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
FormTitleFormat
 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 Information
  • NEW: ePayment Option Included

General Facility Information - Page 2

  • Section AA1 - Application for Non-Title V Permit Renewal
  • Section AA2 - Application for Title V Permit Renewal
  • Section AA3 - Application for Name Change
  • Section AA4 - Application for Ownership Change
  • Section AA5 - Application for an Administrative Amendment
 (.pdf)
A2, A3

A2 - Emission Source Listing for this Application

A3 - 112(r) Applicability Information

(.xlsx)(.pdf)
BSpecific Emission Source Information (Required for all Sources)(.xlsx)(.pdf)
B1Emission Source (Wood, Coal, Oil, Gas, Other Fuel-fired Burner)(.xlsx)(.pdf)
B2Emission Source (Internal Combustion Engines / Generators)(.xlsx)(.pdf)
B3Emission Source (Liquid Storage Tank)(.xlsx)(.pdf)
B4Emission Source (Woodworking)(.xlsx)(.pdf)
B5Emission Source (Coating / Finishing / Printing)(.xlsx)(.pdf)
B6Emission Source (Storage Silo / Bins)(.xlsx)(.pdf)
B7Emission Source (Manufacture of Chemicals / Coatings / Inks)(.xlsx)(.pdf)
B8Emission Source (Incineration)(.xlsx)(.pdf)
B9Emission Source (Other)(.xlsx)(.pdf)
C1Control Device (Fabric Filter)(.xlsx)(.pdf)
C2Control Device (Electrostatic Precipitator)(.xlsx)(.pdf)
C3Control Device (Thermal or Catalytic Oxidizer)(.xlsx)(.pdf)
C4Control Device (Cyclone, Multicyclone, or Other Mechanical)(.xlsx)(.pdf)
C5Control Device (Adsorber)(.xlsx)(.pdf)
C6Control Device (Gaseous Absorber)(.xlsx)(.pdf)
C7Control Device (Condenser)(.xlsx)(.pdf)
C8Control Device (Wet Particulate Scrubber)(.xlsx)(.pdf)
C9Control Device (Other)(.xlsx)(.pdf)
D1Facility-Wide Emissions Summary(.xlsx)(.pdf)
D2Air Pollutant Netting Worksheet and Facility-wide Emission Summary(.xlsx)(.pdf)
D2AAir Pollutant "Project Only" Netting Worksheet(.xlsx)(.pdf)
D3

Modeling Request Forms (3 pages)

(Form Instructions)

(.xlsx)(.pdf)
D4Exempt and Insignificant Activities Summary(.xlsx)(.pdf)
D5Technical Analysis to Support Permit Application (includes P.E. Seal Form)(.xlsx)(.pdf)
D6Modeling Protocol Checklist(.xlsx)(.pdf)
Title V Only Forms
A1-MINORTitle V Minor Modification (Prior to Permit Revision)(.xlsx)(.pdf)
E1Title V General Information(.xlsx)(.pdf)
E2Emission Source Applicable Regulation Listing(.xlsx)(.pdf)
E3Emission Source Compliance Method(.xlsx)(.pdf)
E4Emission Source Compliance Schedule(.xlsx)(.pdf)
E5Title V Compliance Certification(.xlsx)(.pdf)
E6Compliance Assurance Monitoring (CAM) Plan(.xlsx)(.pdf)
Title V Notification Form
 502(b)(10) Change Notification Form(.xlsx)(.pdf)