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 Bureau of Land

Clean Construction or Demolition Debris  (CCDD)
Fill Operations Forms

Beginning July 1, 2008, no person can use CCDD as fill material in a current or former quarry, mine, or other excavation unless they have obtained a permit from the Illinois EPA. You may complete the forms below online and save them on your computer before printing and submitting them.  To view Adobe Acrobat PDF files, you will need the free Acrobat Reader software, available from Adobe's web site.

CCDD Fill Operations with Approved Permits

Regulations, Soil Certification Forms, and Tables for CCDD and USFO, Effective August 30, 2012

Permit Application Forms

Application for Permit for Clean Construction or Demolition Debris Fill Operations (LPC-PA25 Form)
Attachment A - Site Owner and Site Operator Disclosure (LPC-PA25A Form)
Attachment B - Compliance with Section 22.52 of the Act (LPC-PA25B Form)
Attachment C - Compliance with Section 39(i-5) of the Act (LPC-PA25C Form)
39(i) Certification for Individuals Form
39(i) Certification for Legal Entities
Notice of Application for Permit to Manage CCDD (LPC-PA26)
Certification of Authenticity of Official Forms

Note that the LPC-PA25 and 39(i) forms, certification of authenticity of official forms and the proof of notification of elected officials forms are required for all permit applications for new CCDD fill sites or expansions of existing sites.  The other attachments may be necessary in response to answers in the LPC-PA25 form.  See the instructions in the LPC-PA25 form for details.

Permit Modification Forms

For modifying an existing, permitted CCDD Filll Site, a CCDD modification form, Notice of Application for Permit to Manage CCDD form, and Certification of Authenticity are required.  Additionally, for Certification of Closure or Certification of Completion of Post-Closure Care, the application must also include the appropriate Affidavit. For transfer of owner or operator rights, the LPC 661 form must be completed and submitted with the applications.

CCDD Permit Modification Form
Affidavit for Certification of Closure of CCDD Fill Sites and Uncontaminated Soil Fill Operations (USFO)  
Affidavit for Certification of Post-Closure Care of CCDD Fill Sites and Uncontaminated Soil Fill Operations (USFO)  
Certification of Authenticity of Official Forms
CCDD Transfer Form
CCDD Transfer Form Instructions

Certification and Registration Forms

Source Site Certification by Owner or Operator LPC-662 
Uncontaminated Soil Certification by Licensed Professional Engineer or Licensed Professional Geologist LPC-663
Uncontaminated Soil Fill Operation Registration Form by Owner and/or Operator LPC-665
Painted CCDD Certification LPC-667

Miscellaneous Forms

CCDD Fee Form
CCDD Monthly Tons Record

Uncontaminated Soil Fill Operations (USFO) Forms

Beginning August 27, 2012, no person can use soil from an off-site source as a fill material in a current or former quarry, mine, or other excavation of a resource, unless they have registered with the Illinois EPA using LPC-665 form. 

Uncontaminated Soil Fill Operation Registration Form by Owner and/or Operator LPC-665
Affidavit for Certification of Closure of CCDD Fill Sites and Uncontaminated Soil Fill Operations (USFO)
Affidavit for Certification of Post-Closure Care of CCDD Fill Sites and Uncontaminated Soil Fill Operations (USFO)  

CCDD Load Rejection Information

In accordance with a standard operating condition present in all permits issued by the Illinois EPA to CCDD facilities, all CCDD facilities are required to submit a completed CCDD Load Rejection Form to the Illinois EPA after each instance of an incoming load being rejected by the CCDD facility.

All permit applications downloaded off of the Internet and submitted to Illinois EPA must be accompanied by certification of authenticity of official forms. You may also request paper copies by calling 217-524-3300.  Completed applications must be submitted by mail, personal delivery, or delivery service.  Applications may not be submitted via fax or e-mail.

Please ensure that applications and all required attachments are completed in full prior to their submission to the Illinois EPA.  Incomplete applications will be returned and will not be deemed submitted until a complete application is provided. 

Completeness checklist reviews are done within 30 days of receipt of a CCDD permit application to determine if the application is administratively complete. Complete applications are given technical reviews within 90 days of receipt of the application to determine if the permit can be issued.  The completeness checklist for new sites, the completeness checklist for applications for significant modification, and the technical checklist used by Illinois EPA reviewers may be useful.

Completed applications must be submitted to the following address:
Illinois EPA Mail Code #33
1021 North Grand Ave. East
P.O. Box 19276
Springfield, IL 62794-9276

 

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