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Collection Systems Award Nomination Form

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Please complete all required fields!

To be eligible, submit your nomination (along with supporting documentation) by July 1.

Be sure to have supporting documentation ready to submit at the end.

Want to submit a nomination the old-fashioned way? Download the nomination form.

Fields marked with an (*) are required.

Section A: General Information

Organization(*)

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Mailing Address(*)

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City(*)

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State(*)

Please SelectAlabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho IllinoisIndiana Iowa KansasKentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri MontanaNebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon PennsylvaniaRhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

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Zip(*)

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Nominated By

Full Name(*)

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Title(*)

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Phone(*)

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Email(*)

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Alternate Contact(*)

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Alternate Phone(*)

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Next to System Info >

Section B: System Information

Average daily flow in millions of gallons(*)

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Maximum peak daily flow in millions of gallons(*)

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Total miles of sewer maintained (estimated)(*)

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Date original collection system was constructed(*)

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Date of latest collection system improvements(*)

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Total number of manholes (estimated)(*)

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Total number of lift stations(*)

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Number of collection system employees (including supervisor)(*)

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Number of collection system employees who are KWEA members(*)

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< Back to General InfoNext to Award Info >

Section C: Award Information

Number of personnel with ABC collection systems certification(*)

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Average number, per employee, of training hours and/or seminars for collection systems personnel(*)

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Number of reported system overflow discharge(s)(*)

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Does organization have a comprehensive plan for I&I and capacity issues?(*)

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Does organization have a collection system maintenance program?(*)

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Collection system O&M budget in dollars(*)

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Number of backups that were the responsibility of the municipality(*)

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Number of man hours lost due to injuries and/or accidents(*)

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Amount of Systems Inspected Annually:

Television(*)

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Lamp(*)

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Smoke (testing)(*)

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Manhole observation/inspection(*)

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Flow monitoring conducted(*)

Please selectYesNo

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Corrective Maintenance Used:

Rodding/cleaning(*)

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Installation of trenchless technology(*)

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Foaming/root control(*)

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Line replacement/sewer relief(*)

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Manhole adjustments/rehabilitation(*)

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Line repairs(*)

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Lines flushed annually(*)

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Other

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Lift Stations

Number of times checked per week(*)

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Check the items that apply to your lift stations(*)

Adequate spare parts inventory

Emergency plans are in place (e.g. back up power supplies, etc.)

Routine maintenance program is implemented (e.g. exercising valves, grease bearings, record keeping, etc.)

Remote monitoring (e.g. SCADA, telemetry, etc.)

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Safety

Check the safety items that are available and/or apply to your collection system operation(*)

Fully body harness

Ventilation blower

Hazardous gas detector

Tripod or lifting device

Self-contained breathing apparatus

Communication equipment (e.g. radios, mobile phone)

Regular safety meetings

Confined space entry program

Other (please explain)

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Other

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< Back to System InfoNext to Documentation >

Supporting Documentation

Please provide documentation and supporting information detailing outstanding and significant contribution in wastewater collection.

If preferred, you may email your supporting documentation to Alex Darby.

Documentation / Supporting Info

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