ETA 6-39 Inspection of Waste Water Treatment Facilities

OJC 6-39

JOB CORPS ENVIRONMENTAL HEALTH PROGRAM

INSPECTION OF WASTEWATER TREATMENT FACILITIES

_______________________________________________________
Center Name

OMB Control Number: 1205-0219
Expires: xx/xx/xxxx

________________________________________________________________
Center Director

_________________________________________

________________________________________________

Center Address

Year/Quarter (for example, 2008/1 QTR)

This inspection report is not required of centers utilizing a state-approved municipal supply. Indicate nature of facilities by checking below all that apply:

√
1.
2.
3.
4.
5.
6.

√
Septic tank and drainfield
Oxidation pond or nonaerated lagoon
Mechanical aerated lagoon
Evapotranspiration system
Primary settling
Trickling filter

ITEM
OPERATION
*14. All units operating satisfactorily (discuss specific
violations below)
15. Operator checks facility daily and has necessary
certification
16. Equipment in good repair
*17. All units enclosed by fence
18. Control of weed growth; no sludge deposit or build-up
19. Sludge disposed of in approved manner
20. No insect breeding, odors, or other nuisance
21. Operation logs maintained daily with all chemical usage
recorded
EFFLUENT
*22. Effluent meets discharge permit standards+
23. All effluent parameters measured and recorded as
required by discharge permit
24. Discharge volume recorded daily
25. Effluent disinfected as required
SEPTIC TANKS AND DRAINFIELDS
26. Septic tank cleaned regularly
*27. Sewage drainfield operating properly with no liquid
breaking through to ground surface

7.
8.
9.
10.
11.
12.
13.

Activated sludge
Coagulation - flocculation
Phosphorous removal
Filtration
Disinfection - chlorine or other
Land treatment
Other (specify)

WT.
10
7

ITEM
28. Provide the following information. If not available or not measured,
please indicate. (This item has zero weight.)
Extreme and average effluent BOD recorded during the last 3 months.

5
8
3
3
3

Minimum

Average
mg/L
Date

mg/L
Date

Maximum
mg/L
Date

Extreme and average effluent suspended solids recorded during the last
3 months.

5

Minimum
15

Average
mg/L
Date

mg/L
Date

Maximum
mg/L
Date

7
29. Provide the following information. (This item has no weight.)

5
9

a.

Name of operator in charge:
_________________________________________

b.

Laboratory or individual conducting effluent testing:
_________________________________________

c.

Permit effluent standards+

5
15

SCOREa (100 less total weight of violations)
______________

BODSSColiformOtherComments:

________

________
Items circled above are violations found on this date and must be corrected by next inspection or earlier.
*Critical items requiring immediate corrective action by Center Director.
+Standards for discharge of waste into receiving streams are those determined by state authorities in conjunction with the U.S. Environmental Protection
Agency (NPDES permit).
a
A score less than 100 requires follow-up correspondence from the Center Director to the National Office of Job Corps and Regional Office with this
inspection report detailing necessary corrective action and proposed schedule for completion.
Inspection Date: __________________________________

Inspected By:

____________________________________

Agency or Company: ______________________________
I, the Center Director or designee, have received a copy of this report and understand its contents.
__________________________________________________________________________________
SIGNED

TITLE

FORWARD SCANNED FORM AND CORRECTIVE
ACTION WITHIN 7 DAYS OF INSPECTION TO:
U.S. Department of Labor/Office of Job Corps
E-mail: safety@jobcorps.org

OJC 6-39
June 2008

INSPECTION OF WASTEWATER TREATMENT FACILITIES
1.

Purpose. The purpose of this form is to provide Job Corps with a quarterly record of the
performance and health evaluation of Job Corps centers’ wastewater treatment facilities.
This report is not required where waste is discharged into municipal type sewers that
receive minimum treatment as required by the Environmental Protection Agency.

2.

Originator. This form is completed by an appropriate representative of an authorized
public health agency or another qualified environmental health specialist, other than
center-related personnel, selected by the Center Director.

3.

Frequency. Quarterly by December 31, March 31, June 30, and September 30 and any
additional time that conditions may warrant.

4.

Distribution. This form may or may not be a multi-copy form. The original copy is
retained by the center for action purposes. Duplicates of the original should be made and
forwarded to (1) the National Office of Job Corps, (2) the Regional Office of Job Corps, (3)
agency or contractor operator office, and (4) the contracted inspector, if requested.

5.

General Instructions. This form consists of two pages—an inspection form and
instructions. Each item of the inspection form should be completed by the authorized
person performing the inspection.

6.

Detailed Instructions. Self-explanatory.

7.

Disposition. Each recipient of this form is to maintain it on file for a period of 3 years, and
then destroy.

Public Burden Statement: Persons are not required to respond to this collection of information unless it displays a currently valid OMB control
number and expiration date. Public reporting burden for this collection of information, which is required to obtain or retain benefits (29 USC
2881), is estimated to average 75 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. This information collection is for program
management and Congressional reporting purposes. Send comments regarding this burden estimate or any aspect of this collection of
information, including suggestions for reducing the burden, to the U.S. Department of Labor, Office of Job Corps, Room N-4507, Washington, D.C.
20210 (Paperwork Reduction Project 1205-0219).