Looking for a Njdep Forms And Templates? Download it for free!

RAHWAY VALLEY SEWERAGE AUTHORITY

1050 EAST HAZELWOOD AVENUE

RAHWAY, NJ 07065

Phone (732) 388-0868 / Fax (732) 382-0774

NJPDES Permit #0024643

TREATMENT WORKS SEWER CONNECTION

CONSTRUCTION AND DISCHARGE PERMIT

(2001 – 7999 GPD)

RVSA #_____________________

The following sewer connection application form must be completed in lieu of a NJDEP Treatment Works Approval,

pursuant to N.J.A.C. 7:14A–22.4.

Owner/Applicant:______________________________________________ Telephone:______________________________

Email Address:_________________________________________________ Fax:____________________________________

Legal Address:____________________________________________________ Town:________________________________

State:_________________________ Zip Code:_______________ County:________________________________________

Project Engineer:________________________________________________ Telephone:______________________________

Email Address:__________________________________________________ Fax:___________________________________

Legal Address:____________________________________________________ Town:_______________________________

State:_________________________ Zip Code:_______________ County:________________________________________

Builder:________________________________________________________ Telephone:______________________________

Email Address:_________________________________________________ Fax:____________________________________

Legal Address:___________________________________________________ Town:________________________________

State:_________________________ Zip Code:_______________ County:________________________________________

Location of Worksite:_______________________________________________ Town:_______________________________

Name of Facility (if applicable):___________________________________________________________________________

State:_________________________ Zip Code:_______________ County:________________________________________

Tax Map Lot Number:_________________________________ Block Number:____________________________________

Description of Work:_____________________________________________________________________________________

________________________________________________________________________________________________________

Number and Type of Units (see attached page):______________________________________________________________

Nature of Proposed Discharge: Domestic_____________ Commercial_______________ Industrial_________________

Number of Employees if Commercial or Industrial:__________________________________________________________

1 of 2

Treatment Works Sewer Connection Construction And Discharge Permit Form - Rahway Valley Sewerage Authority