Instructions For Filling Out The Notification of Demolition and or Asbestos Renovation Form

All information pertinent to the removal, renovation and/or demolition must be completed by the building owner/operator or authorized agent and submitted with the applicable permit fee to:

Western North Carolina Regional Air Quality Agency
49 Mt. Carmel Road
Asheville, NC 28806

  1. Type of Notification: Indicate the type of notification, and whether or not asbestos is present.
  2. Facility Information: Enter the name of the owner of the facility, the owner's mailing address including box number, street, city, state, zip code, contact name and telephone number.
  3. Facility Information: Complete the building name for the facility to be renovated or demolished, the physical address including street number, street name, city, state, and county. Site location should include the building number, floor number, and room number(s). Complete building size in square feet, number of floors in the building, the age of the building, and its present and prior use.
  4. Contractor: If asbestos containing materials (ACM) are to be removed, complete the name of the removal contractor, the contractor's mailing address including box number, street, city, state, zip code, contact name and telephone number.
  5. Other Contractor: Where demolition of the facility immediately follows the removal of ACM, complete the demolition contractor's name, mailing address including box number, street, city, state, zip code, contact name and telephone number.
  6. Was an Asbestos Inspection Performed on the Facility?: Indicate whether an inspection has already been performed, if yes whether a report is attached and the name and NCHHCB accreditation number of the inspector.
  7. Asbestos Materials in Facility: Estimate the approximate amount of Regulated Asbestos Containing Material (RACM) within the building in each category to be removed from pipes, surface area, and or volume off of other facility components. Enter the approximate estimated amount of Nonfriable Asbestos NOT to be removed.
  8. Scheduled Dates Asbestos Removal: Asbestos removal start date and complete date. Removal includes any activity, such as site preparation that would break up, dislodge, or similarly disturb ACM in a demolition and/or renovation.
  9. Scheduled Dates for Demolition: Complete the demolition start and complete date.
  10. Asbestos / Demolition Work Practices: Describe work practices. This includes asbestos removal and waste handling emission control measures.
  11. Waste Transporter: Complete the name, mailing address, including city, state, zip code, contact person and telephone number of the waste transporter contracted to transport the waste to an approved landfill.
  12. Waste Transporter #2: Complete the name, mailing address, including city, state, zip code, contact person and telephone number of any second waste transporter contracted to transport the waste to an approved landfill.
  13. Waste Disposal Site: Complete the name and location of the waste disposal site where the asbestos containing waste will be disposed including the street, route, or highway of the waste facility, city, state, zip code, contact name and telephone number.
  14. If Ordered Demolition Ordered, Identify Government Agency: Complete the name and address of the authorizing agency, contact name and telephone number, and date of order and date ordered to begin if the facility is being demolished under an order of a state or local government agency (Attach order).
  15. For Emergency Demolition / Asbestos Removal: Describe the emergency, giving date and time of the emergency.
  16. Certification of Training: Signature of owner/operator certifying that an individual trained in the provision of 40 CFR, Part 61, Subpart M will be on site, along with evidence that he/she has received the required training, during the demolition or renovation.
  17. Certification of Accuracy: Signature of owner/operator certifying the accuracy of the information submitted in the permit application notification and that North Carolina accredited personnel are being used on the project.

THE LAST LINE OF THE FORM IS RESERVED FOR THE SIGNATURE OF AN AGENCY REPRESENTATIVE.