La. Admin. Code tit. 33 § IX-1317
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 400 m?
_________Yes, then points = 200
_________No, then
Points = 0.5 X Total Daily Average Discharge (mgd)
Points = 0.5 X ________ = _______
Total Points = __________
Points =10 X Total Daily Average Discharge (mgd)
Points =10 X ________ = ________
Total Points = __________
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)
_______ > 500-1,000 (10 points)
_______ > 1,000-3,000 (20 points)
_______ > 3,000-5,000 (30 points)
_______ > 5,000 lb/day (calculate)
Points = 0.008 X Daily Average Load (lbs.)
Points = 0.008 X ________ = ________
COD or
Daily Average Load =
_______ < 100 lb/day ( 0 points)
_______ > 100-500 ( 5 points)
_______ > 500-1,000 (10 points)
_______ > 1,000-5,000 (20 points)
_______ > 5,000-10,000 (30 points)
_______ > 10,000 lb/day (calculate)
Points = 0.004 X Daily Average Load (lbs.)
Points = 0.004 X ________=________
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 (calculate)
Points = 0.004 X Daily Average Load (lbs.)
Points = 0.004 X ________ = ________
TSS POINTS __________
Total Annual Discharge to Water = ____________ (lbs.)
Points = 0.01 X Annual discharge (lbs.)
Points = 0.01 X __________ = ________
TOXIC POINTS ________
TOTAL POLLUTANT POINTS _______________
Heat Load = Average Summer flow (mgd) X [DELTA]T X 0.00834
where [DELTA]T = Permit Limit (Max. Temp.) -70°
Heat Load =_____(mgd) X____X
0.00834= ______ Billion BTU
Heat Load =
_______ < 4 billion BTU ( 0 points)
_______ > 4-20 billion BTU ( 5 points)
_______ > 20-100 billion BTU (10 points)
_______ > 100-200 billion BTU (15 points)
_______ > 200 billion BTU (20 points)
HEAT LOAD 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-1317