La. Admin. Code tit. 33 § IX-1313
Invoice No._______________
ANNUAL FEE RATING WORKSHEET
PERMIT NO.__________
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 __________
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 = __________
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 = __________
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 _______________
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)
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 __________
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 _______________
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_______
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 _______
La. Admin. Code tit. 33, § IX-1313