Backup Documents 01/22/2013 Item #16D6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO b
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2. Jennifer B. White, ACA Office located in HHVS Z '2 0 ►3
County Attorney Office Department
3. BCC Office Board of County S`c'^e..43
Commissioners �� V:*
4. Minutes and Records Clerk of Court's Office 3rd /(3
I'm
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Hailey Alonso Public Service Division Phone Number 252-8468
Contact/ Department
Agenda Date Item was 1/22/13 f Agenda Item Number 16D6
Approved by the BCC
Type of Document Resolution Number of Original 2
Attached Ab — 2 O Documents Attached
PO number or account `A
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? Y
2. Does the document need to be sent to another agency for additional signatures? If yes, N
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters, must be reviewed and signed -
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NIA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the f7
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's �,.�
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE. ��
Some documents are time sensitive and require forwar 'ng to Tallahassee within a certain 5yi
�
time frame or the BCC's actions are nullified. Be aw a of your deadlines!
8. The document was approved by the BCC on I/2? (inter date)and all changes made
during the meeting have been incorporated in the ttached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the �`A'
BCC,all changes directed by the BCC have been made,and the document is ready for t'e YV
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1606
MEMORANDUM
Date: March 1, 2013
To: Hailey Alonso, Operations Analyst
Public Services Division
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Resolution 2013-20: County Health Dept. Fees, Rates and Charges
Attached is the original document to the agreement referenced above (Item #16D6)
approved by the Board of County Commissioners on January 22, 2013.
The Minutes and Record's Department will hold the second original of this document in the
Board's Official Records.
If you have any questions, please contact me at 252-8411.
Thank you.
Attachment (1)
1606
RESOLUTION NO. 2013- 2 0
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA, SUPERSEDING RESOLUTION NO.
2004-66 AND ALL PRIOR RATE RESOLUTIONS AND SCHEDULES
FOR THE DEPARTMENT OF HEALTH AND ESTABLISHING THE
FEES, RATES AND CHARGES FOR SERVICES RENDERED BY THE
COUNTY HEALTH DEPARTMENT.
WHEREAS, under the authority of Section 154.06 of the Florida Statutes, The
Department of Health may establish fee schedules for public health services rendered through the
Health Department.
WHEREAS, said statutory authority grants the Department of Health the power to
assess fees, co-payments, sliding fee scales, fee waivers and fee exemptions.
WHEREAS, the funds collected under Section 154.06 of the Florida Statutes shall be
expended solely for the purpose of providing health services and facilities within the county
served by the county health department. Fees collected by the county health department pursuant
to department rules shall be deposited with the Chief Financial Officer and credited to the
County Health Department Trust Fund.
WHEREAS, the fees collected by the county health department for public health
services or personal health services shall be allocated to the state and the county based upon the
pro rata share of funding for each service.
WHEREAS, the Board of County Commissioners, shall provide for the transmittal of
funds collected for its pro rate share of personal health services or primary care services rendered
under the provisions of this section to the State Treasury for credit to the County Health
Department Trust Fund, but in any events the proceeds from such fees may only be used to fund
county health department services.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA,that:
Section 1. Resolution No. 2004-66 and all prior rate resolutions and fee schedules for the
Department of Health are hereby superseded in their entirety.
Section 2. The schedule of rates, changes and fees set forth are attached and made an
integral component of this Resolution.
Section 3. The effective date of this Resolution shall be January 22, 2013.
This Resolution adopted after motion, second and majority vote favoring same this 22nd day of
January, 2013.
2013 Resolution—Rates and Charges for Department of Health
16136
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, CLERK COLLIER CO TY, FLORIDA
By
kaa t MR1iifii CLERK t E I IA A. HILLER ESQ.
signa4Ucnly.
AIRWOMAN
Approved as to form
and legal sufficiency:
Jenne r B. White
Assistant County Attorney J .�
Item#
Agenda I��D
Date
�.-l
Date , �
Recd —=--�F�
A et
Deputy Clerk
2013 Resolution—Rates and Charges for Department of Health
1613 6
COLLIER COUNTY HEALTH DEPARTMENT - FEE SCHEDULE
This fee schedule is established as authorized by Florida Statutes Section 154.06. All funds collected shall be
expended soley for the purpose of providing public health services within Collier County.
Financial Eligibility: Shall be determined for all clients receiving personal health services for which a sliding fee
is to be charged, and shall be re-determined a minimum of once a year or shorter if income or family size
changes. Clients that waive the financial eligibility determination shall be assigned to the full fee category and
attest to their decision by signing the HMS generated fact sheet.
Clients will not be charged in the following circumstances:
(1) Clients enrolled in Medicaid, however charges may apply for non-covered services. (2) Childhood
immunizations required for school (pre-K- 12th). Third party payers shall be billed an administration (injection)
fee. (3)Anonymous HIV testing if there is an inability to pay. (4) No charge to a minor's parent(s) if the minor is
without parental consent, has no income and is receiving STD or HIV services. (5) Clients that are part of a
contact or at-risk group related to the investigation of a communicable disease. Charges may apply for any
subsequent clinical examination and treatment.
Note: Patients may not be denied the following services due to their failure or inability to pay: communicable
disease services, TB, STD, HIV/AIDS communicable disease control services.
MEDICAL VISITS
Fees are based on 150% of the current Medicare fee schedule.
Diaq Code Description of Service Current Fee Proposed Fee i Change
99201 New Prob Focused 50.00 50.00` 0.00
99202 New Expanded Prob Focused 75.00; NEW
99203 New Detailed Low
120.00 NEW
99204 New Comp Moderate 175.00 NEW
99205 New Comp High 200.00 NEW
99211 Min Visit MD 40.00 40.00 0.00
99212 Est Prob Focused 50.00 50.00 0.00
99212-STD Est Prob Focused-STD 50.00 50.00 0.00
99213 Est Expanded Prob Focused 75.00 NEW
99214 Est Detailed Visit 120.00 NEW
99215 Est Comp Visit 160.00 NEW
99499 Physical Exam Alone, no other tests(Employment, College) 50.00 50.00 0.00
IMMPE Immigration PE(Adult)with CXR, PPD, RPR, HIV 175.00 175.00 0.00
IMMPE Immigration PE(Child) 115.00 115.00 0.00
ANCILLARY MEDICAL SERVICES
"X-Ray fees are contracted services and may increase or decrease without notice.
Diaq Code Description of Service Current Fee Proposed Fee
36415 Venous Blood Draw 5.00 10.00 5.00
46924 TCA Anal (per treatment) 50.00 50.00 0.00
54065 TCA Male(per treatment) 50.00 50.00 0.00
56501 TCA Female(per treatment) 50.00 50.00 0.00
710XX Chest X-Rays* -Single(1)View 30.00 0.00
-Two(2)View 40.00 0.00
86580 PPD Placement and reading 20.00 20.00 0.00
86703 HIV Testing 20.00 20.00 0.00
1693 MD Completion of 1-693 INS Immigration Form 30.00 30.00 0.00
1606
VACCINATIONS
Vaccine fees are based on the current cost of the vaccine and may increase or decrease without notice. An
administration (injection)fee is applied to all vaccines given.
Diaq Code Description of Service Current Fee Proposed Fee
90471 Immunization Administration 20.00 NEW
90472 Immunization Administration Each Additional Vaccine 5.00 NEW
90632 IM HEP A,Adult Intramuscular 50.00 30.00 (20.00)
90636 IM HEPA-HEPB Vaccine 50.00 55.00 5.00
90649 HPV Vaccine 130.00 NEW
90658 IM Influenza Vaccine 25.00 15.00 (10.00)
90675 Rabies Vaccine, Intramuscular Pre/Intramuscular Post 150.00 205.00 55.00
90707 IM MMR Vaccine 60.00 55.00 (5.00)
90716 Varicella Vaccine 75.00 90.00 15.00
90718 TDAP Vaccine 35.00 NEW
90718 IM TD or Tetnus Vaccine 25.00 25.00, 0.00
90736 IM Zostavax Vaccine 160.00 NEW
90732 IM Pneumonia Vaccine 35.00 60.00 25.00
90744 IM HEP B Vaccine 75.00 35.00; (40,00)
E '
DENTAL SERVICES
Dental fees are based on the 2007 Survey of Fees conducted by the American Dental Association (ADA) for the
South Atlantic Region.
Diaq Code Description of Service Current Fee Proposed Fee
D0120 Periodic oral evaluation-established patient 33.00 35.00 2.00
D0140 Limited oral evaluation-problem focused 50.00 50.00 0.00
D0145 Oral evaluation for a patient under three years of age and counseling 40.00 NEW
D0150 Comprehensive oral evaluation-new or established patient 58.00 58.00 0.00
D0210 Intraoral-complete series(including bitewings) 93.00 93.00 0.00
D0220 Intraoral-periapical first film 20.00 20.00; 0.00
D0230 Intraoral-periapical each additional film 16.00 16.00 0.00
D0240 Intraoral-occlusal film 29.00 29.00; 0.00
D0270 Bitewing-single film 16.00 16.00;,, 0.00
D0272 Bitewings-two films 32.00 32.00 0.00
D0273 Bitewings-three films 40.00 NEW
D0274 Bitewings-four films 45.00 45.00, 0.00
D0277 Vertical bitewings-7 to 8 films 74.00! NEW
D0330 Panoramic film 82.00 82.00 0.00
D0350 Oral/facial photographic images 35.00' NEW
D0460 Pulp vitality tests 20.00 NEW
D0470 Diagnostic casts 75.00 75.00 0.00
PREVENTIVE
D1110 Prophylaxis-adult 64.00 64.00 0.00
D1120 Prophylaxis-child 48.00 48.00 0.00
D1203 Topical application of fluoride-child 27.00 27.00 0.00
D1204 Topical application of fluoride-adult 27.00 27.00 0.00
D1206 Topical fluoride varnish;therapeutic application for moderate to high 30.00 30.00 0.00
D1330 Oral Hygiene Instructions 37.00 37.00 0.00
D1351 Sealant-per tooth 39.00 39.00 0.00
D1510 Space maintainer-fixed-unilateral 233.00 233.00 0.00
D1515 Space maintainer-fixed-bilateral 335.00 335.00 0.00
1606
D1550 Re-cementation of space maintainer 59.00 59.00: 0 00
D1555 Removal of fixed space maintainer 74.00 NEW
RESTORATIVE
D2140 Amalgam-one surface, primary or permanent 91.00 91.00 0.00
D2150 Amalgam-two surfaces, primary or permanent 117.00 117.00 ' 0.00`
D2160 Amalgam-three surfaces, primary or permanent 140.00 140.00 0.00.
D2161 Amalgam-four or more surfaces, primary or permanent 171.00 171.00'. 0.00
D2330 Resin-based composite-one surface,anterior 85.00 90.00 5.00
D2331 Resin-based composite-two surfaces, anterior 139.00 139.00 0.00
D2332 Resin-based composite-three surfaces, anterior 171.00 171.00 r 0,00
D2335 Resin-based composite-four or more surfaces or involving incisal 211.00 211.00: 0.00
D2390 Resin-based composite crown, anterior 227.00 227.00; 0.00
'
D2391 Resin-based composite-one surface, posterior 123.00 123.00 " 0.00
D2392 Resin-based composite-two surfaces, posterior 164.00 164.00 0.00
D2393 Resin-based composite-three surfaces, posterior 204.00 204.00:, 0.00
D2394 Resin-based composite-four or more surfaces, posterior 232.00 232.00; 0.00
D2740 Crown-porcelain/ceramic substrate 800.00. NEW
D2750 Crown-porcelain fused to high noble metal 886.00; NEW
D2752 Crown-porcelain fused to noble metal 854.00; NEW
D2790 Crown-full cast high noble metal 900.00` NEW
D2792 Crown-full cast noble metal 890.00 NEW
D2799 Provisional crown 250.00 250.00 0.00
D2915 Recement cast or prefabricated post and core 99.00 NEW
D2920 Recement crown 77.00 77.00 0.00
D2930 Prefabricated stainless steel crown-primary tooth 197.00 197.00' 0.00
D2931 Prefabricated stainless steel crown-permanent tooth 246.00 246.00; 0.00
D2932 Prefabricated resin crown 246.00` NEW
D2940 Protective restoration 80.00 80.00 0.00
D2950 Core buildup, including any pins 180.00 180.00 0.00
D2952 Post and core in addition to crown, indirectly fabricated 290.00 NEW
D2954 Prefabricated post and core in addition to crown 230.00 230.00 0.00
D2962 Labial veneer(porcelain laminate)-laboratory 887.00 NEW
D2970 Temporary crown (fractured tooth) 250.00 250.00 0.00
ENDODONTICS
D3110 Pulp cap-direct(excluding final restoration) 56.00 56.00 0.00
D3120 Pulp cap-indirect(excluding final restoration) 54.00 54.00 0.00
D3220 Therapeutic pulpotomy(excluding final restoration)-removal of pulp 138.00 138.00 0.00
application of medicament
D3221 Pulpal debridement, primary and permanent teeth 146.00 146.00 0.00
D3230 Pulpal therapy(resorbable filling)-anterior, primary tooth (Excluding 185.00 185.00 0.00
D3240 Pulpal therapy(resorbable filling)-posterior, primary tooth (excluding 209.00 209.00 0.00
D3310 Endodontic therapy, anterior tooth (excluding final restoration) 571.00 571.00 0.00
D3320 Endodontic therapy, bicuspid tooth (excluding final restoration) 665.00 665.00 0.00
D3330 Endodontic therapy, molar(excluding final restoration) 807.00 807.00 0.00
D3346 Retreatment of previous root canal therapy-anterior 625.00 625.00; 0.00
PERIODONTICS
D4211 Gingivectomy or gingivoplasty-one to three contiguous teeth or tooth 160.00 160.00; 0.00
D4249 Clinical crown lengthening-hard tissue 570.00 NEW
D4321 Provisional splinting-extracoronal 350.00' NEW
D4341 Periodontal scaling and root planing-four or more teeth per quadrant 187.00 187.00; 0.00
D4342 Periodontal scaling and root planing-one to three teeth per quadrant 130.00 130.00 0.00
D4355 Full mouth debridement to enable comprehensive evaluation and 132.00 132.00` 0.00
D4381 Localized delivery of antimicrobial agents via a controlled release 40.00 40.00 0.00
D4910 Periodontal maintenance 100.00 100.00 0.00
PROSTHODONTICS, REMOVABLE
1. 606
D5110 Complete denture-maxillary 1,200.00 1,200.00, 0.00
D5120 Complete denture-mandibular 1,200.00 1,200.00 0.00
D5130 Immediate denture-maxillary 1,200.00 1,200.00 . 0.00
D5140 Immediate denture-mandibular 1,200.00 1,200.00; 0.00
D5211 Maxillary partial denture- resin base(including any conventional 880.00 880.00;0 .00
D5212 Mandibular partial denture-resin base(including any conventional 880.00 880.00; 0.00
D5213 Maxillary partial denture-cast metal framework with resin denture 1,300.00 1,300.00'; 0.00
D5214 Mandibular partial denture-cast metal framework with resin denture 1,300.00 1,300.00 0.00
teeth) `
D5225 Maxillary partial denture-flexible base (including any clasps, rests 1,100.00 1,100.00, , 0.00
D5226 Mandibular partial denture-flexible base(including any clasps, rests 1,100.00 1,100.00 0.00
D5410 Adjust complete denture-maxillary 72.00 72.00 0.00
D5411 Adjust complete denture-mandibular 72.00 72.00 0.00
D5421 Adjust partial denture-maxillary 72.00 72.00 '0.00
D5422 Adjust partial denture-mandibular 72.00 72.00 0.00
D5510 Repair broken complete denture base 167.00 167.00; 0.00
D5520 Replace missing or broken teeth-complete denture(each tooth) 150.00 150.00' 0.00
D5610 Repair resin denture base 150.00 150.00' 0.00
D5620 Repair cast framework 238.00 238.00 0.00
D5630 Repair or replace broken clasp 194.00 194.00 0.00
D5640 Replace broken teeth-per tooth 125.00 125.00? 0.00
PROSTHODONTICS, REMOVABLE
D5650 Add tooth to existing partial denture 182.00 182.00 0.00
D5660 Add clasp to existing partial denture 105.00 175.00 70.00
D5730 Reline complete maxillary denture(chairside) 250.00 250.00 0.00
D5731 Reline complete mandibular denture(chairside) 250.00 250.00 0.00
D5740 Reline maxillary partial denture(chairside) 250.00 250.00 0.00
D5741 Reline mandibular partial denture (chairside) 250.00 250.00 0.00
D5750 Reline complete maxillary denture(laboratory) 339.00 339.00 0.00
D5751 Reline complete mandibular denture(laboratory) 339.00 339.00 0.00
D5760 Reline maxillary partial denture(laboratory) 339.00 339.00 0.00
D5761 Reline mandibular partial denture(laboratory) 339.00 339.00 0.00
D5850 Tissue conditioning, maxillary 145.00 NEW
D5851 Tissue conditioning, mandibular 145.00 NEW
PROSTHODONTICS, FIXED
D6210 Pontic-cast high noble metal 886.00 NEW
D6212 Pontic-cast noble metal 860.00 NEW
D6240 Pontic-porcelain fused to high noble metal 874.00 NEW
D6242 Pontic-porcelain fused to noble metal 870.00 NEW
D6245 Pontic-porcelain/ceramic 907.00 NEW
D6740 Crown-porcelain/ceramic 907.00 NEW
D6750 Crown-porcelain fused to high noble metal 886.00 NEW
D6752 Crown-porcelain fused to noble metal 850.00 NEW
D6790 Crown-full cast high noble metal 890.00 NEW
D6792 Crown-full cast noble metal 850.00 NEW
D6930 Recement fixed partial denture 107.00 NEW
D6970 Post and core in addition to fixed partial denture retainer, indirectly 274.00 NEW
D6972 Prefabricated post and core in addition to fixed partial denture 217.00 NEW
D6973 Core build up for retainer, including any pins 180.00 NEW
D6980 Fixed partial denture repair, by report 239.00 NEW
ORAL AND MAXILLOFACIAL SURGERY
D7111 Extraction, coronal remnants-deciduous tooth 90.00 90.00 0.00
D7140 Extraction, erupted tooth or exposed root(elevation and/or forcepts 112.00 112.00 0.00
D7210 Surgical removal of erupted tooth requiring removal of bone and/or 197.00 197.00 0.00
mucoperiosteal flap if indicated 0.00
1606
D7220 Removal of impacted tooth-soft tissue 229.00 229.00; 0.00
D7230 Removal of impacted tooth-partially bony 293.00 293.00 0.00
D7250 Surgical removal of residual tooth roots (cutting procedure) 208.00 208.00 0.00
D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or 374.00 374.00, 0.00
D7310 Alveoloplasty in conjunction with extractions-four or more teeth or 293.00 293.00, 0.00
D7311 Alveoloplasty in conjunction with extractions-one to three teeth or 229.00 229.00 0.00
D7410 Excision of benign lesion up to 1.25 cm , NEW
D7411 Excision of benign lesion greater than 1.25 cm 535.001 NEW
D7510 Incision and drainage of abscess-intraoral soft tissue 159.00 159.001, 0.00
D7530 Removal of foreign body from mucosa, skin, or subcutaneous 246.00; _ NEW
D7880 Occlusal orthotic device, by report 860.00; NEW
D7960 Frenulectomy-Also known as frenectomy or frenotomy-separate 253.00 253.00 0.00
ADJUNCTIVE GENERAL SERVICES
D9110 Palliative (emergency)treatment of dental pain-minor procedure 85.00 85.00 0.00
D9120 Fixed partial denture sectioning 75.00 NEW
D9210 Local anesthesia not in conjunction with operative or surgical 12.00 NEW
D9630 Other Drugs and Medicaments 20.00 20.00 0.00
D9910 Application of desensitizing medicament 27.00 27.00 0.00
D9920 Behavior management, by report 85.00 85.00 0.00
D9940 Occlusal guard, by report 420.00 NEW
D9974 Internal bleaching-per tooth 190.00 200.00 10.00
D9999 Unspecified adjunctive procedure, by Report 20.00 20.00 0.00
ENVIRONMENTAL HEALTH SERVICES
Fees for environmental health services are based on the usual and customary fee for that service.
Description of Service Current Fee Proposed Fee
FOOD
Plan Review(per hour) 50.00 50.00 0.00
GROUP
Plan Review(per hour) 50.00 50.00 0.00
Reinspection (one-time fee) 50.00 50.00 0.00
Construction Inspection (one-time fee) 50.00 50.00 0.00
Adult Family Care(annual fee) 150.00 150.00 0.00
Assisted Living Facilities(annual fee) 250.00 250.00 0.00
Residential Facilities (annual fee) 250.00 250.00 0.00
Schools>200 persons (annual fee) 500.00 500.00 0.00
Schools<200 persons (annual fee) 150.00 150.00 0.00
Other Group Facilities(annual fee) 150.00 150.00 0.00
MHP
Plan Review(per hour) 50.00 50.00 0.00
Reinspection (one-time fee) 50.00 50.00 0.00
TANNING
Plan Review(per hour) 50.00 50.00 0.00
Reinspection (one-time fee) 50.00 50.00 0.00
SWP
Reinspection routine inspections(one-time fee) 75.00 75.00 0.00
Construction Inspection (one-time fee) 100.00 100.00 0.00
Bacteriological Fee(annual fee) 250.00 250.00 0.00
Rough Plumb Inspection (one-time fee) 50.00 50.00; 0.00
Renovation Inspection (one-time fee) 50.00 50.00 0.00
Exempt Pool (one-time fee) 100.00 100.00 0.00
Operator Certificate(one-time fee) 20.00 20.00 0.00
Operator Course(one-time fee) 75.00 75.00;; 0.00
16Db
WATER
Water Letter(one-time fee) 30.00 30.00 0.00
Bacteriological Sample Non-Regulated (one-time fee) 25.00 25.00; 0.00
Sample Collection Non-Regulated (one-time fee) 60.00 60.00! 0.00
Nitrate Sample Non-Regulated (one-time fee) 60.00 60.00 0.00
Bacteriological Sample Regulated(one-time fee) 15.00 15.00'; 0.00
Sample Collection Regulated (one-time fee) 40.00 40.00` 0.00
Nitrate Sample Regulated (one-time fee) 60.00 60.00; 0.00
Lead Sample(one-time fee) 30.00 30.00 0.00
Sodium Sample(one-time fee) 25.00 25.00 0.00
Chloride Sample(one-time fee) 20.00 20.00 0.00
OSTDS
Development Plan Review(one-time fee) 20.00 20.00 0.00
Incidental Plan Review(one-time fee) 10.00 10.00 0.00
Construction Permit Application(one-time fee) 160.00 160.00 0.00
Final Cover Inspection (one-time fee) 75.00 75.00 0.00
ATU Permit(annual fee) 150.00 150.00 0.00
PBT Permit(annual fee) 200.00 200.00 0.00
Reinspection (one-time fee) 75.00 75.00 0.00
Repair Permit(one-time fee) 200.00 200.00 0.00
Septic Letter(one-time fee) 30.00 30.00 0.00
ADMINISTRATIVE SERVICES
Description of Service Current Fee Proposed Fee
VITAL STATISTICS
Birth Certificate (1st Copy) 10.00 10.00 0.00
Birth Certificate (each additional copy) 6.00 6.00 0.00
Death Certificate 8.00 8.00 0.00
MISC FEES
Emergency Management Plan Review(CEMP)- Initial 48.00 NEW
Emergency Management Plan Review(CEMP)- Update/Renewal 24.00 NEW
Duplication (.25 per page for first 25 copies) 0.25 0.25 0.00
Duplication ($1.00 per page after the first 25 copies) 1.00 1.00 0.00
Returned Check 25.00 25.00 0.00
•