240-25 Exibit A and B.pdf

WQM003-T Important Note: A separate Certification C must be submitted for each wastewater conveyance system owner impacted by the project. Certification D: Wastewater Treatment Facility Owner Consistent with N.J.A.C. 7:14A-22.6(a)5 and 22.8(a)3, consent from owner of the receiving wastewater treatment plant associated with the project must accompany TWA applications. Note: This certification is only 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 the TWA application. For this certification, provide the name of the facility/site/project and the wastewater treatment facility owner. In addition, the authorized representative must provide the necessary certifying information. This information includes their signature, date of signature, printed name, and position. This section must also include the resolution number and date authorizing the representative to certify for the wastewater treatment facility owner. The resolution must be submitted with this form. If no such resolution granting authority to sign exists, the full resolution, consenting to the project, must be submitted with this form. Certification E: Certification by the District Sludge Management Lead Planning Agency Consistent with N.J.A.C. 7:14A-22.6(a)5 and 22.8(a)3, consent from the district sludge management lead planning agency associated with the project must accompany TWA applications. Note: This certification is only required for projects that involve construction of residual management units at ultimate residuals management sites. For this certification, provide the name of the facility/site/project and the district sludge management lead planning agency. In addition, the authorized representative for the agency must provide the necessary certifying information. This information includes their signature, date of signature, printed name, and position. This section must also include the resolution number and date authorizing the representative(s) to certify for the agency. The resolution must be submitted with this form. If no such resolution granting authority to sign exists, the full resolution, consenting to the project, must be submitted with this form. Additional Information • Approvals, permits, service contracts, or other reservations of

ng authority to sign exists, the full resolution, consenting to the project, must be submitted with this form. Additional Information • Approvals, permits, service contracts, or other reservations of flow capacity issued or agreed to by any participating municipality or sewerage agency do not constitute the required approval of the DEP. • Pursuant to the NJPDES regulations (N.J.A.C. 7:14A), no application shall be submitted to the DEP if the wastewater treatment facility is not meeting its discharge permit requirements. For computation of actual flow at the receiving wastewater treatment plant, the average flow processed by the facility for the three (3) month period immediately preceding the submission of the application shall be used. • Any document issued by a sewerage authority or municipality which is a tentative, preliminary, or conditional approval shall not be considered a statement of consent. • If an applicant is unable to obtain the required consent from the governing body (Certification A above) or the sewerage authority (Certification B above), they may choose to follow the procedures set forth in N.J.A.C. 7:14A-22.8(a)3v. A completed form, along with accompanying materials, should be submitted to the address identified below and must contain the original wet-ink signatures: Mail Code: 401-02B NJDEP - Division of Water Quality Bureau of Ground Water, Residuals and Permit Administration Permit Administration Section PO Box 420 Trenton, NJ 08625-0420 IMPORTANT NOTICE: False statements, representations, or certifications, in any application, record, or document are subject to fines and penalties as set forth in the Water Pollution Control Act (N.J.S.A. 58:10A- 10F 2 and 3). Last Revised: 8/29/2023 Instructions Page 2 of 2