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Class D Water Operators License Questionnaire

Class D Water Operator's Questionnaire - Class D water operators applying for renewal must complete this questionnaire. Depending on the answers you provide below, you may or may not be able to renew your license.
1. Do you operate a surface water treatment system?   Check Yes or No


2. Do you operate a groundwater system under the influence of surface water?   Check Yes or No


3. Do you operate a groundwater treatment system with 250 or more connections?   Check Yes or No


4. Do you operate multiple groundwater systems and the cumulative number of connections is more than 250?   Check Yes or No


5. Are you an operator working at a groundwater treatment system serving a poplulation of 750 or more?   Check Yes or No.


6. Are you working as a supervisor, crew chief, or foreman in a distribution system with more than 250 connections?   Check Yes or No


7. Are you an operator at a surface water system, but ONLY perform water distribution system construction/maintenance or customer service inspection responsiblities?   Check Yes or No


8. Are you an operator at a groundwater system with 250 or more connections, but ONLY perform water distribution system construction/maintenance or customer service inspection responsibilities?   Check Yes or No


9. Are you an operator at a single groundwater system which has less than 250 connections?   Check Yes or No


10. Are you unemployed at this time?   Check Yes or No


If you answered "Yes" to questions 1 through 6, your Class D license is not renewable.  You must upgrade to the Class C license.  Do not renew your license.  Fees are not refundable.

AFFIDAVIT: By submitting this form I hereby certify under penalty of law that this form contains no willful or negligent misrepresentation or falsification and that all information is true, accurate and complete.  I understand that any misrepresentation or falsification may result in DENIAL of my application or REVOCATION of any license or registration issued as a result of this application.