys Could Result in Containment Spray Ph Outside Design Occurred.Investigation Into Condition Continuing.Update Will Be Submitted by 990514 Ltr ML17335A4961999-01-27027 January 1999 LER 98-057-00:on 981228,discovered That AFW Valves Were Not Tested IAW Inservice Testing Program.Caused by Failure to Recognize Design Bases Features Re Afws by Personnel. Updated LER Will Be Submittted by 990415.With 990127 Ltr ML17335A4921999-01-19019 January 1999 LER 98-052-01:on 981128,no Analysis for NSR Sc Manual Loader for Tdafwp Could Be Found in Original Design.Cause Due to All Failure Modes Not Considered When Compressed Air Sys Originally Designed.Performed Review of Components ML17335A4721999-01-0606 January 1999 LER 98-055-00:on 981207,potential for Condition Outside of Design Bases for Rod Control Sys Was Noted.Caused by Calibration Error Coupled with Single Rod Failure.Condition Rept Investigation Is Ongoing ML17335A4691999-01-0606 January 1999 LER 98-056-00:on 981211,hot Leg Nozzle Gaps Resulted in Plant Being in Unanalyzed Condition.Analyses Are Being Performed by W to Resolve Problem.Updated LER Will Be Submitted by 990211.With 990106 Ltr ML17335A4661999-01-0505 January 1999 LER 98-049-00:on 981020,emergency Boron Injection Flow Path Was Inoperable.Caused by Original Design Deficiency. Engineering Evaluation of Event Is Continuing ML17335A4631999-01-0404 January 1999 LER 98-054-00:on 981202,discovered That at Least One MSSV Had Not Been Reset as Required by Ts.Engineering Is Continuing Review of Extent of Condition for Event.Updated LER Will Be Submitted by 990129.With 990104 Ltr ML17335A4481998-12-30030 December 1998 LER 98-053-00:on 981130,discovered Use of Inoperable Substitute Subcooling Margin Monitor.Caused by Condition Existing Since Installation of Plant Process Computer in 1992.Updated LER Will Be Submitted.With 981230 Ltr ML17335A4581998-12-28028 December 1998 LER 98-052-00:on 981128,turbine Driven AFW Pump Speed Controller Failure Mode Occurred.Caused Because Not All Failure Modes Were Considered When Compressed Air Sys Was Originally Designed.Verified Current Design Change Process ML17335A4281998-12-22022 December 1998 LER 98-051-00:on 981122,reactor Trip Signal from Manual Safety Injection Not Verified as Required by TS Surveillance,Was Discovered.Maintenance Currently Evaluating Significance & Cause of Event ML17335A4111998-12-17017 December 1998 LER 98-047-00:on 981117,potential for Increase Leakage from Reactor Coolant Pump Seals Was Identified.Util Is Working with W to Resolve Issue.Current Expectations Are to Submit Update to LER by 990215.With 981217 Ltr ML17335A4141998-12-16016 December 1998 LER 98-058-00:on 981216,postulated High Line Break Could Result in Condition Outside Design Bases for AF Occurred. Caused by Deficiencies Associated with Administration of HELB Program.Analysis of AF Will Be Completed by 990122 ML17335A4181998-12-16016 December 1998 LER 98-050-00:on 980814,ancillary Equipment Installed in Ice Condenser Was Not Designed to Withstand Design Basis Accident/Earthquake Loads.Caused by Lack of Established Design Criteria.Developed Design Criteria ML17335A3871998-12-11011 December 1998 LER 98-031-01:on 980610,potential Common Mode Failure of RHR Pumps Were Noted.Caused by Inaccurate Values.Accurate Miniflow Numbers Have Been Determined by Flow Testing ML17335A3821998-12-0808 December 1998 LER 98-039-01 Re EOP Step Conflicts with Small Break LOCA Analysis.Ler 98-039-00 Has Been Canceled.With 981208 Ltr ML17335A3781998-12-0707 December 1998 LER 98-007-00:on 981106,high Energy Line Break Effects in Auxiliary FW Sys Was Noted.Cause of Event Is Under Investigation & Will Be Completed by 990220.Updated LER Will Be Submitted by 990310.With 981207 Ltr ML17335A3771998-12-0303 December 1998 LER 98-046-00:on 981103,determined That Afs Was Unable to Meet Design Flow Requirements During Special Test.Caused by Failure to Consider All Aspects of Sys Operation in Design of Suction Basket Strainers.Sys Will Be Redesigned ML17335A3741998-12-0202 December 1998 LER 97-011-02:on 970822,operation Was Noted Outside Design Bases for ECCS & CSP for Switchover to Recirculation Sump Suction.Caused by Ineffective Change Mgt.Revised Procedure for Switchover 01(02) Ohp 4023.ES-1.3 1999-09-17
[Table view] Category:TEXT-SAFETY REPORT
MONTHYEARML17335A5641999-10-18018 October 1999 LER 99-024-00:on 990708,literal TS Requirements Were Not Met by Accumlator Valve Surveillance.Caused by Misjudgement Made in Conversion from Initial DC Cook TS to W Std Ts.Submitted License Amend Request.With 991018 Ltr ML17335A5531999-10-0707 October 1999 LER 99-023-00:on 990907,inadequate TS Surveillance Testing of ESW Pump ESF Response Time Noted.Caused by Inadequate Understanding of Plant Design Basis.Surveillance Tests Will Be Revised & Implemented ML17335A5631999-09-30030 September 1999 Monthly Operating Rept for Sept 1999 for DC Cook Nuclear Plant,Unit 1.With 991012 Ltr ML17335A5621999-09-30030 September 1999 Monthly Operating Rept for Sept 1999 for DC Cook Nuclear Plant,Unit 2.With 991012 Ltr ML17335A5481999-09-30030 September 1999 Non-proprietary DC Cook Nuclear Plant Units 1 & 2 Mods to Containment Sys W SE (Secl 99-076,Rev 3). ML17335A5451999-09-28028 September 1999 Rev 1 to Containment Sump Level Design Condition & Failure Effects Analysis for Potential Draindown Scenarios. ML17326A1291999-09-17017 September 1999 LER 99-022-00:on 990609,electrical Bus Degraded Voltage Setpoints Too Low for Safety Related Loads,Was Discovered. Caused by Lack of Understanding of Design of Plant.No Immediate Corrective Actions Necessary ML17326A1481999-09-17017 September 1999 Independent Review of Control Rod Insertion Following Cold Leg Lbloca,Dc Cook,Units 1 & 2. ML17326A1211999-08-31031 August 1999 Monthly Operating Rept for Aug 1999 for Cook Nuclear Plant, Unit 2.With 990915 Ltr ML17326A1201999-08-31031 August 1999 Monthly Operating Rept for Aug 1999 for Cook Nuclear Plant, Unit 1.With 990915 Ltr ML17326A1121999-08-27027 August 1999 LER 99-021-00:on 990728,determined That GL 96-01 Test Requirements Were Not Met in Surveillance Tests.Caused by Failure to Understand Full Extent of GL Requirements. Surveillance Procedures Will Be Revised or Developed ML17326A1011999-08-26026 August 1999 LER 99-020-00:on 990727,EDGs Were Declared Inoperable.Caused by Inadequate Protection of Air Intake,Exhaust & Room Ventilation Structures from Tornado Missile Hazards. Implemented Compensatory Measures in Form of ACs ML17326A0911999-08-16016 August 1999 LER 99-019-00:on 990716,noted Victoreen Containment Hrrms Not Environmentally Qualified to Withstand post-LOCA Conditions.Caused by Inadequate Design Control.Reviewing Options to Support Hrrms Operability in Modes 1-4 ML17326A0771999-08-0404 August 1999 LER 98-029-01:on 980422,noted That Fuel Handling Area Ventilation Sys Was Inoperable.Caused by Original Design Deficiency.Radiological Analysis for Spent Fuel Handling Accidents in Auxiliary Bldg Will Be Redone by 990830 ML17335A5461999-08-0202 August 1999 Rev 0 to Evaluation of Cook Recirculation Sump Level for Reduced Pump Flow Rates. ML17326A0871999-07-31031 July 1999 Monthly Operating Rept for July 1999 for DC Cook Nuclear Plant,Unit 1.With 990812 Ltr ML17326A0861999-07-31031 July 1999 Monthly Operating Rept for July 1999 for DC Cook Nuclear Plant,Units 2.With 990812 Ltr ML17326A0741999-07-29029 July 1999 LER 99-018-00:on 990629,determined That Valve Yokes May Yield Under Combined Stress of Seismic Event & Static,Valve Closed,Stem Thrust.Caused by Inadequate Design of Associated Movs.Operability Determinations Were Performed for Valves ML17326A0661999-07-26026 July 1999 LER 99-017-00:on 990625,noted That Improperly Installed Fuel Oil Return Relief Valve Rendered EDG Inoperable.Caused by Personnel Error.Fuel Oil Return Valve Was Replaced with Valve in Correct Orientation.With 990722 Ltr ML17326A0651999-07-22022 July 1999 LER 98-014-03:on 980310,noted That Response to high-high Containment Pressure Procedure Was Not Consistent with Analysis of Record.Caused by Inadequate Interface with W. FRZ-1 Will Be Revised to Be Consistent with New Analysis ML17326A0491999-07-13013 July 1999 LER 99-016-00:on 990615,TS Requirements for Source Range Neutron Flux Monitors Not Met.Caused by Failure to Understand Design Basis of Plant.Procedures Revised.With 990713 Ltr ML17326A0331999-07-0101 July 1999 LER 99-004-01:on 971030,failure to Perform TS Surveillance Analyses of Reactor Coolant Chemistry with Fuel Removed Was Noted.Caused by Ineffective Mgt of Tss.Chemistry Personnel Have Been Instructed on Requirement to Follow TS as Written ML17326A0511999-06-30030 June 1999 Monthly Operating Rept for June 1999 for DC Cook Nuclear Plant,Unit 2.With 990709 Ltr ML17326A0501999-06-30030 June 1999 Monthly Operating Rept for June 1999 for DC Cook Nuclear Plant,Unit 1.With 990709 Ltr ML17326A0151999-06-18018 June 1999 LER 99-014-00:on 990521,determined That Boron Injection Tank Manway Bolts Were Not Included in ISI Program,Creating Missed Exam for Previous ISI Interval.Caused by Programmatic Weakness.Isi Program & Associated ISI Database Modified ML17325B6421999-06-0101 June 1999 LER 99-013-00:on 990327,safety Injection & Centrifugal Charging Throttle Valve Cavitation During LOCA Could Have Led to ECCS Pump Failure.Caused by Inadequate Original Design Application of Si.Throttle Valves Will Be Developed ML17325B6311999-06-0101 June 1999 LER 99-S03-00:on 990430,vital Area Barrier Degradation Was Noted.Caused by Inadequate Insp & Maint of Vital Area Barrier.Repairs & Mods Were Made to Barriers to Eliminate Degraded & Nonconforming Conditions ML17326A0061999-05-31031 May 1999 Monthly Operating Rept for May 1999 for Dcp.With 990609 Ltr ML17326A0071999-05-31031 May 1999 Monthly Operating Rept for May 1999 for DC Cook Nuclear Plant,Unit 2.With 990609 Ltr ML17325B6351999-05-28028 May 1999 LER 99-S02-00:on 990428,vulnerability in Safeguard Sys That Could Allow Unauthorized Access to Protected Area Was Noted. Caused by Inadequate Original Plant Design.Mods Were Made to Wall Opening to Eliminate Nonconforming Conditions ML17265A8231999-05-24024 May 1999 LER 98-037-01:on 990422,determined That Ice Condenser Bypass Leakage Exceeds Design Basis Limit.Caused by Pressure Seal Required by Revised W Design Not Incorporated Into Aep Design.Numerous Matl Condition Walkdowns & Assessments Made ML17325B6001999-05-20020 May 1999 LER 99-012-00:on 990420,concluded That Auxiliary Bldg ESF Ventilation Sys Not Capable of Maintaining ESF Room Temps post-accident.Caused by Inadequate Control of Sys Design Inputs.Comprehensive Action Plan Being Developed ML17325B5861999-05-10010 May 1999 LER 99-002-00:on 990415,discovered That TS 4.0.5 Requirements Were Not Met Due to Improperly Performed Test. Caused by Incorrect Interpretation of ASME Code.App J Testing Will Be Completed & Procedures Will Be Revised ML17325B5811999-05-0404 May 1999 LER 99-011-00:on 990407,air Sys for EDG Will Not Support Long Operability.Caused by Original Design Error.Temporary Mod to Supply Makeup Air Capability in Modes 5 & 6 Was Prepared ML17325B5771999-05-0303 May 1999 LER 99-010-00:on 990401,RCS Leak Detection Sys Sensitivity Not in Accordance with Design Requirements Occurred.Caused by Inadequate Original Design of Containment Sump Level. Evaluation Will Be Performed to Clearly Define Design ML17335A5301999-04-30030 April 1999 Monthly Operating Rept for Apr 1999 for DC Cook Nuclear Plant,Unit 1.With 990508 Ltr ML17335A5291999-04-30030 April 1999 Monthly Operating Rept for Apr 1999 for DC Cook Nuclear Plant,Unit 2.With 990508 Ltr ML17325B5581999-04-16016 April 1999 LER 99-006-00:on 990115,personnel Identified Discrepancy Between TS 3.9.7 Impact Energy Limit & Procedure 12 Ohp 4030.STP.046.Caused by Lack of Design Basis Control.Placed Procedure 12 Ohp 4030.STP.046 on Administrative Hold ML17325B5471999-04-12012 April 1999 LER 99-009-00:on 990304,as-found RHR Safety Relief Valve Lift Setpoint Greater than TS Limit Occurred.Cause Investigation for Condition Has Not Been Completed.Update to LER Will Be Submitted,Upon Completion of Investigation ML17325B5321999-04-0707 April 1999 LER 99-S01-00:on 990308,discovered That Lock for Vital Gate Leading to Plant 4KV Switchgear Area Was Nonconforming & Vulnerable to Unauthorized Access.Caused by Inadequate Gate Design & Inadequate Procedures.Mods Are Being Made to Gate ML17325B5161999-04-0101 April 1999 LER 99-007-00:on 981020,calculations Showed That Divider Barrier Between Upper & Lower Containment Vols Were Overstressed.Engineers Are Currently Working on Analyses of Loads & Stress on Enclosures ML17325B5491999-03-31031 March 1999 Monthly Operating Rept for Mar 1999 for DC Cook Nuclear Plant Unit 2.With 990408 Ltr ML17325B5441999-03-31031 March 1999 Monthly Operating Rept for Mar 1999 for DC Cook Nuclear Plant,Unit 1.With 990408 Ltr ML17325B5221999-03-29029 March 1999 LER 99-001-00:on 960610,degraded Component Cooling Water Flow to Containment Main Steam Line Penetrations,Identified on 990226.Caused by Inadequate Understanding of Design Basis.Additional Investigations Ongoing ML17325B4801999-03-18018 March 1999 LER 99-004-00:on 971030,failure to Perform TS Surveillance Analyses of Rc Chemistry with Fuel Removed Was Noted.Cause of Event Is Under Investigation.Corrected Written Job Order Activities Used to Control SD Chemistry Sampling ML17325B4741999-03-18018 March 1999 LER 99-005-00:on 940512,determined That Rt Breaker Manual Actuations During Rod Drop Testing Were Not Previously Reported.Caused by Lack of Training.Addl Corrective Actions,Including Preventative Actions May Be Developed ML17325B5671999-03-0202 March 1999 Summary of Unit 1 Steam Generator Layup Chemistry from 980101 to 990218. ML17325B4631999-02-28028 February 1999 Monthly Operating Rept for Feb 1999 for DC Cook Nuclear Power Station,Unit 2.With 990308 Ltr ML17325B4621999-02-28028 February 1999 Monthly Operating Rept for Feb 1999 for DC Cook Nuclear Plant,Unit 1.With 990308 Ltr ML17325B4571999-02-24024 February 1999 LER 99-003-00:on 990107,CR Pressurization Sys Surveillance Test Did Not Test Sys in Normal Operating Condition.Caused by Failure to Recognize Door 12DR-AUX415 as Part of CR Pressure Boundary.Performed Walkdown of Other Doors 1999-09-30
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REGULATl INFORMATION DIBTRIBUTIONQ'STEM <RIDE)
ACCESSION NBR: 8707130305 DOC. DATE: 87/07/02 NOTARIZED: NO DOCKET 0 FACIL: 50-315 Donald C. Cook Nuclear Power Plant> Unit 1> Indiana 0 05000315 AUTH. NAME AUTHOR AFFILIATION BLINDS A. A. Indiana Zc Michigan Electric Co.
SMITHS'. G. Indiana 8c Michigan Electric Co.
RECIP. NAME RECIP IENT AFFILIATION
SUBJECT:
LER 87-008-00:on 870604iESF actuation occurred due to extreme high level in steam generator 12. Caused bg mispositioning of both level controller 5 feedwater flow selector switch. Level controller refurbished. W/870702 ltr.
DISTRIBUTION CODE: IE22D COPIES RECEIVED: LTR ENCL SIZE:
TITLE: 50. 73 Licensee Event Report (LER)i Incident Rpt> etc.
NOTES:
REC IP IENT COPIES RECIPIENT COPIES ID CODE/NAME LTTR ENCL ID CODE/NAME LTTR ENCL PD3-3 LA 1 PD3-3 PD 1 1 WIGQINQTONi D 1 INTERNAL: ACRS MICHELSON 1 1 ACRS MOELLER 2 2 AEOD/DOA 1 1 AEOD/DSP/ROAB 2 2 AEOD/DSP/TPAB 1 1 DEDRO 1 NRR/GEST/ADE 0 NRR/DEST/ADS 0 NRR/DEST/CEB 1 1 NRR/DEST/ELB 1 1 NRR/DEST/ICSB 1 1 NRR/DEST/MEB 1 NRR/DEST/MTB 1 1 NRR/DEST/PSB 1 NRR/DEST/RSB 1 1 NRR/DEST/SGB 1 1 NRR/DLPG/HFB 1 1 NRR/DLPG/GAB 1 NRR/DOEA/EAB 1 1 NRR/DREP/RAB ~ 1 1 NRR/DREP/RPB 2. 2 RN~ RB NRR/PMAS/PTSB 1 EQ FILE 02 1 1 RES DEPY GI 1 1 RES E FORDS J 1 1 RES/DE/EIB 1 RQN3 FILE 01 1 1 EXTERNAL: EG~<<G GROHi M 5 5 H ST LOBBY NARD 1 1 LPDR 1 1 NRC PDR 1 1 NSIC HARRIS' 1 NSIC MAYST Q 1 TOTAL NUMBER OF COPIES REQUIRED: LTTR 44 ENCL 42
NRC Form 355 (043) 0 US. NUCLEAR REOULATORY COMMISSION APPROVED OMR NO. 3150410l LICENSEE EVENT REPORT (LER) EXPIRESI SISIISS FACILITYNAMK (I) DOCKET NUMBER (2) PA E TITLE (Cl D.C. Cook Nuclear Plant, Unit 1 0 5 0 0 0 3 1 5 1 OF P 4 ESF Actuation (Reactor Trip) Due to extreme High Steam Generator Level Resultin from Mis ositioned Control Switches EVENT DATE (5) LER NUMBER (5) REPORT OAT K (7) OTHER FACILITIES INVOLVED (SI MONTH OAY YEAR YEAR SEQUENTIAL C.W RNVCUCN MONTH OAY YEAR FACILITYNAMES DOCKET NUMBERISI NUMSNII NUMSNII 0 5 0 0 0 0 6 0 4 8 7 8 7 0 0 0 0 0 2 8 7 0 5 0 0 0 THIS REPORT IS SUBMITTED PURSUANT T0 THE REOUIREMENTs oF 10 cFR (II Icrrocc onr or moro of trrr forloiffnpl (11 OPERATINO MODE (5) 20A02(N) 20A05(c) 50.73(a) (2 l(h) 73.7101)
POWER 20AOS tc l(1)(i) 5035(c)(I ) 50,73(a)(2)(r) 7371(cl LEUEL p 9 p 20AOS(cHI ) (Nl 5024(cl(2) 50.73(a) (2)(rN) DTHER ISprcrfy in Aororct oolow onrf In Toit, IIRC Fomr 20.405(c) (1) (IN) 50.734)(2) (I) 50.734) (2)(rNI)(A) 388AI 20A054) (1)(lr) 50.734)(21(NI 50.73(a I (2) (rid) (5) 20AOS(c)(1)4) 50.734)(2)(NI) 50.73(c) (2)(xl LICENSEE CONTACT FOR THIS LKR (12)
NAME TELEPHONE NUMBER AREA CODE A. A. Blind Assistant, Plant Manager 6 1 64 6 5- 5 9 0 1 COMPLETE ONE LINE FOR EACH COMPONENT FAILURE DESCRIBED IN THIS RKPORT (13) r CAUSE SYSTEM COMPONENT MANUFAC. EPORTABLE MANUFAC. EPORTABLE TUR ER TO NPRDS CAUSE SYSTEM COMPONENT TURER TO NPROS SUPPLKMENTAL REPORT EXPECTED ('ll) MONTH OAY YEAR EXPECTED SUBMISSION DATE (15)
YKS Ilfyrt, ccrnplrtr EXPECTED SIIEMISSION DATEI NO ABSTRACT ILlmlt to lr00 rPrtrr, I A, rPProiimorrly fit ttn rlnPlororto tyorrwltmn ffnrrl (IS)
On June 4, 1987, at 1034 hours0.012 days <br />0.287 hours <br />0.00171 weeks <br />3.93437e-4 months <br />, an ESF actuation (turbine/reactor trip) occurred due to an extreme high level in Steam Generator number 12. The level transient occurred during the performance of a test procedure. During the execution of the test, an operator was directed to place the automatic/manual level controller in the manual position, then transfer the steam flow and feedwater flow selector switches from the Channel I position to the Channel II position. Once transferred, the level controller can be placed in the automatic position and testing can commence on Channel I.
The cause of the event was the mispositioning of both the level controller (due to malfunction) and the feedwater flow selector switch (due to misleading switch position labeling) . This resulted in an increase in feedwater pump speed, the automatic opening of the Steam Generator number 12 feedwater flow control valve and sub-sequent extreme high Steam Generator level.
The level controller was removed, inspected, refurbished and determined to be operable. The escutcheon plate on the feedwater flow selector switch has been relabeled to identify the correct position. In addition, a memo was issued to all operators describing lessons learned from this event.
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NRC Form 358A U)L NUCLEAR REOULATORY COMMISSION 983 I LICENSEE EVENT REPORT (LER) TEXT CONTINUATION APPROVEO OMS NO. 3IEO-0104 EXPIRES: 8/31/88 FACIUTY NAME ill DOCKET NUMBER (2I LER NUMBER ISI PACE l3I YEAR 54CVENTIAL RtVISION NVM54R NVM 4R D.C. Cook Nuclear Plant, Unit 1 0 6 0 0 0 3 1 5 8 7 0 0 8 0 0 0 2 oF 0 4 TEXT /SIRIW NMCe /I/etvlRS vtt ahWont////IC %%drm SSSI8/ l1TI Conditions Prior to Occurrence Unit 1 in Mode 1 (Power Operation) at 90 percent Reactor Thermal Power.
Descri tion of Event On June 4, 1987, at 1034 hours0.012 days <br />0.287 hours <br />0.00171 weeks <br />3.93437e-4 months <br />, an Engineered Safety Features actuation (turbine trip/reactor trip) occurred due to a extreme high level in Steam Generator (EIIS/SG) number 12. The Steam Generator level transient occurred during the performance of a surveillance test procedure, 1-THP-4030-STP.019 (Steam Generator 1 and 2 mismatch set number 1). During the execution of the test, the control room operator is directed to place the automatic/manual level controller (EIIS/LC) in the manual position, then transfer both the steam flow and feedwater flow selector switches (EIIS/33) from the "Channel ILI position to the "Channel IIN position. Once transferred, the automatic/manual level controller can be placed in the automatic position and testing can commence on channel I.
When the control room operator (Licensed Reactor Operator) acted
'o place the automatic/manual level controller in manual, the switch did not. fully travel to the manual position detent (the switch is spring loaded to the manual position and should have traveled to manual once it was moved, even slightly, from the automatic detent position) . Consequently the controller remained in automatic, unknown to the operator. The operator then rotated steam flow selector switch from channel I to channel II. No adverse effects resulted from this transfer. The operator then acted to transfer the feedwater flow selector switch from channel I to channel II. It was later determined that the selector switch was not fully rotated to the channel II position due to misleading switch position labeling and therefore neither the channel I or channel II output was selected. With the level controller still in automatic, it compared a full power steam flow signal with a zero feedwater flow signal. This resulted in an increase in feed-water pump (EIIS/P) speed and the automatic opening of the steam generator number 12 feedwater flow control valve (EIIS/FCV).
The ensuing transient occurred so rapidly the actions taken by the operator to regain control of steam generator level were ineffective [this was complicated by the fact that there was an erroneous low steam generator level indication available to the operator due to a mechanical interference within the steam generator level recorder (EIIS/LR)] and a turbine trip/reactor trip sequence was initiated [opening of the reactor trip breakers (EIIS/BKR), insertion of reactor control rods (EIIS/ROD), feedwater isolation, automatic starting of the motor-driven and turbine-driven auxiliary feedwater pumps (EIIS/P) ] . There was no automatic or manual actuation of the intermediate head safety injection system.
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NRC Form 388A US. NUCLEAR REGULATORY COMMISSION 883)
LICENSEE EVENT REPORT (LER) TEXT CONTINUATION APPROVEO OMB NO. 3180-0105 EXPIRES: 8/31/88 PACIUTY NAME lll DOCKET NUMBER IE) LER NUMBER (8) PAGE (3) rr 55CVENTIAL 'P RSVr5ION YEAR NVMS ~ R NVM55R D.C. Cook Nuclear Plant, Unit 1 0 s 0 o o 3 1 5 8 7 0 0 8 8 7 0 3 QF 0 4 TE)TT /e/rrroo rpooo/5/orp/8mS Ir ~//RC a 38883/ I)T)
, Operations personnel immediately implemented the special emergency operating procedure 1-0HP-4023.E-O to verify proper response of the automatic protection system (EIIS/JC) and to assess plant conditions for initiating appropriate recovery actions.
The Unit was stabilized in Mode 3 (Hot Standby) at approximately 1100 hours0.0127 days <br />0.306 hours <br />0.00182 weeks <br />4.1855e-4 months <br />, June 4, 1987. The NRC was notified of the event via the ENS at 1120 hours0.013 days <br />0.311 hours <br />0.00185 weeks <br />4.2616e-4 months <br />, June 4, 1987.
With the exception of the malfunction of the level controller switch mechanism and the steam generator level recorder, there were no inoperative structures, components, or systems that contributed to this event.
Cause of Event Several unrelated items (both human factors related) combined to result in this event: 1) the automatic/manual level controller transfer switch malfunctioned which prevented typical (spring assisted) travel to the manual position, and 2) the feedwater flow selector switch was not fully rotated to the channel II position [The reason this did not occur is twofold. First, the escutcheon plate on the subject selector switch incorrectly identified the channel II position at 45 degrees from channel I (in reality the channel II position is 90 degrees from channel I). Secondly, the subject selector switch is the only switch with the channel II position at 90 degrees, the channel II position on all corresponding selector switches is at the 45 degree position.
Anal sis of Event This Engineered Safety Features actuation which resulted in a reactor trip, is reportable pursuant to 10 CFR 50.73 (a)(2)(iv) .
The automatic protection system responses; turbi'ne trip/reactor trip, and resultant actuations, were all verified to have functioned properly as a result of the Engineered Safety Features actuation.
Based on the above, public were not affected.
it is concluded that the health and safety of the It was noted, however, that the control room temperature indication, the chart drive for the wide range reactor coolant system temperature recorders, and the Unit Megawatt Recorder malfunctioned. Further investigation revealed that these abnormal responses were due to a broken wire on a critical control room power circuit breaker. This broken wire was the result of a cable pull
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LICENSEE EVENT REPORT (LER) TEXT CONTINUATION APPROVEO OMS NO. 3180M)04 EXPIRES: 8/31/88 SACILITY NAME 11) OOCKET NUMSER )31 LER NUMSER (8) PAGE (3)
YEAR SEOVSNTIAL REVISION NVM SR NUMSSR D.C. Cook Nuclear Plant, Unit TEXT (4 IIRNS rpecr lr /PEUksIL INS ~ HRC Form CSEA'rl ))7) 1 0 s 0 0 0 3 1 5 8 7 0 0 8 0 0 4 oF 0 4 operation which took place approximately 15 minutes prior to the reactor trip actuation. In addition, the Operation Sequence Monitor (OSM) failed.to print the correct or accurate equipment actuation times, consequently a complete time study was not possible. Through secondary means, it was determined that the reactor trip breakers actuated in less than 100 ms which is consistent with previous data.
All other applicable actuations were also verified.
Corrective Actions Immediate corrective action involved Operations personnel implementing plant procedures to verify proper response of the automatic protection system and to assess plant conditions for initiating appropriate recovery actions. The automatic/manual level controller was removed, inspected, refurbished, and determined to be operable. The steam generator number 12 level recorder was repaired and returned to service. The escutcheon plate for the number 12 Steam Generator feedwater flow selector switch has been relabeled to identify the required 90 degree throw. In addition,,
a memo was issued to all operators describing lessons learned from this event. Corrective action has been taken on all attendent equipment malfunctions noted in the event analysis section.
Failed Com onent Identification No component failures were directly related to the cause of this event.
Previous Similar Events None.
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~ PIONl looerla INDIANA 8r MICHIGANELECTRIC COMPANY OONALO C. COOK NUCLEAR PLANT P.O. Box 456, Brldgemen, MI 49106 Telephone (616) 465.5901 July 2, 1987 United States Nuclear Regulatory Commission Document Control Desk Washington, D.C. 20555 Operating License DPR-58 Docket No. 50-315 Document Control Manager:
Zn accordance with the criteria established by 10 CFR 50.73 entitled Licensee Event Re ortin S stem, the following report is being submitted:
87-008-00 Sincerely, W. G. Smith, r.
Plant Manager WGS:afh Attachment cc: A. B. Davis, Region ZZZ J. E. Dolan M. P. Alexich R. F. Kroeger H. B. Brugger R. W. Jurgensen NRC Resident, Znspector D. L. Wigginton R. C. Callen, MPSC D. Hahn, MDPH G. Charnoff, Esq.
Dottie Sherman, ANZ Library ZNPO J. G. Feinstein/B.P. Lauzau PNSRC A. A. Blind File