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Connecticut Department of Public Health Drinking Water Section CERTIFICATION EXAMINATION – SMALL WATER SYSTEM OPERATOR Examination has been scheduled for the certification as a Small Water System Operator. It will be held at the Department of Transportation (DOT), 2800 Berlin Turnpike, Newington, CT. They are scheduled as follows: Small Water System Operator - Tuesday, November 4, 2014, 9:30 a.m. Sections 25-32-7a through 14 of the Regulations of Connecticut State Agencies specify the minimum exam qualifications (education and experience). Regulations can be accessed on our website (go to www.ct.gov/dph/publicdrinkingwater” click on ““Drinking Water Topics A-Z,” then “R” then “Regulations,” then “www.ct.gov/eregulations “ then search on “Certification of Water Treatment Plant Operators”). The enclosed “Regulation Summary” document provides an outline of these minimum education and experience requirements. Qualified operators who are interested in taking an examination must submit a complete application (see enclosed application instructions) by September 22, 2014. APPLICATIONS POSTMARKED OR HAND DELIVERED AFTER THAT DATE WILL BE RETURNED. Please be sure that the application is complete, includes all applicable diplomas, and is signed by you and your Chief Operator and / or supervisor (as applicable). The original application must be submitted. A "fax" copy is not acceptable. An application fee of two hundred and twenty four dollars ($224), made payable to the “TREASURER, STATE OF CONNECTICUT” is required to be submitted with the application. The application fee cannot be refunded even if the applicant is found ineligible. Only checks (personal, certified check or money order) made out to the “TREASURER, STATE OF CONNECTICUT” in United States dollars will be accepted. All applicants will be notified in writing as to whether or not they will be allowed to sit for the examination. If the applicant is approved/confirmed for the exam an exam packet fee of forty one dollars ($41), must then be paid to the Association of Boards of Certification directly. The procedure for paying this exam packet fee will be specified in the exam confirmation letter. Please contact the Drinking Water Section, Enforcement & Certification Unit at (860) 509-7333 if you have any questions. Page | 1 Connecticut Department of Public Health Drinking Water Section CERTIFICATION EXAMINATION – SMALL WATER SYSTEM OPERATOR Application Instructions: Small Water System Operator Examination Qualified operators (see Education and Experience Requirements, page 6) who are interested in taking an examination must submit a complete application by the September 22, 2014 deadline. The CT Department of Public Health (CT DPH) will review each application to determine if the applicant has met the minimum requirements and each applicant will receive either a written confirmation letter, for their placement in the exam, or a letter of rejection, listing the reasons for rejection. The confirmation letter is needed for admittance into the examination site. Note the following: • Applications postmarked or hand delivered after the deadline and incomplete applications will not be accepted and will be returned. Re-submittals must also be submitted by the deadline. • The original application must be submitted. Copies, faxes or prior certification applications will not be accepted and will be returned. • Applications must be complete and must include the necessary application fee ($224), diplomas, transcripts and signatures. • Qualified applicants must submit completed pages 3 and pages 4 or 5. • If an examination application fails to provide all of the required information, an additional application fee is not required for re-submission, as long as the re-submission is postmarked or hand delivered on or before the application deadline. Page 3 APPLICANT’S CONTACT INFORMATION: Provide complete contact information as requested. The mailing address is the location where you wish to have all correspondence from the CT DPH mailed to. Should you change your contact information it is your responsibility to notify the CT DPH in writing. Note that the CT DPH frequently provides information updates (training course offerings, changes in policies, etc.) via e-mail. APPLICANT’S STATEMENT OF CERTIFICATION: It is the applicant’s responsibility to ensure that all information provided in the application is correct. APPLICANT’S CURRENT CT DPH CERTIFICATION STATUS: Provide the requested information. RE-APPLICATION: Check the below Re-application box if you are applying for an exam that you have previously been approved to take and indicate the prior exam date. DEMONSTRATE COMPLETION OF HIGH SCHOOL EDUCATION BY APPLICANT: Check off on the document, which is included with the application, that demonstrates that the applicant has completed a high school education. Page 4 Verification of Public Water System (PWS) Operator Work Experience: This page of the application is to be completed by the applicant’s Chief Operator and/or supervisor only if the applicant wishes to document the applicant’s water operator work experience of a particular PWS. This page is to be submitted by the applicant along with the rest of the application and is assessed by the CT DPH to determine whether the applicant has sufficient experience to be eligible for the examination and to responsibly operate a Small Water System. Check off only the activities the applicant routinely performed for the PWS and listed period. NOTE: CHECKING ALL ACTIVITIES ISN’T NECESSARY TO DEMONSTRATE A SUFFICIENT AMOUNT OF EXPERIENCE. Page 5 Demonstrate Educational Training as a Substitution for Experience: This page of the application is only to be completed by the applicant if the applicant has completed approved educational training and where the applicant requests the CT DPH evaluate this training towards meeting the minimum 6 months of water operator experience requirement. EXAMINATION FEES: An application fee of two hundred and twenty four dollars ($224), made payable to the “TREASURER, STATE OF CONNECTICUT” is required to be submitted with the application. The application fee cannot be refunded even if the applicant is found ineligible. Only checks (personal, certified check or money order) made out to the “TREASURER, STATE OF CONNECTICUT” in United States dollars will be accepted. William Sullivan Sanitary Engineer 3, CT DPH 410 Capitol Ave., MS#51WAT P.O. Box 340308 Hartford, CT 06134 All applicants will be notified in writing as to whether or not they will be allowed to sit for the examination. If the applicant is approved/confirmed for the exam an exam packet fee of forty one dollars ($41), must then be paid to the Association of Boards of Certification directly. The procedure for paying this exam packet fee will be specified in the exam confirmation letter. Page | 2 Connecticut Department of Public Health Drinking Water Section APPLICATION: CERTIFICATION EXAMINATION – SMALL WATER SYSTEM OPERATOR Examination Date: November 4, 2014 APPLICANT’S CONTACT INFORMATION Last Name M. Initial First Name Company Name (can be left blank) Address Line 1 (St. Address or P.O. Box #) Address Line 2 (Apt. #, Suite #, Box # - can be left blank) City ST Email Telephone Fax Cell Phone Social Security Number* Zip Date of Birth APPLICANT’S STATEMENT OF CERTIFICATION: I certify that the information that I have provided in this application is correct and I understand that any deceptive or fraudulent information is grounds for suspension, revocation, or any other disciplinary action set forth in section 19a-17 of the Connecticut General Statutes. ___ Applicant’s Printed Name Applicant’s Signature APPLICANT’S CURRENT CT DPH OPERATORR CERTIFICATION STATUS (Check all that apply) not currently certified active certification, or inactive certification Backflow Preventer Tester Tester/Inspector Date signed RE-APPLICATION Check Re-application box if you are applying for an exam that you have previously been approved to take and indicate the prior exam date: Re-application Prior exam date DEMONSTRATE COMPLETION OF HIGH SCHOOL EDUCATION One of the following documents must be submitted to demonstrate that the applicant has completed a high school level of education: (Check off one of the following the documents, which is to be included with this application) a copy of your high school diploma high school equivalency diploma (GED) high school or post-high school transcript post-high school diploma letter from high school verifying graduation Other: FOR STATE USE ONLY Date Stamp Substantiated Length of Experience: Substantiated Completion of High School Education: Written Test Score Issued Certification Number: Effective Date: Envl. Post Mark(PM) Date:______/____/______ Expiration Date: Attach Envl. If PM is after 9/22/14 Internal Check Number: Page | 3 Connecticut Department of Public Health Drinking Water Section APPLICATION: CERTIFICATION EXAMINATION – SMALL WATER SYSTEM OPERATOR Verification of Public Water System (PWS) Operator Work Experience Applicants Last Name: First: Applicants Job Title: Public Water System (PWS) ID: Name of PWS where applicant gained water operator experience: Length/Period of applicant’s experience operating the above named PWS Distribution System: DATES - From: To: (write in “To Present” if currently operating) Applicant’s Employment Status (during the length of time listed above) full time employee or part time ( hours/week) Check off only the activities the applicant routinely performed for the above named PWS and listed period. NOTE: CHECKING ALL BOXES ISN’T NECESSARY TO DEMONSTRATE THE REQUIRED AMOUNT OF EXPERIENCE. OPERATE Collect or Oversee the Collection of Water Samples Flush, Clean, Disinfect Distribution System Conduct or Oversee and Maintain a Record Of All Installations, Maintenance and Repairs to System Perform Routine Chemical/Turbidity Tests Review Test Results for Compliance With Established Standards Make Corrections Following Investigations of Water Quality and/or Quantity Problems Maintain and Arrange for the Calibration of Instrumentation Associated with the Operation of the Water System Respond To Emergencies According to an up to Date Emergency Response Plan Record, Where Meters Are Required, the Quantity And Instantaneous Flow of Water Maintain & Repair Piping & Storage Tank(s) Maintain & Repair Instrumentation Exercise Valves Replace Cartridge Filter Conduct Routine On-Site Inspections for Issues of Sanitary Significance or Potential Security Vulnerability ADMINISTRATION Complete Operation Reports/Data Entry (i.e. water quality, sampling site plan, well production logs, Consumer Confidence Reports) Issue Public Notifications Following Violations Respond to Customer Complaints Schedule Routine Maintenance Maintain Spare Parts & Chemical Inventory Prepare Budgets Prepare &/or Maintain Emergency Response Plans Evaluate PWS Compliance with Regulations and industry standards Keep Accurate Records Accompany CT DPH during Inspections / Sanitary Surveys Develop or Participate in the Development of Plans for the Installation or Modification of Wells, Storage Tanks, or Distribution System Piping Other (if necessary list other water operator work duties the applicant has routinely performed): ______________________________________________ ______________________________________________ ______________________________________________ CHIEF OPERATOR and/or SUPERVISOR VERTIFICATION: I verify that the applicant’s water operator experience as described on this page is correct and understand that if I am a certified operator, any deceptive or fraudulent information is grounds for suspension, revocation, or any other disciplinary action set forth in section 19a-17 of the Connecticut General Statutes. __ Printed Name Signature Title Date Phone Page | 4 Connecticut Department of Public Health Drinking Water Section APPLICATION: CERTIFICATION EXAMINATION – SMALL WATER SYSTEM OPERATOR Demonstrate Educational Training as a Substitution for Experience This page of the application is only to be completed by the applicant if the applicant has completed CT DPH approved educational training and where the applicant requests the CT DPH evaluate this training towards meeting the minimum 6 months of water operator experience requirement. Note the following summarizes the required experience and experience substitution requirements for applicants of the Small Water System Operator Examination: Small Water System Operator Required Experience: 6 months of experience in operation of a small water system, distribution system or treatment plant, Experience Substitution: 20 hours of training that is deemed acceptable to the DPH To meet the 20 hour training substitution requirement, the applicant must have attended training no more than three years prior to the date of the examination for which the applicant is applying and the training must include all of the following subject areas: • • • • • • • • • • Sources (including source protection) Basic water treatment (groundwater) Pumps Water quality Distribution system operation & maintenance (including cross connection control, disinfection, metering) Sampling Customer service Regulations Operator safety Management (financial, administration, personnel, emergency planning) Security issues shall be an integral part of the training and covered under the appropriate subject areas. List the educational training that the applicant request to be accepted towards meeting the above listed criteria. Dates School Location Training Course Name For individual college or training course work listed above, the applicant must include copies of transcripts or certificates (including course descriptions) along with this application. For earned college degrees a copy of the diploma or transcript, which documents the earned degree, must be submitted with the application. Page | 5 Connecticut Department of Public Health Drinking Water Section Regulation Summary: Education and Experience Requirements for Water Treatment Plant, Distribution System and Small Water System Operator Certification Examinations Reference: Section 25-32-7a to 25-32-14 of the Regulations of Connecticut State Agencies (RCSA) To become certified as a water operator (see Certified Operator Types and Levels below), individuals must pass an examination administered by the Connecticut Department of Public Health (DPH). In order to qualify for an examination an individual must meet the minimum education and experience requirements as specified below (see the referenced RCSA cited above). 1. Education Requirement: For all operator certification types and class levels the examination applicant must have a high school diploma or high school equivalency diploma. Education Substitution: For Small Water System examination applicants 6 months of experience in operation of a small water system, treatment plant or distribution system may be substituted for the education requirement. This cannot be the same 6 months used to satisfy the experience requirement. 2. Minimum Operational Experience Requirements: To be certified as a Water Treatment Plant, Distribution System or Small Water System Operator individuals must meet the minimum experience requirement described below. Certified Operator Types and Levels Small Water System Operator Required Experience: 6 months of experience in operation of a small water system, distribution system or treatment plant Experience Substitution: 20 hours of training that is deemed acceptable to the DPH Distribution System Class I Operator Required Experience: 1 year of experience in operation of distribution system(s) Experience Substitution: none Distribution System Class II Operator Required Experience: 2 years of experience in operation of distribution system(s) Experience Substitution: up to 1 year of educational training beyond high school in a field applicable to distribution systems may be substituted for an equal amount of required experience, however, 1 year of experience is required Distribution System Class III Operator Required Experience: 4 years of experience in operation of distribution system(s) Experience Substitution: up to 3 years of educational training beyond high school in a field applicable to distribution systems may be substituted for an equal amount of required experience, however, 1 year of experience is required Water Treatment Plant Class I Operator Required Experience: 1 year of experience in operation of Class I or higher Treatment Plant(s) Experience Substitution: none Water Treatment Plant Class II Operator Required Experience: a total of 2 years of experience in operation of Class II or higher Treatment Plant(s) and/or in “direct responsible charge” of Class I Treatment Plant(s) Experience Substitution**: up to 1 year of educational training beyond high school in a field applicable to water treatment may be substituted for an equal amount of required experience, however, 1 year of experience is required Page | 6 Connecticut Department of Public Health Drinking Water Section Regulation Summary: Cont. Water Treatment Plant Class III Operator Required Experience: a total of 3 years of experience in operation of Class III or higher Treatment Plant(s) and/or in “direct responsible charge” of Class II Treatment Plant(s) Experience Substitution**: up to 2 years of educational training beyond high school in a field applicable to water treatment may be substituted for an equal amount of required experience, however, 1 year of experience is required Water Treatment Plant Class IV Operator Required Experience: a total of 4 years of experience in operation of Class IV Treatment Plant(s) and/or in “direct responsible charge” of Class III Treatment Plant(s) Experience Substitution**: up to 3 years of educational training beyond high school in a field applicable to water treatment may be substituted for an equal amount of required experience, however, 1 year of experience is required ** =Wastewater experience may be accepted as “education in a field of study applicable to water treatment ” and substituted for experience as allowed by the regulations. The following conditions apply: 1) The applicant must be certified as a wastewater treatment operator, 2) 50% of the time of wastewater experience may be accepted as education; and 3) A minimum of one year of water treatment experience is still required to qualify for the examination. To become certified as a Operator-in-Training (OIT), for each of the Certified OIT Types and Levels listed below, individuals must pass an examination administered by the CT DPH. In order to take an examination an individual must meet the minimum education requirements as specified below (see the referenced RCSA cited above). 1. Educational Requirements: In order to qualify for an examination for each of the operator OIT certification types and class levels listed below, the applicant must have a high school diploma or high school equivalency diploma. Applicants must also have a “certificate of achievement in water management” from a Connecticut Community College or must have course equivalent, as determined by the department. Certified OIT Types and Levels Distribution System OIT Class I Distribution System OIT Class II Distribution System OIT Class III Water Treatment Plant OIT Class I Water Treatment Plant OIT Class II Water Treatment Plant OIT Class III Water Treatment Plant OIT Class IV Page | 7