Collection Systems Application Please note that this application must be completed at one time. There is no option to save. Required fields are noted with a red *. "*" indicates required fields Step 1 of 5 20% Acknowledgement*I hereby acknowledge that by filling out this application, I am including any and all pertinent information related to my approval for the NEWEA Collection Systems examination. I further acknowledge that the review committee will approve me for the highest grade level I qualify for based on the information provided on this application and once the review process is complete, if there is any additional information I wish to add I will need to fill out a new application, including the applicable fee. I acknowledge Name (as it appears on your license/ID)* First Middle Last Mailing Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Best Number to reach you*Email (please enter the email you would like your exam voucher to be sent)* Have you taken or do you plan on taking any training/prep course for this exam?* Yes No Are you physically capable of performing the duties of an operator in the grade for which you are applying? Yes No Are you ReTesting (taking the same grade level for a better score)?* Yes No If "yes", what Grade Level?*select grade levelGrade IGrade I OITGrade IIGrade II OITGrade IIIGrade III OITGrade IVGrade IV OIT EDUCATION & TRAININGDid you attend High School?* Yes No Last Grade CompletedSelect grade9th10th11th12thDid you graduate from High School?* Yes No If yes, list your graduation year.If yes, list the location of the schoolDid you obtain your GED?* Yes No If yes, list your graduation year.If yes, list the location of the schoolDid you attend a College or University?* Yes No List Dates AttendedList your MajorCredit or Degree ObtainedDate of Leaving or GraduatingDid you obtain a secondary degree from a College or University? Yes No List Dates AttendedList your MajorCredit or Degree ObtainedDate of Leaving or GraduatingList other educational courses completed such as vocational school, correspondence course, armed services, specialized courses, operators’ short courses, business school, etc. Give date, name and duration of course and name of school or sponsoring organization. EXPERIENCEName of the wastewater collection system*Give your title*Give a detailed description of the duties you perform at your present position as they relate to wastewater collection systems*Are you in responsible charge?* Yes No If not, to whom do you report?How long have you held your present position?*List in detail all positions you have held as they pertain to wastewater collection systems*Start DateEnd DateEmployer and LocationDescribe in detail all dutiesList who you reported to Add RemoveGive a detailed description of each job indicating SPECIFIC DUTIES (i.e. operate a high velocity cleaner, CCTV system, inspect pump stations, respond to blockages & odor complaints, etc.) Use the + sign to add more rows. Classification of Wastewater Collection SystemsThe point system is based on the 13 areas described in Section 9.2 of the brochure. Grade I: 1 - 21 Grade II: 21 - 39 Grade III: 40 - 55 Grade IV: 56 - >1. Largest Pipe Size (diameter in inches)* Up to 42" Greater than 42" 2. Average Total Flow MGD* 0 - 0.10 0.10 - 0.40 0.40 - 0.70 0.70 - 1.00 1.0 - 5.0 5.0 - 10.0 10.0 - 20.0 20.0 - 50.0 50.0 - 100.0 100.0 > Do you have industrial flow in excess of 20% of total flow?* Yes No This field is hidden when viewing the formIndustrial flow in MGD3.. Total Miles of Sewer Sanitary & Combined. Do not include storm sewers.* 0 - 10 10 - 20 20 - 50 50 - 100 100 > 4. Pump Stations Under Control of Collection Systems Operatorsa. Standby power* Yes No b. Dry well station* Yes No c. Wet well station* Yes No d. Grit removal* Yes No e. Comminution* Yes No f. Bar rack* Yes No g. Aeration* Yes No h. Variable speed pumps* Yes No i. Number of stations* 2-4 5-10 10 > This field is hidden when viewing the formj1. Number of alarm systems 1 2-4 5-10 10 > j. Alarm systems Flow Personal Safety telecommunications Select All5. Flow Measurement in Collection Systems** Yes No 6. Inverted Siphons* Yes No 7. Combined Sewers* Yes No 8. Force Main* Yes No 9a. Chemical Additions - Hypochlorite* Yes No 9b. Chemical Additions - Gas* Yes No 9c. Chemical Additions - Other* Yes No Chemical Additions - Other (explain)10. Odor Control System* Yes No 11. SCADA System* Yes No 12. Oldest Part of System* Prior 1940 Prior 1960 Prior 1980 New 13. Mechanical Equipmenta. High Pressure jet truck* Yes No b. Mechanical rodder* Yes No c. Bucket Machine* Yes No d. Combination vacuum/jet truck* Yes No e. Closed circuit TV equipment* Yes No f. High pressure grouter* Yes No g. Other (be specific)14. Population Served by the Collection System* 1,500 or less 1,501-15,000 15,001-50,000 50,001 and greater 15. Does the collection system serve:* Municipality Industry Institution Other If "other" please explain16. Do the wastes received in your system present unusual problems? If so, explain: Do you currently hold a NEWEA issued Collection Systems Certification?*YesNoIf "yes", list grade level and date of issueAre you seeking Reciprocity to NEWEA regarding your certification/license from another state/organization?* Yes No If "yes", what state, grade and date of issue?If not currently employed in a collection system, why do you consider yourself qualified for certification?Please review the Collection Systems Brochure and select the grade of operator certification for which you qualify*select optionGrade IGrade IIGrade IIIGrade IVREFERENCESGive names and phone numbers of at least two persons, not relatives, who have knowledge of your character, experience, and ability.List your first reference's name and phone number*List your second reference's name and phone number*Agreement*I hereby certify that this application contains no willful misrepresentations or falsifications, and that the information given by me is true and complete to the best of my knowledge and belief. I further agree to abide by the provisions of the Certification Program of the New England Water Environment Association, Inc. I agree Acknowledgement*I hereby acknowledge that this application is complete and contains all pertinent information related to obtaining my Collection Systems Certification. I further acknowledge that once the review process is complete, if there is any additional information I wish to add I will need to fill out a new application, including the applicable fee. I acknowledge PAYMENTApplication Fees*select optionCollection System Application Fee - $75.00ReciprocityTotal Payment Method* Credit Card Purchase Order/Send Check Purchase Order/Check #*Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name Please hit submit ONCE and be patient. If you hit submit multiple times, you will be charged multiple times. Δ
