Application Forms for Air Quality Permit to Construct/Operate Non-Title V and Title V Facilities
Use our Application Matrix to determine which application forms are required.
A $25.00 processing fee will be charged for returned checks in accordance with the North Carolina General Statue 25-3-512
Submit, to the appropriate NC DAQ regional Office, the following number of permit applications and supporting data:
- Two (2) copies for Non-Title V Facilities
- Three (3) copies for Title V Facilities
- Six (6) copies for Title V Facilities subject to NCAC 2D.0530, .0531, or 1200, plus one additional copy for each affected State
- Three (3) copies of any modeling analysis/report and one (1) copy of the modeling files
| Form | Title | Format | |
|---|---|---|---|
| Title V and Non-Title V Form Instructions | (.docx) | ||
| Application Checklists | |||
|---|---|---|---|
| Title V Permit Application Checklist | (.docx) | (.pdf) | |
| Non-Title V Permit Application Checklist | (.docx) | (.pdf) | |
| Non-Title V and Title V Forms | |||
|---|---|---|---|
| A |
General Facility Information - Page 1
General Facility Information - Page 2
|
(.pdf) | |
| A2, A3 |
A2 - Emission Source Listing for this Application A3 - 112(r) Applicability Information |
(.xlsx) | (.pdf) |
| B | Specific Emission Source Information (Required for all Sources) | (.xlsx) | (.pdf) |
| B1 | Emission Source (Wood, Coal, Oil, Gas, Other Fuel-fired Burner) | (.xlsx) | (.pdf) |
| B2 | Emission Source (Internal Combustion Engines / Generators) | (.xlsx) | (.pdf) |
| B3 | Emission Source (Liquid Storage Tank) | (.xlsx) | (.pdf) |
| B4 | Emission Source (Woodworking) | (.xlsx) | (.pdf) |
| B5 | Emission Source (Coating / Finishing / Printing) | (.xlsx) | (.pdf) |
| B6 | Emission Source (Storage Silo / Bins) | (.xlsx) | (.pdf) |
| B7 | Emission Source (Manufacture of Chemicals / Coatings / Inks) | (.xlsx) | (.pdf) |
| B8 | Emission Source (Incineration) | (.xlsx) | (.pdf) |
| B9 | Emission Source (Other) | (.xlsx) | (.pdf) |
| C1 | Control Device (Fabric Filter) | (.xlsx) | (.pdf) |
| C2 | Control Device (Electrostatic Precipitator) | (.xlsx) | (.pdf) |
| C3 | Control Device (Thermal or Catalytic Oxidizer) | (.xlsx) | (.pdf) |
| C4 | Control Device (Cyclone, Multicyclone, or Other Mechanical) | (.xlsx) | (.pdf) |
| C5 | Control Device (Adsorber) | (.xlsx) | (.pdf) |
| C6 | Control Device (Gaseous Absorber) | (.xlsx) | (.pdf) |
| C7 | Control Device (Condenser) | (.xlsx) | (.pdf) |
| C8 | Control Device (Wet Particulate Scrubber) | (.xlsx) | (.pdf) |
| C9 | Control Device (Other) | (.xlsx) | (.pdf) |
| D1 | Facility-Wide Emissions Summary | (.xlsx) | (.pdf) |
| D2 | Air Pollutant Netting Worksheet and Facility-wide Emission Summary | (.xlsx) | (.pdf) |
| D2A | Air Pollutant "Project Only" Netting Worksheet | (.xlsx) | (.pdf) |
| D3 |
Modeling Request Forms (3 pages) |
(.xlsx) | (.pdf) |
| D4 | Exempt and Insignificant Activities Summary | (.xlsx) | (.pdf) |
| D5 | Technical Analysis to Support Permit Application (includes P.E. Seal Form) | (.xlsx) | (.pdf) |
| D6 | Modeling Protocol Checklist | (.xlsx) | (.pdf) |
| Title V Only Forms | |||
|---|---|---|---|
| A1-MINOR | Title V Minor Modification (Prior to Permit Revision) | (.xlsx) | (.pdf) |
| E1 | Title V General Information | (.xlsx) | (.pdf) |
| E2 | Emission Source Applicable Regulation Listing | (.xlsx) | (.pdf) |
| E3 | Emission Source Compliance Method | (.xlsx) | (.pdf) |
| E4 | Emission Source Compliance Schedule | (.xlsx) | (.pdf) |
| E5 | Title V Compliance Certification | (.xlsx) | (.pdf) |
| E6 | Compliance Assurance Monitoring (CAM) Plan | (.xlsx) | (.pdf) |
| Title V Notification Form | |||
|---|---|---|---|
| 502(b)(10) Change Notification Form | (.xlsx) | (.pdf) | |