240-25 Exibit A and B.pdf

WQM003-T D. CERTIFICATION BY THE WASTEWATER TREATMENT FACILITY OWNER Notes: This certification is required for applications that include a sewer connection/extension. This certification must be completed by the owner of the wastewater treatment facility receiving the wastewater identified in this application. Name of Facility/Site/Project: Certifying Statement: “I hereby certify that the committed flow to the below identified wastewater treatment plant does not exceed the presently permitted design capacity and, with the additional flow proposed by this application, the permitted design capacity is not anticipated to be exceeded. For the purposes of this certification, committed flow means the sum of the (1) actual metered flow, (2) flow from DEP approved TWA applications (not yet operational), and (3) flow from locally approved projects that do not require DEP approval. I further certify that the treatment plant is currently complying with its conventional and non-conventional NJPDES permit requirements (see N.J.A.C. 7:14A- 22.17(b)-(d), percent removal and toxicity requirements excluded from this certification) as determined by a rolling average of the three most recent monthly discharge monitoring reports that were required to be submitted to the Department as of this date, and based upon my assessment of all information pertinent to this permit request, is anticipated to continue to do so with the additional flow from this project.” Name of Wastewater Treatment Plant NJPDES Permit Number Name of Authority Accepting for Treatment Signature of Authorized Representative * Date Print or Type Name Print or Type Position Email Telephone * Authorization to sign for the agency: Resolution # Date (Note: Submit the resolution with this certification. If no such resolution granting authority to sign exists, the full resolution, consenting to the project, must be submitted with this certification.) Last Revised: 8/29/2023