LPC-PA25B 2025

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  1. Click ‘Get Form’ to open the LPC-PA25B in the editor.
  2. Begin with Section I: SITE IDENTIFICATION. Enter the facility name, office phone number (if available), and provide a detailed physical site location including street, city, county, and zip code.
  3. Proceed to Section II: CONFLICT OF INTEREST DISCLOSURE. Carefully read the prohibition details and identify all relevant persons who have a direct financial interest or benefit related to the clean construction or demolition debris fill operation.
  4. In the provided columns, fill in the NAME, POSITION/RELATION, and DESCRIPTION OF INTEREST/BENEFIT for each identified person. Ensure all entries are accurate and legible.
  5. Review all sections for completeness and accuracy before submitting your form. Utilize our platform’s features to save your progress as needed.

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CCDD. Clean construction or demolition debris. CCDD FILL OPERATION. A current or former quarry, mine, or other excavation where clean construction or demolition debris is used as fill material.
Clean construction or demolition debris (CCDD or Clean CDD) is uncontaminated broken concrete without protruding metal bars, bricks, rock, stone, or reclaimed asphalt pavement generated from construction or demolition activities.
If buried below grade outside of a groundwater well setback zone, the construction and demolition debris must be covered with sufficient uncontaminated soil to support vegetation within 30 days of the completion of the burial. Broken concrete without protruding metal bars may be used for erosion control.
If the property meets the definition of a potentially impacted property, full MAC table soil sampling will be needed, and the LPC-663 form is required. If the property does not meet the definition of a potentially impacted property, then LPC-662 can be used and only a pH sample is needed.
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