As part of the Core Area Wastewater Treatment Program for the Capital Regional District (CRD), Brown and Caldwell and Stantec Consulting, Ltd. were tasked with developing and analyzing alternatives for locating multiple new wastewater treatment plants and conveyance systems and for preparing a biosolids management plan and recommending final collection, treatment and biosolids processing systems. To meet this end, three regional treatment plant alternatives and eleven biosolids alternatives were evaluated using a triple bottom line (TBL) analysis that included consideration of economic, environmental, and social costs for each alternative. To compare alternatives on an equal basis, the impacts used to evaluate each alternative were monetized based on either directly available economic information (e.g. capital costs, cost of fuel, etc.) or assumed community and environmental impacts (e.g. the cost of a traffic delay, a perceived loss in property value, pollutant discharge, etc.). The final results of the TBL evaluation incorporated a detailed accounting of the carbon footprint along with an implementation risk analysis and formed the basis for the regional wastewater treatment and biosolids management recommendations. The fully monetized TBL led to the identification of critical impacts and benefits for alternatives and provided a justifiable basis for sound decisions.