NJAW - Main Extension

Section 1 - Applicant's Information

Applicant *Party Entering Into Agreement

Applicant's Status *

If Other

Organized and existing under the laws of the State of *

Address

Street address *Street address line 2

City *

State / Province *

Postal / Zip Code *

Country

Contact Name

First name *

Last Name *

Phone Number *

E-mail *

Section 2 - General Project Information

Project Name *

Project Address or Closest Street:

Street address

City

State / Province

Postal / Zip Code

County *

Block & Lot Number(s) *

Type of Project *

If Other

Type Of Service Being Requested *

WaterSewerBoth

Proposed Size & Length of main (Water):

Proposed Size & Length of main (Sewer):

Does this project require (either by law or other) to be BID and constructed utilizing prevailing wage? *NOTE: “The determination of whether prevailing wage requirements apply is the sole responsibility of the developer, contractor, and their advisors. ” *

YesNo

Section 3 - Applicant's Engineering Information

Applicant’s Engineer (if applicable): *

Engineering Contact (Name): *

Engineering Firm: *

Engineer's Street Address:

Street address

City

State / Province

Postal / Zip Code

Engineer's Phone Number *Please enter a valid phone number.

Engineer’s E-mail: *

The Designated Primary Point Of Contact For This Project Is: *

The Applicant Contact Noted in Section 1The Engineering Contact Noted in Section 3

Section 4 - Main Extension Requirements

Proposed water system design must meet the Water Main Extension Design Requirements and Water Main Technical Specification.

The design plans must show: water mains, water laterals, sewer mains, sewer laterals storm sewers, electric, telephone, other utilities, hydrants, lot lines, easements, right-of-ways (public/dedicated or private/non-dedicated), roadways and structures.

Submit: One electronic copy of the water system design plans; as a PDF created from the AutoCAD drawings *

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Submit a brief Engineer’s Report summarizing the design of the project, and include site details [i.e., medical facility (# of beds), retail building (square footage), restaurant, pool, clubhouse, apartment units/buildings, # of stories, etc.]. *

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Sewer Main Extension Requirements / Checklist:

Applicable - If applicable, see above Main Extension Requirements, plusNot Applicable (If Not, Skip To Section 6)

If a Water Company Sewer Master Plan or Comprehensive Plan exists, the proposed facilities must meet the design and planning requirement of the Master Plan.

Does this project fall within the state’s CAFRA boundary line?

YesNo

If Yes, A determination letter from the NJDEP or a NJ licensed Engineer (signed and sealed) must be submitted with this application. Should a CAFRA Permit Be required, no installation work of sewer mains or services shall commence, until such time that the CAFRA Permit is issued.

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Section 5 - Estimated Demands

Demands: Complete and submit with this application the Demand Calculator Worksheet to support anticipated domestic water and sewer demands for the site.

Attached Completed Worksheet *

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Section 6 - Service Requirements

Please be aware of the cross connection and backflow requirements as listed here:
Note: If basement apartments are proposed, those services are to be included in the totals below.

	# of Domestic Services	# of Irrigation Services	# of Sewer Laterals	# of Fireline Services	# of Multi-use Services

1 inch

2 inch

4 Inch

6 Inch

8 Inch

Other

Is this project involved with any of the following activities that re categorized as high consumption? *

Section 7 - Fire Hydrants & Fire Flow Requirements

Fire Hydrants: Plans must show the location of all fire hydrants and identify as either Public or Private.

Number of Proposed New Public Fire Hydrants: *If none, put zero

Number of Proposed New Private Fire Hydrants:* *If none, put zero

Fire Flow Requirements: Complete and submit with this application the Fire Flow Calculation Worksheet to support municipal fire flow requirements for the site. If project is only residential, refer to “Table A” on the “sign-off” page of the worksheet.

Attached Completed Worksheet *

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Section 8 - Easements

Is Easement required?If no, skip to section 9

Plans should consider the limits of all necessary easements. Discussion with your New Jersey American Water Project Manager is recommended to properly locate and identify the general easement conditions.

For any area of the project in which water main is installed on private property and requires an easement, applicant is to provide a metes and bounds description(s) and corresponding survey map(s) prepared by a Licensed Surveyor describing the proposed easement(s).

Property Owner:

Owner's Status:

If Other

Organized and existing under the laws of the State of:

Property Owners Address

Street address

City

State / Province

Postal / Zip Code

Easement Site Location

Block & Lot Number(s)

County Location

Municipal location

Is there a Mortgagee on the property where the easement is required?

YesNo

Section 9 - Application Fee And Signature

All applications for main extensions will require a non-refundable application fee to be submitted along with the application.

Your NJAW project manager will contact you about how to complete this payment.

Application Fee (check all boxes that apply) *

$250 - If this is a Water or Sewer Main Extension to One Single Family Home.$1,000 - If the project includes both Water and Sewer Main Extensions from NJAW$2,500 - If this is a Main Extension to all Other Residential, Commercial or Other Property.$2,500 - If a NJDEP BWS&WP Permit (including Master Permit) or TWA Permit is needed.

Total Application Fee Required *

By signature below, I certify that the information provided in this application is true, accurate, and complete.

Name: *Person Completing the Application

Title: *

Date Of Signature *

Signature *

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