APPLICATION FOR GCUA ENDORSEMENT FOR

NJDEP SEWER EXTENSION PERMIT (TWA)

Date: ________________

1. Municipality/MUA:

2. Project name:
 

3. Total number of units in project:       Total project flow:           GPD
 

Existing Development: New Development:
 

Provide Breakdown of number and types of structures being proposed:
 

Through which GCUA Metering Station will this flow be metered?
 

4. Name of Developer: (please print/type)
 

Name of Contact Person:

Address:

Telephone number:
 

5. Name of Project Engineer:

Name of Contact Person:

Address:

Telephone number:

6. Signature and seal of local Municipality/MUA certifying that this project has received approval for submission to the GCUA and the NJDEP:
 

Name:

Title:
 

GCUA Form #Con-94

1) GCUA's application form #CON-94 (original), signed by the local Municipality/MUA,

along with the Project Check List completed
 

2) Two (2) original signed and sealed (embossed) copies of NJDEP Treatment Works Approval Permit Application Form TWA-1
 

3) Two (2) copies of Notifications to Local Agencies by certified mail (return receipt requested)
 

4) Two (2) original signed and sealed (embossed) copies of NJDEP Form WQM-006, with

cost estimate attached. NOTE: Four (4) copies must be submitted when the project includes a metering station
 

5) Two (2) sets of construction specifications, each with original signatures and embossed seal. NOTE: Four (4) sets must be submitted when the project includes a metering station
 

6) Two (2) sets of final plans and profiles, originally signed and sealed (embossed) on each
sheet. NOTE: Four (4) sets must be submitted when the project includes a metering station
 

7) Two (2) original signed copies of NJDEP Statements of Consent Form, WQM-003. A
certified copy of the Resolution from the Municipality/MUA approving the project must be attached
 

8) Two (2) copies of GCUA Dry Sewer Affidavit with original signatures and Notary Public
on each copy

9) Two (2) Copies of U.S.G.S. Map with the project site appropriately outlined.
If applicable, attach certification from local engineer that project is located within the
delineated GCUA Service Area

10) GCUA Project Review Fee per attached Fee Schedule (make check payable to GCUA)
 

PLEASE NOTE: Completed applications must be received by GCUA no later than 10 days prior to any GCUA Board Meeting. (GCUA meetings are held on the 2nd and the 4th Wednesday of each month. Applications received after this time will be held until the next scheduled Public Meeting.    No sewage flow can be introduced into these sanitary sewer until the applicant applies for and receives an Allocation of Capacity from the GCUA and Operating Approvals from the local Municipality/MUA, the GCUA and the NJDEP, where applicable.

STEP 2

GCUA Allocation of Capacity

ALL projects having NJDEP Treatment Works Approvals issued after July 20, 1977 MUST
receive an Allocation of Capacity from the GCUA prior to the introduction of wastewater flow into the sanitary sewers.

An applicant may request an Allocation of Capacity for his project provided that the NJDEP Permit is valid (not expired) at the time of the request. (It is the Permittee's responsibility to ensure that the NJDEP Permit has not expired and that all Special Provisos of the Permit, if any, have been complied with at the time of his request to the GCUA).

The GCUA will grant Allocation(s) of Capacity in accordance with its Policy and Procedures in effect at the time the application is received. A copy of the Authority's prevailing Policy and Procedures may be obtained upon request.

Each application for Allocation of Capacity must be presented to the GCUA Board of Commissioners for approval at a scheduled Public Meeting. The following procedure will be strictly adhered to:

• Completed applications must be received no later that one (1) week prior to the scheduled Public Meeting. APPLICATIONS RECEIVED AFTER THIS TIME WILL BE HELD UNTIL THE NEXT MEETING.
• Incomplete applications will not be processed by GCUA until all information has been received.
• Applications will be processed by GCUA on a "First In, First Out" basis.

1)GCUA's application form #ALL-94 (original), signed and sealed by the local Municipality/MUA

2)Address List (use GCUA form #AL-1)

3)Proof of ability to begin construction of the project within 120 days of the date on which

the GCUA approves the applicant's request for an Allocation of Capacity. GCUA will

accept as adequate "proof of construction" a copy of any one (1) of the following:

a)an executed contract for construction of the sanitary sewer

b)a bond relative to the construction of the sanitary sewer

c)a sworn affidavit (notarized) that construction has been initiated

4)GCUA Construction Expansion Fees (In accordance with Schedule I)

Following approval of the application, the GCUA will issue a Construction Expansion Fund Permit(s) to the project owner. The necessary forms (for approval to operate the sewer system) will be forwarded by GCUA to the Municipality/MUA for endorsement of either a partial or final "operating permit".

Upon Completion of the project, application must be made to the local Municipality/MUA, GCUA and the NJDEP (when required by the NJDEP) for operation of the sanitary sewer system. In the case of partially completed projects, partial operation approval is required.

Approval to Operate (Partial)

• GCUA application form # OP-P-94 (original) signed and sealed by the local Municipality/ MUA
• Two (2) original copies of GCUA form OP-1, signed and sealed by the certifying engineer
• Two (2) original copies of GCUA form OP-2, signed and sealed by the local Municipality/MUA

• GCUA application form # OP-F-94 (original), signed and sealed by the local Municipality/MUA
• Two (2) original copies of NJDEP form WQM-005, signed and sealed by the certifying engineer
• Two (2) original copies of NJDEP form WQM-008, signed by the local Municipality/MUA

If you have any questions on any of the procedures outlined in these instructions please contact:
Eileen Grundlock, GCUA's Developing Projects Coordinator, at (609) 423-3500.

A: PROJECT INFORMATION
 

• Name of Project:

Existing Development New Development (circle one)

• Projected Flow: GPD

(portion for which this endorsement is requested)

• Number of connections (Domestic Consumer Units):

• Direct Connection to GCUA Interceptor? YES NO (circle one)

• If local connection, please indicate the metering station point at which flow will enter the GCUA Interceptor System (this information can be provided by the local sewer agency/MUA):

• Does the proposed sewer or water system traverse any GCUA easement areas?

B: PROJECT DESIGN INCLUDES: (CIRCLE YES or NO)

Pump Station and Force Main YES NO

Inverted Siphon YES NO

Grease Interceptor YES NO

Oil and / or Sand Trap: YES NO

Any form of Industrial Pretreatment YES NO

The above GCUA review fees are due and payable at the time of project submission.

NOTE: Class 3 and Class 4 projects may also require inspection by GCUA personnel. The applicant will receive a separate invoice for these costs.

- Refer to Instructions on Page 4 and Provide All Applicable Information. Please Print or Type.

• APPLICANT / OWNER*

 

Permanent Legal Address
 

City or Town State Zip Code

* Applicant/Owner should be the eventual owner of the proposed Treatment Works.
 

2. LOCATION OF ACTIVITY
 

Name of Facility/Site
 

Street Address/Location

Lot No. Block No.
 

City or Town State Zip Code
 

Municipality County

• NEW JERSEY LICENSED PROFESSIONAL ENGINEER

 

Name of Firm, if employee
 

Mailing Address

City or Town State Zip Code
 

Telephone ( ) Telefax ( )

• ESTIMATED CONSTRUCTION COST AND APPLICATION FEE

 

b. Application Fee $

(in accordance with N.J.A.C. 7:1C-1.5 et seq., made payable to Treasure, State of NJ, Environmental

Services Fund)

• OTHER REQUIRED PERMITS

Permit Type Application Status Application Date

(or Application No.)

Pending Approved*

(check one)
 

• Treatment Works Approval

 
• Exemption From Sewer Ban

 
• Water Quality Management Plan Amendment

 

• CAFRA

 
• Stream Encroachment

 
• Fresh Wetlands

 
• Tidal or Coastal Wetlands

 
• Waterfront Development

 
• NJDPES (DSW,DGW or SIU)

 
• Pinelands Certificate

 
• Delaware & Raritan Canal Commission

 
• Hackensack/Meadowlands Commission

 
• Other Related Approvals

 

• Project Description (Brief Description of Proposed Treatment Works and Intended Use)

• APPLICANT'S AGENT (Optional)

 

(Applicant /Owner's Name)

authorize to act as my agent/representative in all matters pertaining to my application the following person:
 

Name Position
 

Address City

State Zip Code Telephone ( )
 
 
 

Signature of Agent Date Signature of Applicant/Owner Date
 

• PROPERTY OWNER'S CERTIFICATION

 

(Property Owner's Name)

own the property in this application. As owner, I grant permission for the activity to be permitted under this application and authorize the Department of Environmental Protection to conduct on-site inspections,

if necessary. If the construction activity will take place in an easement, I certify that with this

application, I presently have or will obtain permission of the property owner (s) prior to initiation of

construction of this proposed treatment works.
 

Signature of Agent Date
 
 

Print or Type: Name and Position
 
 
 

• STATEMENT OF PREPARER OF PLANS, SPECIFICATIONS AND ENGINEER'S REPORT AND/OR ABSTRACT

 

Signature of Engineer Date

Print or Type: Name and Position
 
 
 

PROFESSIONAL ENGINEER'S

EMBOSSED SEAL

TWA - 1 Revision 2/97

• PROPER CONSTRUCTION AND OPERATION CLAUSE

 

be properly constructed and operated in accordance with the engineering plans, specifications and

conditions under which approval is granted by the Department of Environmental Protection.
 

Signature of Applicant/Owner Date

Print or Type: Name and Position
 
 
 

• CERTIFICATION BY APPLICANT/OWNER

 

criminal penalties for submitting false, inaccurate, or incomplete information, including fines and/or imprisonment.
 

Signature of Applicant/Owner Date

Print or Type: Name and Position

This form should accompany all Treatment Works Approval permit applications.
 

• General Information - (items #1 through #4, #6) Complete the requested applicant and

• Other Required Permits (items #5) - Please list all permits issued for the subject project (in addition to the permits being applied for at this time).
• Signature (items #7 through #11) - all signatures must comply with N.J.A.C. 7:14A-2.4 and N.J.A.C. 7:14A-22.8. Where indicated under items #1, #10 and #11, the applicant/owner should be the eventual owner of the proposed treatment works. Item #8 shall be completed by the owner of the property.