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VI TPDES Permit Fee Form Updated 8/27/2020 1 DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION WATER CONTROL PROGRAM USVI Territorial Pollution Discharge Elimination System (TPDES) Application Fees and Annual Discharge Fees for Individual TPDES Permit This form is used when paying application and annual discharge fees for an individual TPDES permit. 12 VIRR § 184-35(b) requires permit applicants and permittees to pay: ▪ an application fee when applying for a new or renewed TPDES permit; • an annual discharge fee each year (or partial year) in which the permit is in effect; and • a special fee when applying for certain modifications to an existing permit. I. FEE PAYMENT: After you have completed section V below (Determining Your Fee Payment) complete this section to indicate the type of fee you are paying and the amount. I am paying (check one): ☐ an application fee because I am applying for a new or renewed TPDES permit ☐ an annual discharge fee ☐ a special application fee to modify a TPDES permit The amount of my fee is [enter number determined below in section V (Determining Your Fee Payment). $_______________ Submit your fee payment and this completed form by either hand delivering them to DPNR-DEP before going to the DPNR Cashier’s office OR by mailing them to one of the following addresses: DPNR-DEP DPNR-DEP ATTN: WPC Program ATTN: WPC Program CW Turnbull Public Library #45 Mars Hill 4607 Tutu Park Mall Frederiksted, VI 00840 St. Thomas, VI 00802 Make checks payable to: Department of Planning and Natural Resources DPNR will send receipts for payments submitted by mail. II. PERMIT TRACKING TPDES Permit Tracking Number (if known) III. FACILITY OPERATOR INFORMATION Operator Point of Contact Information First Name, MI, Last Name Title Phone Email VI TPDES Permit Fee Form Updated 8/27/2020 2 Secondary Contact Name/Title (if applicable) Secondary Contact Email IV. FACILITY INFORMATION Facility Name Facility Physical Address V. DETERMINING YOUR FEE PAYMENT: Check the box for the type of fee you are paying (new permit or permit renewal, annual discharge fee, or special application fee for permit modification) and then follow the directions in that section to determine your fee. Check the appropriate fee and enter the information requested. ☐ APPLICATION FEE FOR NEW PERMIT OR PERMIT RENEWAL Due when you submit your permit application to DPNR. Information provided below should match information provided on your permit application. ☐ I am a public school. Enter this amount in Section I above. $0 If you are not a public school, follow steps 1 through 4 below to calculate the normal application fee. 1. Enter your maximum daily discharge flow in gallons per day. This should be the combined total of the maximum daily discharge flows from all outfalls combined. Maximum daily discharge flow is the maximum design flow or estimated engineered maximum flow that is capable of being discharged from the system. It shall be based on the permit application and permitted levels. 2. Using your maximum daily discharge flow reported above, look up your application fee listed on Table 1 (below) and enter that amount. 3. Enter $500 if your permit has a mixing zone or $0 if your permit does not have a mixing zone. 4. Add lines 2 and 3 and enter it to the right. This is the NORMAL PERMIT APPLICATION FEE for a new or renewed permit. ☐ I am a private school, municipality, or church or other religious organization. If the form does not automatically fill in a number to the right, multiply your Normal Permit Application Fee from line 4 by 0.15 and enter that amount. This is your Application Fee. Enter it in Section I above. ☐ I am not a public school, private school, municipality, or church or other religious organization. If the form does not automatically fill in a number to the right, enter the Normal Permit Application Fee from line 4. This is your Application Fee. Enter this amount in Section I above. 0 $0.00 0 VI TPDES Permit Fee Form Updated 8/27/2020 3 ☐ ANNUAL DISCHARGE FEE: Effective and due on October 1, 2020, an annual discharge fee is required for each permittee conducting operations. Each year after, the annual discharge fee is due on March 31. For the first year you are covered by a permit, if the coverage starts after February 1, the annual fee is due 60 days after the date coverage starts. The information you supply below should match data reported on your discharge monitoring reports (DMRs). ☐ I am a public school. No fee. Enter this amount in Section I above. $0 If you are not a public school, follow steps 1 through 10 below to calculate your average daily discharge flow and Normal Annual Discharge Fee. All discharge amounts and volumes are for the prior calendar year and should be entered in gallons per day. If your facility was not in operation in the prior calendar year or you anticipate significant variations in discharge amounts from the prior year, please contact DPNR for further directions. 1. Enter your average daily discharge flow for the prior calendar year 2. My average daily volume of wastewater discharged through an approved irrigation or land application infrastructure is__________ gallons per day. If the form does not automatically fill in a number to the right, enter the number that is 0.5 times the number you entered in this box. 3. My average daily volume of wastewater from systems producing potable water is __________ gallons per day. If the form does not automatically fill in a number to the right, enter the number that is 0.5 times the number you entered in this box. 4. My average daily volume of wastewater used as once-through non- contact cooling water is ________________ gallons per day. If the form does not automatically fill in a number to the right, enter the number that is 0.75 times the number you entered in this box. 5. My average daily volume of the wastewater determined by DPNR to be flow-through discharge is _________________ gallons per day. DO NOT ENTER a number in this box unless you have received DPNR’s approval to do so. If the form does not automatically fill in a number to the right, enter the number that is 0.99 times the number you entered in this box. 6. If your average daily discharge flow entered on line 1 includes average stormwater discharge that is covered by a VI MSGP or VI CGP, then enter that stormwater discharge amount to the right in gallons per day 7. This is your Average Daily Discharge Flow that will be used to determine your annual discharge fee. If the form does not automatically fill in a number to the right, subtract the numbers in the far-right column in lines 2 through 6 from that in line 1 and enter that number to the right. 8. Enter the Permit Fee amount listed in Table 2 (below) for the Average Daily Discharge Flow in line 7. 9. Enter $500 if your permit includes a mixing zone and $0 if it does not. 10. This is your NORMAL ANNUAL DISCHARGE FEE. If the form does not automatically fill in a number to the right, add the numbers in the far-right column in lines 8 and 9 and enter that number to the right. 0.00 0.00 0.00 0.00 0.00 0 VI TPDES Permit Fee Form Updated 8/27/2020 4 ☐ Full year fee: I will have a permit in effect for each month during the current calendar year. If the form does not automatically fill in a number to the right, enter your Normal Annual Discharge Fee (the amount in line 10). This is your Annual Discharge Fee. Enter it in Section I above. ☐ Partial year fee : I will have a permit in effect for only __________ months during the current calendar year. If the form does not automatically fill in a number to the right, enter the amount that is your Normal Annual Discharge Fee (the amount in line 10) times the number of months your permit will be in effect for the current calendar year divided by 12. This is your Annual Discharge Fee. Enter it in Section I above. ☐ I am a private school, municipality, or church or other religious organization, and my permit will be in effect for each month during the current calendar year. If the form does not automatically fill in a number to the right, enter the amount that is the Normal Annual Discharge Fee (the amount in line 10) times 0.15. This is your Annual Discharge Fee. Enter it in Section I above. ☐ I am a private school, municipality, or church or other religious organization, and my permit will be in effect for only ___________ months during the current calendar year. If the form does not automatically fill in a number to the right, enter the amount that is the Normal Annual Discharge Fee (the amount in line 10) times 0.15 times the number of months your permit is in effect this calendar year divided by 12. This is your Annual Discharge Fee. Enter it in Section I above. NOTE: If your permit expires this year and you are renewing it, your permit is considered to be in effect for the full year for purposes of calculating your annual discharge fee. If your operations and discharges changed dramatically under the renewal permit, please contact DPNR for guidance. ☐ SPECIAL APPLICATION FEE FOR PERMIT MODIFICATIONS: Due when you apply to modify your permit at any time other than during permit renewal. ☐ I am making a minor modification (as set forth in 12 VIRR 184-75 (reprinted below)). No fee. Enter $0 in Section I above. $0 ☐ I am a public school. Enter $0 in Section I above. $0 If you are not a public school and you are making a permit modification that is not a minor modification, follow steps 1 through 4 below to calculate your Normal Special Application Fee. Then check the appropriate box and fee below that. 1. Enter the maximum daily discharge flow in gallons per day for your permit as modified. 2. Using your maximum daily discharge flow reported in line 1, look up the application fee listed on Table 1 (below) and enter that amount. 3. Enter $500 if your permit has a mixing zone or $0 if it does not. 4. This is your NORMAL SPECIAL APPLICATION FEE for a permit modification. If the form does not automatically fill in a number to the right, add the numbers in the far-right columns in lines 2 and 3 and enter this number to the right. 0 Select Select $0.00 $0.00 $0.00 0 VI TPDES Permit Fee Form Updated 8/27/2020 5 ☐ I am making a permit modification that involves an antidegradation determination and/or an increase in permitted capacity. If the form does not automatically fill in a number to the right, enter the Normal Special Application Fee from line 4. This is your Special Application Fee. Enter this amount in Section I above. ☐ I am making a permit modification that does not involve an antidegradation determination and that does not increase my permitted capacity. If the form does not automatically fill in a number to the right, multiply the Normal Special Application Fee (line 4) by 0.5. This is your Special Application Fee. Enter this amount in Section I above. ☐ I am a private school, municipality, or church or other religious organization, and I am making a permit modification that involves an antidegradation determination and/or an increase in permitted capacity. If the form does not automatically fill in a number to the right, multiply 0.15 by the Normal Special Application Fee (line 4). This is your Special Application Fee. Enter this amount in Section I above. ☐ I am a private school, municipality, or church or other religious organization and I am making a permit modification that does not involve an antidegradation determination and does not increase my permitted capacity. If the form does not automatically fill in a number to the right, multiply 0.15 by the Normal Special Application Fee (line 4) and then divide by 2. This is your Special Application Fee. Enter this amount in Section I above. CERTIFICATION I certify under penalty of law that this document and all attachments (if any) were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Name Title Signature Date Email FOR INTERNAL DPNR USE ONLY: Payment received by: ☐ mail ☐ in person ☐ Payment of $__________ sent to Cashier’s Office by ______________________ on ____________ ☐ Receipt sent to permittee by _______________________________ on ______________ ☐ Fee determination verified by ______________________________ on ______________ ☐ Fee payment recorded in data base by _______________________ on ______________ ☐ Form filed by ____________________________________________ on __________________ 0 $0.00 $0.00 $0.00 VI TPDES Permit Fee Form Updated 8/27/2020 6 TABLE 1 APPLICATION FEE MAXIMUM DAILY DISCHARGE FLOW (Gallons Per Day) APPLICATION FEE (USD) 0-1,000 $50 1,001 to 10,000 $100 10,001 to 50,000 $500 50,001 to 100,000 $1,100 100,001 to 1,000,000 $2,200 1,000,001 to 5,000,000 $3,300 5,000,001 to 10,000,000 $4,400 10,000,001 to 40,000,000 $5,500 40,000,001 to 100,000,000 $6,600 greater than 100,000,000 $7,700 Minor modifications are defined in 12 VIRR 184-75 as modifications that only: (a) Correct typographical errors; (b) Require more frequent monitoring or reporting by the permittee; (c) Change an interim compliance date in a schedule of compliance, provided the new date is not more than 120 days after the date specified in the existing permit and does not interfere with attainment of the final compliance date requirement; or (d) Allow for a change in ownership or operational control of a facility where the Director determines that no other change in the permit is necessary, provided that a written agreement containing a specific date for transfer of permit responsibility, coverage, and liability between the current and new permittees has been submitted to the Director. (e) Delete a point source outfall when the discharge from that outfall is terminated and does not result in discharge of pollutants from other outfalls except in accordance with permit limits. (f) Incorporate conditions of a POTW pretreatment program that has been approved in accordance with the procedures in 40 CFR 403.11 (or a modification thereto that has been approved in accordance with the procedures in 40 CFR 403.18) as enforceable conditions of the POTW's permits. TABLE 2 ANNUAL DISCHARGE FEE AVERAGE DAILY DISCHARGE FLOW (Gallons per Day) ANNUAL DISCHARGE FEE 0-1,000 $250 1,001-10,000 $500 10,001 to 50,000 $1,000 50,001 to 100,000 $1,400 100,001 to 250,000 $1,700 250,001 to 500,000 $2,250 500,001 to 1,000,000 $5,500 1,000,001 to 2,000,000 $7,250 2,000,001 to 5,000,000 $10,000 5,000,001 to 10,000,000 $15,500 10,000,001 to 20,000,000 $22,250 20,000,001 to 40,000,000 $31,500 40,000,001 to 100,000,000 $42,250 greater than 100,000,000 $55,000