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) Non Hazardous Oil Contaminated Soil Certification Form 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 Facility Information ARD-2 Boiler Registration ARD-3 Process and Manufacturing Equipment Registration ARD-4 Fuel or VOC Storage Tank Equipment Registration ARD-5 Fuel Loading Facility Registration ARD-6 Incinerator Equipment Registration ARD-7 Engine and Turbine Registration ARD-8 Asphalt Plant Registration

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-2 Internal Combustion Engine - Emergency Generators or Fire Pump Engines
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

Alteration of Terrain
Alteration of Terrain Application Form Completion of Construction Form Land Resource Management Complaint Form \| Form Only in Word Start of Construction Form Excavation, Grading, and Reclamation Projects – Periodic Reporting

Asbestos Abatement
Asbestos abatement entity (contractor) Word \| PDF Asbestos abatement supervisor Word \| PDF Asbestos abatement worker Word \| PDF Asbestos consultants Word \| PDF Asbestos disposal site contractor Word \| PDF Asbestos disposal site worker Word \| PDF Demolition/Renovation Notification Form Demolition/Renovation Notification Form Instructions
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
Application to Register an Existing Dam Dam Construction Inspection Acknowledgment Form Application to Construct or Reconstruct a Dam Dam Operation, Maintenance and Response Form Dam Removal Attachment for Wetlands Application EAP Notification Checklist Form

Drinking Water
Drinking Water and Groundwater program forms
Emergency Response Forms
Hazardous Waste Incident Report Petroleum Discharge Incident Report
Exotic Aquatic Plants
Research Grant Application

File Review
RSA 91-A: Right-to-Know
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 (IDR) 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 Programs
NH Green Hospitality Program Application – Restaurant NH Green Hospitality Program Application – Lodging
Pools and Spas
Application for Public Pool Application for Public Spa

Quality Assurance Project Plans (QAPP)
Quality Assurance Project Plans (Watershed Assistance Program)
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 Quality Certification Renewal Form Sludge Site Permit Application Sludge Permit Waiver Application

Sewer
Joint NHDES & RD Sign Rural Development Provisions Community Development Block Grant (CDBG) Provisions SAG Project Sign SRF Project Sign Sewer Connection Permit Application
Shoreland
Land Resource Management Complaint Form \|\| Form Only in Word Shoreland Application Shoreland Redevelopment Waiver Request Form

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

Solid Waste
Annual Facility Report form for Active Solid Waste Facilities Landfill Closure/Incinerator Closure Grant Applications Standard Permit Applications Permit by Notification Permit Modifications Waiver Request
Spill Response and Complaint Investigation Section
Complaint 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 Installer Application Pressure Distribution Worksheet Protective Well Radii Chart Release Form For Protective Well Radii Repair or Replacement-in-Kind of an Individual Sewage Disposal System Application Revised Soil Grouping for Establishing Lot Size Site Assessment Subdivision Application Subsurface Systems File And Archive Record Request Form Land Resource Management Complaint Form \|\| Form Only in Word Transfer of Ownership Application Waiver Request

Surface Water
Application for Products Proposed to be Applied to Land or Water River Nomination Form Salt Use Report Form NEW! Submit Datalogger Results Online
Underground Storage Tank
Underground Storage Tank Forms Please contact the Oil Remediation and Compliance Bureau at (603) 271-3899 or orcb.wmd@des.nh.gov for more information on underground storage tank related forms.

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

Water Well Board
Well Completion Report Form Water Well Contractor Application Pump Installer Application Pump Installer Application Well Completion Report Form Abandoned Well Registration Report Abandoned Well Registration Report Setback Reduction Form Consumer Complaint Form Water Well Contractor Application
Wetlands
Wetlands Bureau Forms/Applications

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