Printable Forms

Permit Application Forms

We strongly recommend that applicants contact the Forsyth County Environmental Affairs Department before beginning work on a permit application. We can often provide explanations and suggestions that prevent misunderstandings and streamline the overall application process.

  1. Standard Air Quality Permit Application and Instructions
  2. CAA 112(j) Part 2 Case-By-Case MACT Application for Industrial, Commercial and Institutional Boilers and Process Heaters
  3. D3-3 Form: Emission Source (Reduction and Recycling Activities)
  4. Transportation Facility Permit Application
  5. Asbestos Application/Notification Form
  6. Burning Permit Application for Structural Fire Training

Registration Forms

  1. Perchloroethylene Dry Cleaning Operations
  2. Paint Stripping & Miscellaneous Surface Coating Operations (Subpart HHHHHH)
  3. Land-Clearing Open Burning
  4. Gasoline Dispensing Stations
  5. Fire Training Notification Form

Other Forms

  1. Emissions Inventory
  2. Dispersion Modeling Protocol
  3. Dispersion Modeling Request
  4. Stack Test Protocol Submittal
  5. Title V Compliance Certification
  6. Special Award Application

Permit Application Forms

Standard Air Quality Permit Application and Instructions

All air quality permit application submittals must include the appropriatepermit application fee, a completed D3-3 Form, and supporting calculations and technical data. The application includes 45 forms and a matrix.

  1. Permit Application
  2. Permit Application
  3. Permit Application Instructions

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CAA 112(j) Part 2 Case-By-Case MACT Application for Industrial, Commercial and Institutional Boilers and Process Heaters

Title V facilities that are also major sources of hazardous pollutants are required to submit a Case-By-Case MACT permit application to comply with Section 112(j) of the Clean Air Act for affected boilers and indirect-fired process heaters. Part 1 and Part 2 applications were requested by the Department in a letter to potentially affected facilities issued on June 12, 2009. Facilities may choose to use the form provided here and the emissions standards provided in the NC DAQ guidance (referenced in the application) to satisfy the requirement to submit a Part 2 MACT application. Part 2 applications must be submitted to the Department no later than September 30, 2009.

  1. Permit Application
  2. Permit Application

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D3-3 Form: Emission Source (Reduction and Recycling Activities)

A D3-3 Form must be submitted with each:
- payment of an annual permit fee,
- permit application for modification of an existing facility, and
- permit application for a new facility.

  1. D3-3 Form and Instructions
  2. D3-3 Form and Instructions
  3. D3-3 Form and Instructions
  4. D3-3 Form with Examples

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Transportation Facility Permit Application

Parking lots with more than 1500 spaces, parking decks with more 750 spaces, or any combination of lots and decks with more than 1000 spaces need to apply for and receive a transportation facility permit with the Department before beginning construction.

  1. Permit Application

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Asbestos Demolition/Renovation

In accordance with the federal NESHAP regulations for asbestos, notifications must be provided and permits obtained from the FCEAD for all operations involving renovation or demolition. Renovation includes the removal of greater than 160 square feet or 260 linear feet of friable asbestos materials or non-friable asbestos materials that will become friable when disturbed.

Notification is required for demolition and a permit must be obtained from the FCEAD whether asbestos is involved or not. An asbestos survey is required to obtain a demolition permit.

  1. Application/Notification Form

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Burning Permit Application for Structural Fire Training

A burning permit must be obtained from the FCEAD by any person or organization wishing to intentionally burn a facility for the purpose of fire training.

  1. Permit Application for Fire Training

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Registration Forms

Perchloroethylene Dry Cleaning Operations

Dry Cleaners using Perchloroethylene are required to register their facility with FCEAD. These facilities are regularly inspected and federal law requires that FCEAD be notified and that the facility owner certify their compliance with federal regulations. Completion of the registration form provided will satisfy both local and federal requirements.

  1. Registration Form
  2. Registration Form
  3. Instructions

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Paint Stripping & Miscellaneous Surface Coating Operations (Subpart HHHHHH)

Facilities that use methylene chloride to strip paint, auto body shops, and other facilities that spray paint metal or plastic surfaces are subject to federal emission standards. Federal law requires that FCEAD and USEPA be notified and that the facility owner certify their compliance with federal regulations. FCEAD has developed Notification of Compliance Status Forms (NOC) in Excel and PDF format for Paint Stripping (NOC-S), Misc. Coatings (NOC-MSC), Motor Vehicle Surface Coating (NOC-ME), and a form for requesting an exemption for Motor Vehicle Coating (MEX) for download. For more information on Paint Stripping & Miscellaneous Surface Coating Operations (Subpart HHHHHH) click here.

  1. Initial Notification Form IN
  2. Paint Stripping Form NOC-S
  3. Misc Coating Form NOC-MSC
  4. Motor Vehicle Form NOC-ME
  5. Motor Vehicle Exemption Form
  6. Initial Notification Form IN
  7. Paint Stripping Form NOC-S
  8. Misc Coating Form NOC-MSC
  9. Motor Vehicle Form NOC-ME
  10. Motor Vehicle Exemption Form

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Land Clearing Open Burning

Property owners and\or contractors are required to register if they intend to open burn under the guidelines of the land- clearing open burning regulations. In rare instances, LCOB operators may request a setback waiver if all parties within the setback distance have read and signed a waiver form. More information about this is within the downloadable form below

  1. Registration Form
  2. Setback Waiver Form

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Gasoline Dispensing Stations

Owners of Gasoline Dispensing Stations are required to register if they currently use or will be dispensing 50,000 gallons of gasoline or more in a year.

  1. Registration Form
  2. Registration Form
  3. Instructions

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Fire Training Notification Form

FCEAD requires prior notification from permitted facilities to conduct fire training exercises for the dates and times stated.

  1. Fire Training Notification

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Other Forms

Emissions Inventory

Industrial facilities that have an air quality permit are required to prepare and submit an inventory of their air pollution emissions periodically. Title V sources and non-Title V sources with NOx or VOC emissions greater than 25 tons per year are required to conduct an emissions inventory annually. Non-Title V sources with NOx and VOC emissions of less than 25 tons per year are required to conduct an emissions inventory every five years, to coincide with permit renewal. Facilities should contact FCEAD if they think they may be required to submit an inventory but have not been notified. The pollutant code list is available both as a tab within the EI Code Tables and as a separate .pdf file.

Facilities required to submit an inventory should complete and submit the forms provided here or contact the Department to receive a Microsoft Access database interface for entering this data. To read more information, click here to see the letter sent to permitted facilities.

  1. Emissions Inventory (EI) Forms
  2. EI Instructions
  3. EI Code Tables
  4. EI Pollutant List

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Dispersion Modeling Protocol

This checklist can be used when submitting an air toxics modeling analysis. Completing this checklist can help expedite the review process by ensuring all the necessary information has been submitted and addressed.

  1. Modeling Protocol Procedures & Checklist
  2. Modeling Guidelines

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Dispersion Modeling Request

Applicants submitting an air toxics modeling determination are required to complete a D2M form documenting the stack parameters used in the analysis. In addition, applicants requesting assistance from the Department in completing a modeling analysis should also complete this form to provide stack information to the modeling staff.

  1. Toxic Modeling Worksheet

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Stack Test Protocol Submittal

The Stack Test Protocol Submittal Form is used to initiate communication between representatives of a permitted facility, testing consultants, and to identify and resolve any specific testing concerns prior to testing. Submit all forms and additional information to the Department at least 30 days prior to testing.

  1. Stack Test Protocol Submittal Form
  2. Stack Test Protocol Submittal Form

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Title V Compliance Certification

All Title V facilities are required to submit compliance certifications annually. Certifications must be signed by a responsible company official as defined in FCAQTC Rule 3Q .0503(15) and 40 CFR Part 70. Permittees are required to identify each permit term and condition and describe its compliance status. Annual compliance certifications must be submitted to FCEAD and EPA Region 4 (Atlanta).

FCEAD is providing this form to assist you in this effort. Use of this form is not required and FCEAD will accept compliance certifications prepared in other formats. The Department can provide you with a digital copy of your current permit to assist you with preparing the certification (This will allow you to copy and paste text from your permit into the certification). Please contact your case manager if you would like a digital copy of your permit. The form, including tables for addressing individual terms and conditions, and instructions is available in MS Word format. The tables only are also available in MS Excel format.

  1. Certification Form and Instructions
  2. Compliance Summary Report)

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Special Award Application

Businesses and institutions may apply to the Environmental Affairs Advisory Board for Special Air Quality and Special Environmental Awards. Applications should by submitted by May 15.

  1. Application Form

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