LAC 33:IX.1313. Treatment Works Treating Domestic Sewage Annual Fee Rating Worksheet

Invoice No._______________ ANNUAL FEE RATING WORKSHEET PERMIT NO.__________ 1. FACILITY COMPLEXITY DESIGNATION Primary SIC _______________ Other SIC __________ Complexity Designation = __________ I ( 0 points) __________ II (10 points) __________III (20 points) __________ IV (30 points) __________ V (40 points) __________ VI (50 points) COMPLEXITY DESIGNATION POINTS __________ 2. FLOW VOLUME AND TYPE A. Wastewater Type I Is total Daily Average Discharge greater than 60 mgd? _________Yes, then points = 30 _________No, then Points = 0.5 X Total Daily Average Discharge (mgd) Points = 0.5 X________ = ____________ Total Points = __________ B. Wastewater Type II Is total Daily Average Discharge greater than 5 mgd? ________Yes, then points = 50 ________No, then Points=10 X Total Daily Average Discharge (mgd) Points=10 X ________ = _____________ Total Points = __________ C. Wastewater Type III Is total Daily Average Discharge greater than 25 mgd? ________Yes, then points = 50 ________No, then Points=2 X Total Daily Average Discharge (mgd) Points=2 X ________ = ______________ Total Points = __________ FLOW VOLUME AND TYPE POINTS _______________ 3. TRADITIONAL POLLUTANTS A. BOD or Daily Average Load = _______  50 lb/day ( 0 points) _______ > 50-500 ( 5 points) _______ > 500-1000 (10 points) _______ > 1000-3000 (20 points) _______ > 3000-5000 (30 points) _______ > 5000 lb/day (40 points) COD or Daily Average Load = _______  100 lb/day ( 0 points) _______ > 100-500 ( 5 points) _______ > 500-1000 (10 points) _______ > 1000-5000 (20 points) _______ > 5000–10000 (30 points) _______ > 10,000 lb/day (40 points) BOD OR COD DEMAND POINTS __________ (whichever is greater) B. TSS Daily Average Load = _______  100 lb/day ( 0 points) _______ > 100-500 ( 5 points) _______ > 500-1000 (10 points) _______ > 1000-5000 (20 points) _______ > 5000–10000 (30 points) _______ > 10,000 lb/day (40 points) TSS POINTS __________ C. AMMONIA or (Alternative nitrogen parameter used) Daily Average Load = _______  200 lb/day ( 0 points) _______ > 200-500 ( 5 points) _______ > 500-1000 (10 points) _______ > 1000-5000 (20 points) _______ > 5000-10000 (30 points) _______ > 10,000 lb/day (40 points) AMMONIA POINTS _____________ TOTAL POLLUTANT POINTS _______________ 4. POTENTIAL PUBLIC HEALTH IMPACTS Is the receiving water to which the wastewater is discharged or a water body to which it is a tributary used as a drinking water supply source within 50 miles downstream? ________No (0 points) ________Yes, then … Complexity Designation _____I, II ( 0 points) _____III ( 5 points) _____IV (10 points) _____V (20 points) _____VI (30 points) POTENTIAL PUBLIC HEALTH IMPACT POINTS_______ 5. MAJOR/MINOR FACILITY DESIGNATION Has your facility been designated a major facility by the administrative authority? ________Yes, then Points = 25 ________No, then Were effluent limitations assigned to the discharge based on water quality factors in the receiving stream? ________No, then Points = 0 ________Yes, then Points = 5 TOTAL MAJOR/MINOR POINTS TOTAL RATING POINTS ASSIGNED