N.C. Department of Environment and Natural Resources
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Permits >> Application forms & instructions >> Title V, Non-Title V

Application Forms for Air Quality Permit to Construct/Operate Non-Title V and Title V Facilities

Instructions for these forms are under construction. (Old Form Instructions). 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 Number Form Title Format
Non-Title V and Title V Forms
  Title V Permit Application Checklist DOC  
Administrative Application (General Information) (page 1)
Administrative Application (continued) (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
NOTE: You now can fill in, save, and print Form AA using the free Adobe Reader.
A1 Facility General Information MS Excel PDF
A2 Emission Source Listing for this Application MS Excel PDF
A3 112(r) Applicability Information MS Excel PDF
A4  New
Updated Forms
Survey of Facility Emission Reduction Activities MS Excel  
Source Reduction Codes PDF  
B Specific Emission Source Information (Required for all Emission Sources) MS Excel PDF
B1 Emission Source (Wood, Coal, Oil, Gas, Other Fuel-fired Burner) MS Excel PDF
B2 Emission Source (Internal Combustion Engines / Generators) MS Excel PDF
B3 Emission Source (Liquid Storage Tank) MS Excel PDF
B4 Emission Source (Woodworking) MS Excel PDF
B5 Emission Source (Coating / Finishing / Printing) MS Excel PDF
B6 Emission Source (Storage Silo / Bins) MS Excel PDF
B7 Emission Source (Manufacture of Chemicals / Coatings / Inks) MS Excel PDF
B8 Emission Source (Incineration) MS Excel PDF
B9 Emission Source (Other) MS Excel PDF
C1 Control Device (Fabric Filter) MS Excel PDF
C2 Control Device (Electrostatic Precipitator) MS Excel PDF
C3 Control Device (Thermal of Catalytic) MS Excel PDF
C4 Control Device (Cyclone, Multicyclone, or Other Mechanical) MS Excel PDF
C5 Control Device (Adsorber) MS Excel PDF
C6 Control Device (Gaseous Absorber) MS Excel PDF
C7 Control Device (Condenser) MS Excel PDF
C8 Control Device (Wet Particulate Scrubber) MS Excel PDF
C9 Control Device (Other) MS Excel PDF
D1 Facility-Wide Emissions Summary MS Excel PDF
D2 Air Pollutant Netting Worksheet MS Excel PDF
D3 Modeling Request Forms (three pages)   PDF
D3 Instructions for Modeling Request Forms   PDF
D4 Exempt and Insignificant Activities Summary MS Excel PDF
D5 Technical Analysis to Support Permit Application (includes P.E. Seal Form) MS Excel PDF
D6 Modeling Protocol Checklist   PDF
Title V Only Forms
A1-MINOR Title V Minor Modification (Prior to Permit Revision) MS Excel PDF
E1 Title V General Information MS Excel PDF
E2 Emission Source Applicable Regulation Listing MS Excel PDF
E3 Emission Source Compliance Method MS Excel PDF
E4 Emission Source Compliance Schedule MS Excel PDF
E5 Title V Compliance Certification MS Excel PDF
E6 Compliance Assurance Monitoring (CAM) Plan MS
Title V Notification Form
  502(b)(10) Change Notification Form MS Excel PDF

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Last Modified: Tue October 01 12:56:24 2013
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