Forms/Applications - Public Information and Permitting Unit - NH Department of Environmental Services

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Aboveground Storage Tanks
Applications for the Construction of a New and Substantially Modified Petroleum AST Facility (Env-Wm 1402) Registration Form for an Aboveground Bulk Storage Facility

Activity and Use Restrictions; Waste Management
Application for Activity and Use Restriction (AUR) Self-Certification Form for Activity and Use Restriction

Air Emissions Inventory Reporting
Annual Emissions Statement Form INV-E1 Instructions for Form INV-E1 Annual Emissions Statement Form INV-E2 Instructions for Form INV-E2 Annual NOx Emissions Statement Form INV-N1 Instructions for Form INV-N1 Annual NOx Emissions Statement Form INV-N2 Instructions for Form INV-N2 Annual VOC Emissions Statement Form INV-V1 Instructions for Form INV-V1 Annual VOC Emissions Statement Form INV-V2 Instructions for Form INV-V2 Annual SO2 Emissions Statement Form INV-N1 Instructions for Form INV-N1
Air Permit Application Forms
ARD-1 General Information – All Permit Application Instructions for Form ARD-1 ARD-2 Fuel Burning Equipment Registration Instructions for Form ARD-2 ARD-3 Process and Manufacturing Equipment Registration Instructions for Form ARD-3 ARD-4 Fuel or VOC Storage Tank Equipment Registration ARD-5 Fuel Loading Facility Registration ARD-6 Incinerator Equipment Registration Sample Ownership Affidavit

Air Permit-by-Notification Information
PBN-1 General Facility Information Permit-by-Notification – Non-Metallic Mineral Processing Plants PBN-2 Equipment Component Inventory List – Non-Metallic Mineral Processing Plants PBN-3 Non-Metallic Mineral Processing Plants – Summary of Results of Subpart OOO Visible Emissions Testing PBN-4 Notice of Relocation Permit-By-Notification – Non-Metallic Mineral Processing Plants

Air (General) Permit Registration Information
GSP-1 General Facility Information All Registrations Instructions for Form GSP-1 GSP-2 Internal Combustion Engines Used as Emergency Generators Instructions for Form GSP-2 Instructions for filling out Online Registration for General State Permit for Emergency Generator
Air Title V Permit and State Permit Reporting
Title V Operating Permit Reporting Guidance Appendix A: Annual Compliance Certification, Parts 1 through 3 Appendix B: Instructions for Completion of the Annual Compliance Certification Appendix C: Semi-Annual Permit Deviation and Monitoring Report, Parts 1 through 5 Appendix D: Instructions for Completion of the Semi-Annual Permit Deviation and Monitoring Report Appendix E: Permit Deviation Reporting Form Compliance Report Cover Sheet

Asbestos Abatement
Asbestos abatement entity (contractor) Asbestos abatement supervisor Asbestos abatement worker Asbestos consultants Asbestos disposal site contractor Asbestos disposal site worker Demolition/Renovation Notification Form
Auto Salvage Yards – Green Yards
Motor Vehicle Salvage Yard Environmental Compliance Manual & Self-Audit Checklist Green Yards Certification Application Packet

Brownfields Program
Application for Eligibility Determination – Current Owner Version Application for Eligibility Determination – Prospective Purchaser Version

Bulk Water Haulers
Bulk Water Delivery Notification Form

Dam Bureau
Attachment to the Standard Dredge and Fill Application for Dam Removal Projects Dam Construction or Reconstruction Existing Dam Permit

Drinking Water
Drinking Water and Groundwater program forms Water System Generator Information Form

Emergency Response Forms
Hazardous Waste Incident Report Petroleum Discharge Incident Report

Exotic Aquatic Plants
Prevention Grant Application Research Grant Application

Groundwater/Landfills
Application for a Groundwater Management Permit Application for a Renewal of Groundwater Management Permit Application for a Groundwater Release Detection Permit Application for a Renewal of Groundwater Release Detection Permit Application for a Groundwater Permit Transfer Notification of Proposed Groundwater Management Permit & Groundwater Management Zone

Hazardous Waste Compliance
Hazardous Waste Declassification Request Form Hazardous Waste Limited Permit Application Form Hazardous Waste Notification Form Hazardous Waste Transporter Application Packet Request for Waiver

Industrial Wastewater
Industrial Wastewater Indirect Discharge Request Application

Laboratory Services
Test Containers for Homeowners Test Containers for Public Water Supplies

Mercury
Mercury Switch Collection Container Request

Petroleum Reimbursement Funds
Sample Cover/Transmittal Letter to Accompany Reimbursement Claim Request for Reimbursement Authorization Request for Reimbursement – Summary of Invoiced Costs

Pollution Prevention
Governor’s Award for Pollution Prevention Application

Pools and Spas
Application for Public Pool Application for Public Spa

Quality Assurance Project Plans (QAPP)
Quality Assurance Project Plans (Watershed Assistance Program)

Reporting and Information Management; Waste Management
Declassification Request Manifest Instructions Hazardous Waste Notification Form Notification Form Instructions Sample Declassification Request Sample Manifest Form

Residuals (Sludge/Septage)
Permit by Notification for Septage Holding Tank Septage Facility Permit Application Septage Hauler Application Septage Permit Modification Application Septage Holding Tank – Permit By Notification Form Septage Site Permit Application Septage Application for Waiver Sludge Hauler Application Sludge Facility Permit Application Sludge Permit Modification Application Sludge Quality Certification Application Sludge Site Permit Application Sludge Permit Waiver Application

Sewer
Bidding Requirements (Section A) Contract Forms (Section B) Joint General Conditions (Section C) Joint DES & RD Sign Rural Development Provisions Sewer Connection Permit Application Community Development Block Grant (CDBG) Provisions SAG Project Sign SRF Federal Provisions (Section D) SRF Project Sign

Shoreland
Land Resource Management Complaint Form \|\| Form Only in Word Shoreland Application Shoreland Redevelopment Waiver Request Form

Site Specific
Alteration of Terrain Application Form Land Resource Management Complaint Form \|\| Form Only in Word

Small Quantity Generators
Declassification Form Notification Form Notification Form Instructions Sample Declassification Form Self-Certification Form SQG Self-Certification Instructions

Solid Waste
Annual Recycling and Waste Report for State Agencies Post-Closure Inspection Form Landfill Closure/Incinerator Closure Grant Applications Standard Permit Applications Permit by Notification Permit Modifications Waiver Request

Spill Response and Complaint Investigation Section
Complaint Form Initial Response Action Reporting Form Reporting Form

Stormwater
Notice of Intent (NOI) Application Form Storm Water Management Program Implementation Schedule Form Item by Item Instructions

Subsurface – Septic & Subdivision
Construction Approval Checklist Designer Application Individual Sewage Disposal System Application Inspection Compliance Report Form & Letter to Installers Installer Application Pressure Distribution Worksheet Protective Well Radii Chart Release Form For Protective Well Radii Revised Soil Grouping for Establishing Lot Size Site Assessment Subdivision Application Subdivision Clarification Land Resource Management Complaint Form \|\| Form Only in Word Transfer of Ownership Application Waiver Request

Surface Water
Temporary Surface Water Permit Application

Underground Storage Tank
Application for the Construction of New and Substantially Modified Underground Storage Facilities (Env-Wm 1401) Application for the Construction of a Corrosion Protection System Registration for Underground Storage Tank Systems Underground Storage Tank Closure Notification

Used Oil
Used Oil Collection Center Grant Application

Wastewater
See above for Septage Forms and Sludge Forms Wastewater Grant Pre-application Wastewater Grant Application

Water Well Board
Abandoned Well Registration Report Consumer Complaint Form Non-Conforming Well Location Form Pump Installer Application Standard Release Form Water Well Contractor Application Well Completion Report Form

Wetlands
Land Resource Management Complaint Form \|\| Form Only in Word Mitigation Agreement Form Wetlands Minimum Impact Forestry Notification Notification of Routine Roadway and Railway Maintenance Activities Notification of Trail Development Activities Having Minimum Wetlands Impact Permit by Notification Forms and Booklets Recreational Mineral Dredging Application Seasonal Dock Notification for Lakes and Ponds Wetlands Standard Dredge & Fill Application Wetlands Permit Application Form PDF \| Word Wetlands Grandfathered Shoreline Structures Certification Form Wetlands Minimum Impact Agriculture Form

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