United States Nuclear Regulatory Commission - Protecting People and the Environment

EA-97-409 - Sequoyah 1 & 2 (Tennessee Valley Authority)

December 8, 1997

EA 97-409

Tennessee Valley Authority
ATTN: Mr. O. J. Zeringue,
Chief Nuclear Officer and
Executive Vice President
6A Lookout Place
1101 Market Street
Chattanooga, Tennessee 37402-2801

SUBJECT:  NOTICE OF VIOLATION AND PROPOSED IMPOSITION OF CIVIL
          PENALTY - $55,000 
          (NRC SPECIAL INSPECTION REPORT NOS. 50-327/97-13 AND 
          50-328/97-13)

Dear Mr. Zeringue:

This refers to the special inspection conducted on July 25 through September 4, 1997, at the Sequoyah facility. The purpose of the inspection was to review the misalignment of spare vital battery No. V to vital battery board No. IV on July 24, 1997. The results of the inspection were sent to you by letter dated September 11, 1997. An open, predecisional enforcement conference was conducted in the Region II office on November 19, 1997, with you and members of your staff, to discuss the violations, the root causes, and your corrective actions to preclude recurrence. A list of conference attendees and copies of the Nuclear Regulatory Commission's (NRC) and Tennessee Valley Authority's (TVA) presentation materials are enclosed.

Based on the information developed during the inspection and the information that was provided during the conference, the NRC has determined that violations of NRC requirements occurred. The violations are cited in the enclosed Notice of Violation and Proposed Imposition of Civil Penalty (Notice), and the circumstances surrounding them are described in detail in the subject inspection report.

On July 24, 1997, a Senior Reactor Operator (SRO) failed to realign spare vital battery No. V to vital battery board No. IV properly, after hanging a clearance on 125 volt direct current (DC) vital battery No. IV. As a result, vital battery board No. IV was inoperable for approximately 30 hours. Based on the additional information that was provided during the conference, the NRC concluded that three violations of regulatory requirements occurred. The violations include: (1) the failure to meet Technical Specification (TS) 3.8.2.3 requirements to maintain four DC vital battery channels energized and operable; (2) the failure to follow procedures associated with realigning the spare vital battery No. V to a vital battery board; and, (3) the failure to follow administrative procedures to ensure that the position of 125 volt DC distribution system breakers were subject to independent verification. These violations and a number of other concerns described below indicate serious weaknesses in the performance of the operations staff. In this case, the operations staff demonstrated a lack of inquisitiveness and a lack of strict adherence to procedures in performing the realignment of the vital battery.

During this event, the SRO went to the wrong distribution panel to close a breaker and found a breaker with similar labels already closed. Although the SRO questioned the unexpected breaker status, he failed to adequately investigate the discrepancy, did not notify the control room of the potential configuration control issue, and did not note the failure to close the breaker as a deviation from the procedure. Several steps later in the procedure, he opened the same breaker yet failed to recognize the incongruity. At the conference, you stated that your procedures and expectations in this situation allow the cognizant supervisor, i.e., the SRO, to resolve the discrepancy; yet, the SRO was closely involved in performing the steps of the procedure which compromised his ability to oversee the work independently.

Problems with auxiliary unit operator (AUO) rounds practices were also noted. Tests of the batteries indicated that it is likely that the battery voltage was below required surveillance limits at the time AUO rounds were performed; however, the AUO failed to identify reduced voltage at the board. Control room operators initially performing the battery realignment, and subsequent oncoming crews, did not identify the lack of an expected main control room alarm, and the procedure did not highlight that an alarm was expected. Lastly, an SRO entered an incorrect Technical Specification action statement during the initial vital board realignment.

The root causes of the misalignment event, i.e., the failure to evaluate the unexpected as-found condition and/or weaknesses associated with component labeling, were similar to previous events. NRC Inspection Report 50-327,-328/97-03 documented an event in which an operator found a valve in an unexpected position and did not notify the control room, resulting in the isolation of the spent fuel pool cooling pump for about two hours while the pump was running. Enforcement Action 97-232, issued on July 10, 1997, documented operator errors in investigating discrepant indications of reactor coolant system (RCS) level resulting in an RCS drain down event. Licensee Event Report (LER) 95-08 documented a reactor trip which occurred when an operator opened a wrong breaker on the wrong vital 120 VAC board.

The NRC recognizes that the actual safety and risk significance of the inoperable vital battery board was mitigated by the fact that a spare battery charger was aligned to the board and the charger would have provided power to the board in all scenarios except for a loss of offsite power. In addition, the NRC commends the training instructor who recognized that the vital battery board supply breaker was not in the correct position and took prompt action to notify the Operations staff. Nonetheless, these violations are of significant regulatory concern to the NRC due to: (1) problems in the performance of the operating staff; (2) the fact that multiple opportunities existed to prevent and detect the inoperability of the vital battery board; and, (3) previous events involving similar operator errors and problems attributable to component labeling have occurred and corrective action did not preclude repetition of the problems. Therefore, the violations have been categorized in the aggregate in accordance with the "General Statement of Policy and Procedures for NRC Enforcement Actions" (Enforcement Policy), NUREG-1600, as a Severity Level III problem.

In accordance with the Enforcement Policy, a base civil penalty in the amount of $55,000 is considered for a Severity Level III problem. Because your facility has been the subject of escalated enforcement actions within the last two years,(1) the NRC considered whether credit was warranted for Identification and Corrective Action in accordance with the civil penalty assessment process described in Section VI.B.2 of the Enforcement Policy. NRC determined that credit was not warranted for Identification because prior opportunities to identify the violations existed. Your corrective actions included: (1) revising the operating procedure to require independent verification of breaker position; (2) hanging caution tags on the five No. 107 breakers to ensure proper identification; (3) plans to relabel all 125, and 250 volt DC and 120 volt AC boards; (4) developing job performance measures for work on the 125 volt DC batteries; (5) revising the battery procedure to identify the No. V battery in-service alarm, including the appropriate TS action statement in the battery procedure; (6) reviewing other operations and maintenance procedures to ensure proper independent verifications have been identified; and, (7) taking appropriate personnel actions. Based on the above, the NRC determined that credit was warranted for the factor of Corrective Action.

Therefore, to emphasize the importance of attention to detail and appropriate implementation of TS requirements, and in recognition of your previous escalated enforcement actions, I have been authorized, after consultation with the Office of Enforcement, to issue the enclosed Notice of Violation and Proposed Imposition of Civil Penalty (Notice) in the base amount of $55,000 for the Severity Level III problem.

The apparent violations identified in NRC Inspection Report No. 50-327, 328/97-13 included a failure to stop the evolution when a procedural step could not be performed and failure to promptly identify an adverse condition (out-of-tolerance battery voltage). At the predecisional enforcement conference, you indicated that, although your expectations for operator performance were not met in these areas, you concluded that procedural requirements had been met. Because these circumstances were factored into our assessment of prior opportunities to identify the breaker misalignment, these apparent violations are withdrawn. In addition, at the conference, you provided information indicating that AUO rounds to assess battery room temperature and battery voltage on vital battery No. V were appropriate. This apparent violation is also withdrawn.

You are required to respond to this letter and should follow the instructions specified in the enclosed Notice when preparing your response. In your response, you should document the specific actions taken and any additional actions you plan to prevent recurrence of the violations. After reviewing your response to this Notice, including your proposed corrective actions and the results of future inspections, the NRC will determine whether further NRC enforcement action is necessary to ensure compliance with NRC regulatory requirements.

In accordance with 10 CFR 2.790 of the NRC's "Rules of Practice," a copy of this letter and its enclosures will be placed in the NRC Public Document Room.

                                   Sincerely, 

                                   Original signed by
                                   Bruce S. Mallett for 

                                   Luis A. Reyes
                                   Regional Administrator

Docket Nos. 50-327, 50-328
License Nos. DPR-77, DPR-79

Enclosures:
1. Notice of Violation and Proposed Imposition of Civil Penalty
2. NRC Presentation Materials
3. TVA Presentation Materials
4. List of Attendees

cc w/encls:
Senior Vice President
Nuclear Operations
Tennessee Valley Authority
6A Lookout Place
1101 Market Street
Chattanooga, TN 37402-2801

Jack A. Bailey, Vice President
Engineering & Technical Services
Tennessee Valley Authority
6A Lookout Place
1101 Market Street
Chattanooga, TN 37402-2801

Masoud Bajestani
Site Vice President
Sequoyah Nuclear Plant
Tennessee Valley Authority
P. O. Box 2000
Soddy-Daisy, TN 37379

General Counsel
Tennessee Valley Authority
ET 10H
400 West Summit Hill Drive
Knoxville, TN 37902

Raul R. Baron, General Manager
Nuclear Assurance
Tennessee Valley Authority
4J Blue Ridge
1101 Market Street
Chattanooga, TN 37402-2801

Mark J. Burzynski, Manager
Nuclear Licensing
Tennessee Valley Authority
4J Blue Ridge
1101 Market Street
Chattanooga, TN 37402-2801

Pedro Salas, Manager
Licensing and Industry Affairs
Sequoyah Nuclear Plant
P. O. Box 2000
Soddy-Daisy, TN 37379

J. T. Herron, Plant Manager
Sequoyah Nuclear Plant
Tennessee Valley Authority
P. O. Box 2000
Soddy Daisy, TN 37379

Director
Division of Radiological Health
3rd Floor, L and C Annex
401 Church Street
Nashville, TN 37243-1532

County Executive
Hamilton County Courthouse
Chattanooga, TN 37402


NOTICE OF VIOLATION
AND
PROPOSED IMPOSITION OF CIVIL PENALTY

Tennessee Valley Authority                Docket Nos. 50-327 and 50-328
Sequoyah Units 1 & 2                      License Nos. DPR-77 and DPR-79
                                          EA 97-409

During an NRC inspection conducted from July 25 through September 4, 1997, violations of NRC requirements were identified. In accordance with the "General Statement of Policy and Procedures for NRC Enforcement Actions," NUREG-1600, the NRC proposes to impose a civil penalty pursuant to Section 234 of the Atomic Energy Act of 1954, as amended (Act), 42 U.S.C. 2282, and 10 CFR 2.205. The particular violations and associated civil penalty are set forth below:

A. Technical Specification 3.8.2.3. requires four direct current (DC) vital battery channels to be energized and operable, with each channel consisting of a 125 volt DC board, a 125 volt DC battery bank, and a full capacity charger.

Contrary to the above, on July 24, 1997, at approximately 6:13 a.m., 125 volt DC battery bank No. IV was disconnected from 125 volt DC board No. IV causing the No. IV DC vital battery channel to be inoperable. The channel remained inoperable until 11:32 a.m. on July 25, a period of approximately 30 hours. (01013)

B. Technical Specification 6.8.1.a requires, in part, that procedures shall be established, implemented, and maintained covering the activities recommended in Appendix A of Regulatory Guide 1.33, Revision 2, February 1978, "Quality Assurance Program Requirements (Operation)." Appendix A of Regulatory Guide 1.33, Section 3, includes procedures for onsite emergency power sources (DC System).

System Operating Instruction (SOI) 0-SO-250-1, "125 Volt DC Vital Power System," Revision 9, Section 8.4, provides instructions for placing vital battery V in service for battery boards I, II, III, or IV. Step 8.4.8 of SOI 0-SO-250-1 required the operator to "Place Distribution Panel...B-S breaker (107) in "ON" position to align feed to desired Vital Battery Board."

Contrary to the above, on July 24, 1997, an SRO failed to implement step 8.4.8 of SOI 0-SO-250-1, in that, while aligning vital battery V to feed vital battery board No. IV, he did not place distribution panel B-S breaker (107) in the "ON" position to align feed to vital battery board No. IV. (01023)

C. 10 CFR 50, Appendix B, Criterion V requires, in part, that activities affecting quality shall be prescribed by documented instructions, procedures, or drawings of a type appropriate to the circumstances and shall be accomplished in accordance with these instructions, procedures, or drawings.

Site Standard Practice SSP-12.6, Equipment Status Verification and Checking Program, Revision, Section 3.3, Verification Instructions, Step 3.3.1, Independent Verification Requirements, states, "Independent verification is required for the following situations on breakers, valves, and components in those systems listed in Appendix A...." One situation listed stated, "Any activity that, if done improperly, could remain undetected until that structure, system or component was called on to mitigate an accident or transient as described in the FSAR,..." Appendix A, List of Systems and Components Requiring Independent Verification, includes the "125V Vital DC Distribution System Components that supply control power essential for the Shutdown Boards to function properly."

Contrary to the above, on July 24, 1997, the licensee failed to include requirements for independent verification, as specified by SSP-12.6, in Systems Operating Procedure 0-SO-250-1, 125 Volt DC Vital Power System, Revision 9, Section 8.4, Placing Vital Battery No. V in Service for Battery Board I, II, III, or IV. Placing vital battery No. V in service, if done improperly, could remain undetected until that structure, system or component was called on to mitigate an accident or transient as described in the FSAR. Vital battery board No. V, while in service for battery boards I, II, III, or IV, would supply control power essential for the shutdown boards to function properly. (01033)

These violations represent a Severity Level III problem (Supplement I).

Pursuant to the provisions of 10 CFR 2.201, Tennessee Valley Authority (Licensee) is hereby required to submit a written statement or explanation to the Director, Office of Enforcement, U.S. Nuclear Regulatory Commission, within 30 days of the date of this Notice of Violation and Proposed Imposition of Civil Penalty (Notice). This reply should be clearly marked as a "Reply to a Notice of Violation" and should include for each alleged violation: (1) admission or denial of the alleged violation, (2) the reasons for the violation if admitted, and if denied, the reasons why, (3) the corrective steps that have been taken and the results achieved, (4) the corrective steps that will be taken to avoid further violations, and (5) the date when full compliance will be achieved. If an adequate reply is not received within the time specified in this Notice, an order or a Demand for Information may be issued as to why the license should not be modified, suspended, or revoked or why such other action as may be proper should not be taken. Consideration may be given to extending the response time for good cause shown. Under the authority of Section 182 of the Act, 42 U.S.C. 2232, this response shall be submitted under oath or affirmation.

Within the same time as provided for the response required above under 10 CFR 2.201, the Licensee may pay the civil penalty by letter addressed to the Director, Office of Enforcement, U.S. Nuclear Regulatory Commission, with a check, draft, money order, or electronic transfer payable to the Treasurer of the United States in the amount of the civil penalty proposed above, or may protest imposition of the civil penalty in whole or in part, by a written answer addressed to the Director, Office of Enforcement, U.S. Nuclear Regulatory Commission. Should the Licensee fail to answer within the time specified, an order imposing the civil penalty will be issued. Should the Licensee elect to file an answer in accordance with 10 CFR 2.205 protesting the civil penalty, in whole or in part, such answer should be clearly marked as an "Answer to a Notice of Violation" and may: (1) deny the violations listed in this Notice, in whole or in part, (2) demonstrate extenuating circumstances, (3) show error in this Notice, or (4) show other reasons why the penalty should not be imposed. In addition to protesting the civil penalty in whole or in part, such answer may request remission or mitigation of the penalty.

Any written answer in accordance with 10 CFR 2.205 should be set forth separately from the statement or explanation in reply pursuant to 10 CFR 2.201, but may incorporate parts of the 10 CFR 2.201 reply by specific reference (e.g., citing page and paragraph numbers) to avoid repetition. The attention of the Licensee is directed to the other provisions of 10 CFR 2.205, regarding the procedure for imposing a civil penalty.

Upon failure to pay any civil penalty due which subsequently has been determined in accordance with the applicable provisions of 10 CFR 2.205, this matter may be referred to the Attorney General, and the penalty, unless compromised, remitted, or mitigated, may be collected by civil action pursuant to Section 234c of the Act, 42 U.S.C. 2282c.

The response noted above (Reply to Notice of Violation, letter with payment of civil penalty, and Answer to a Notice of Violation) should be addressed to: Mr. James Lieberman, Director, Office of Enforcement, U.S. Nuclear Regulatory Commission, One White Flint North, 11555 Rockville Pike, Rockville, MD 20852-2738, with a copy to the Regional Administrator, U.S. Nuclear Regulatory Commission, Region II and a copy to the NRC Resident Inspector at the Sequoyah Nuclear Plant.

Because your response will be placed in the NRC Public Document Room (PDR), to the extent possible, it should not include any personal privacy, proprietary, or safeguards information so that it can be placed in the PDR without redaction. If personal privacy or proprietary information is necessary to provide an acceptable response, then please provide a bracketed copy of your response that identifies the information that should be protected and a redacted copy of your response that deletes such information. If you request withholding of such material, you must specifically identify the portions of your response that you seek to have withheld and provide in detail the bases for your claim of withholding (e.g., explain why the disclosure of information will create an unwarranted invasion of personal privacy or provide the information required by 10 CFR 2.790(b) to support a request for withholding confidential commercial or financial information). If safeguards information is necessary to provide an acceptable response, please provide the level of protection described in 10 CFR 73.21.

Dated at Atlanta, Georgia
this 8th day of December 1997


1. A Severity Level III problem was issued on July 10, 1997, (EA 97-232), for violations associated with a reactor coolant system (RCS) inadvertent drain down. Two Severity Level III problems and proposed civil penalties of $50,000 each were issued on December 24, 1996, (EA 96-414), for inadequate corrective actions related to maintenance of reactor trip breakers and other equipment. A Severity Level III violation and proposed civil penalty of $50,000 was issued on November 19, 1996, (EA 95-269), related to fire protection program deficiencies. A Severity Level II violation and proposed civil penalty of $80,000 were issued on February 20, 1996, (EA 95-252), related to employee discrimination in Department of
Labor Case Nos. 92-ERA-19 and 92-ERA-34.

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