NC0089699_Rating Work Sheet_20170613

0
NPDES Permit Rating Work Sheet
SCORE SUMMARY
NPDES No.: 1 N! C I I v l 91 l 9! I
Factor
Description
Total Points
1
Toxic Pollutant Potential
3o
2
Flow/Streamfiow Volume
y
3
Conventional Pollutants
0
4
Public Health Impacts
/ 0
S
Water Quality Factors
to
6
Proximity to Near Coastal Waters
`S v
TOTAL (Factors 1 through 6)
S1. Is the total score equal to or greater than 80? ❑ Yes (Facility is a major) a No
S2. If the answer to the above question Is no, would you like this facility to be discretionary major?
❑ No
❑ Yes (Add 500 points to the above score and provide reason below:
Reason:
NEW SCORE:
OLD SCORE:
rQ-u a, IFv dvi gw z
Permit Reviewer's Name
('?Ifs to _ 6 3r7
Phone Number
Date
4

NPDES Permit Rating Work Sheet FACTOR 5: Water Quality Factors NPDES No.: 1 u I -C 1 d 10 111 (oo
16191 91
A. is (or will) one or more of the effluent discharge limits based on water quality factors of the receiving stream (rather than
technology -based federal effluent guidelines, or technology -based state effluent guidelines), or has a wastdoad allocation
been assigned to the discharge?
Code Points
tir Yes 1 10
❑ No 2 0
B. Is the receiving water In compliance with appllcabk water quality standards for pollutants that are water quality limited In
the permit?
Code Points
j� Yes 1 0
❑ No 2 5
C. Does the effluent discharged from this facility exhibit the reasonabk potential to violate water quality standards due to whole
effluent toxicity?
Code Points
❑ Yes 1 10
No 2 0
Code Number Checked: Al!I 6 i� I C I ZI xx
Points Factor 5: A 1/ 1 0 1+ B I L E + C I Q 1 =!—/ 161 TOTAL
FACTOR 6: Proximity to Near Coastd Waters
A. Base Score. Enter Now code here (from factor 2): I � I - I
Check appropriate facility HPRI Code (from PCS):
HPRI i
Code
HPRI Score
❑ 1
1
20
❑ 2
2
0
3
3
30
4
4
0
❑ 5
5
20
HPRI code checked: 1_I
Enter the multiplication factor that corresponds
to the Now code: I—I—1
Row Code Muitiplication Factor
11, 31, or 41
0.00
12, 32, or 42
0.05
13, 33, or 43
0.10
14or34
015
21 or 51
0.10
22 or 52
0.30
23 or 53
0.60
24
1.00
Base Score. (HPRI Score) x (MOtiplicatfon Factor) _ (TOTAL POINTS)
8. Additional Points — NEP Program C. Additional Points— Gnat Lakes Area of Concern
For a facility that has an HPRI code of 3, does the facility For a facility that has an HPRf code of S, does the fadlity
discharge to one of the estuaries enrolled In the National discharge any of the pollutants of concern Into one of the
Estuary Protection (NEP) program (see Instructions) or Great lakes' 31 areas of concern (see instructions)
the Chesapeake Bay?
Code Points Code Points
❑ Yes 1 10 ❑ Yes 1 10
❑ No 2 0 O No 2 0
Code Number Checked: A I_I 911 C t_I
Points Factor 6: A I_I_I � B I_I_j + C I i_I = t_�_I TOTAL
Cl