NC0000175_Permit Rating Worksheet_20120228

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NPDES Permit Rating Work Sheet 0 kvular.MciltIon
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Reach Number: I I I I I I I I I I I I
Is this factlity a steam electric power plant (SiC=491 1) Is this permit for a municipal separate storm sewer
with one " more of the following characteristics? serving a population greater than 100,0007
1. Power output SOO MW or greater (not Using a cooling pond/lake)
2- A nuclear power plant ❑ YIES, smo Is 700 (stop here)
3. Cooling water discharge greater dun 25% of the receiving stream's 7Q10 flaw rate ❑ NO (continuo)
❑ YES, score Is 600 (stop here) ❑ NO (continue)
FACTOR 1: Toxic Pollutant Potential
PCs SIC code: I I I I I
Pflnvuy SIC Coda 111±1111,
Other SIC Codes: I I I I I
I I I I I I I
I I
Industrial Subcategory Code. I I I
I (Code 000 if no subcategory)
Determine the Toxicity potential from Appendix A. Be sure to use the TOTAL toxicity potential column and check one)
Toxicity Group Code Points
Toxicity Group Code Points
Toxicity Group Code
Points
❑ No process
❑ 3.
7. 7
35
wage streams 0 0
❑ 4. 4 20
us. a
40
1. d) (9
13s. 5 25
09. 9
45
❑ 2. 2 10
0 6. 6 30
❑ 10. 10
so
FACTOR 2: Flow /Stream Flow
Volume (Can,*9616, @Mor$ocftnA orSoaffim,11, chock a* am)
Section A —Wastewater Row Only Considered Section B-- Wastewater and Stream Flow Considered
Wastewater Type
Code Points Wastewater Type
Percent of Insburn Code
Points
(See Instructions)
(See Instructions)
wastewater Comen.
Type 1: Flow 4c 5 MCD
❑ 11 0
tration at Receiving
Flow S to 10 MGD
❑ 12 10
Stream Low Flow
Flow >10 to 50 MGD
O 13 20
Flow > 50 MCD
O 14 30 TYPE Vill:
CIO% 0 41
0
Type 11: Flow <1 MCD
❑ 21 10
210% to <50% 0 42
10
Flow I to 5 MGD
Flow >S to 10 MCD
0 22 20
❑ 23 30
25M 0 43
20
Flow >10 MCD
❑ 24 so. Type W
<10% O 51
. 0
Type III: Flow <1 MGD
0 31 0
ZIO%to<"%
Flow I to S MCD
❑ 32 10
Flow >5 to 10 MGD
❑ 33 20
❑ .40
a U S3
30
Flow >10 MCD
34
Code Checked horn Section A or 8:
&L,
Total tal Points Factor 2:
LLILI

B. Total Suspended Solids CMS)
sure to use the human health toxicity group column — check one below)
Toxicity Group Code Points Toxicity Group Code
Points
Toxicity Group
Code
Points
❑ No process ❑ 3. 3
Permit Umits: (check one)
❑
<100 Ibs/day
1
0
0
❑ B.
9
100 to 1000 ibs/day
2
�i,
Cl 9.
9
25
>1000 to 5000 Ibs/day
10
(jam
10
30
❑
>5000lbs/day
20
Code Checked: t_t
Points Scored:. l LI�
C. Nitrogen Pollutant: (check one)
❑ Ammonia
❑ Other.
NRrogen EquhWent
Code
Points
Permit Limits: (check one)
0
<300 Ibs/day
1
0
❑ '
300 to 1000 lbs/day
2
S
O
>1000 to 3000 Ibs/day
3
15
O
>3000lbs/day
4
20
Code Ctkcked .
tal Point: Fedor 3:1 1
FACTOR 4: Public Health ltlrlpac:t
Is there a public ddnking water supply located within 50 miles downstream of the effluent discharge (this Includes any body of
water to which the receiving water Is a tributary)? A public drinking water supply may Include InOitradon galledes, or other
methods of conveyance that ultimately get water from the above referenced supply.
❑ YES (if yes, check toxicity potential number below)
NO (If no, go to Factor S)
Determine the human hmkh toxicity potential from AppwWlx A. Use the same SIC code and subcategory reference as In Factor 1. (Be
sure to use the human health toxicity group column — check one below)
Toxicity Group Code Points Toxicity Group Code
Points
Toxicity Group
Code
Points
❑ No process ❑ 3. 3
0
❑ 7,
7
1 is
waste streams 0 0 " ' 4. 4
0
❑ B.
B
20
❑ I. 1 0 ❑ S. S
S
Cl 9.
9
25
❑ 2' 2 0 ❑ 6. 6
10
❑ 10.
10
30
C6& Number Checked: i I_-1
Total Points Factor 4: t_IQl
2

NPDES Permit Rating Work Sheet
FACTORS .Water Quality Factors NPOES No.: I N I GI o l o 14 I o 1/ 1 7151
Rt -
A. . is (or wile one or more of the diluent discharge !!nits based on water quality factors of the remWng steam (rather than
technology -based kderal effluent guideflna; or irchnology -based state dAuent gWdtlines), or has a wvstdoad allocation
been assigned to the discharge?
cAds
IM Yes ( C1DJ .
D No 2 0
R h the rec wing wager In comptlance with applicable water qualty standards forpolutants that are water quality United In
the Permit? _
Code Points
D Yes 1 0
No
C. Does the effluent discharged from this f adlity exhibit the reasonable potential to violate water quality standards due to whole
effluent toxicity?
14 Yes 10
D No 2 0
FACTOR 6: Proximity to New Coastal Waters
A. Base Score: Enter low code here (from Factor 2): Lf-, LL
Check appropriate facility HPRI Code (from PCS):
HPRI 0
Code
HPN Score
❑ 1
1
20
❑ 2
2
0 .
O 3
3
30
D 4
4
0
D S
S
20
HPRI code dwdced: L_1
(TOTAL POKM
Enter the muldplcadon factor that corresponds
to the Now code: k � e 1
Base scat: (HPRI score) 0 x (Multiplication Factor) . 3 y =
B. Additional Points — NEP Program
For a fadNty that has an HPRI code of 3, does the fadllty
discharge to one of the estuaries enrolled In the National
Estuary Protection (NEP) program (see Instructions) or
the Chesapeake Bay?
Flow Code MuMplkatfon Factor
11, 31, or 41
0.00
12, 32, or 42
US
13, 33, or 43
0.10
14 or 34
0.15
21 or St
0.10
22 or 52
0.30
23 or 53
0.60
24
1.00
D
(TOTAL POKM
C. Additional Points— Chat Lakes Area of Concern
For a fadlity that has an HPRI code of S, does the facility
discharge any of the pollutants of concern into one of the
Chat lakes' 31 areas of concern (see instructions)
Code Points Code Points
D Yes 1 10 ❑ Yes 1 10
D No 2 0 D No 2 0
:Cade NumberCh "- A I B ly _) : `r I
Points Factor a.. A I 1_t +' B I I
--r C F I;i : l :.: ,. I TOTAL
3

r
NEW SCORE:
OLD SCORE:
4
4` s Name p
/
Phone Number
,212 1 ?1Z4 i y
Date
NPDFS Permit Rating Work Sheet
NPDES NO.: 1,4 GI
SCORE SUMMARY
Faotor
Description Total Points
1
Toxic Pollutant PotentW
2
Flow/Streamflow Volume 8
3
Conventional Pollutants
4
Public Health Impacts b
S
water Quality Factors ZS
6
Proximity to Near Coastal Waters O
6 5
TOTAL (Factors, through 6)
Si. Is the total score equal
to or greater than 807 ❑ Yes (Facility Is a major) No
S2. M the answer to the above question is no, would you like this be lity to be discredonary major?
No
❑ Yes (Add S00 points to the above scone and provide reason below.
Reason:
NEW SCORE:
OLD SCORE:
4
4` s Name p
/
Phone Number
,212 1 ?1Z4 i y
Date