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Uncontaminated Soil Certification Forms for Clay Fill & Dirt

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662 source-site-certification-form (1) (pdf)

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663 uncontaminated-soil-certification-form (pdf)

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LPC-662 & LPC-663 CERTIFICATION

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Incoming Materials

 We accept dirt and clay  to repair settling, erosion and fortify the soil. When you bring soil from a construction or other project, you must demonstrate that the soil is uncontaminated. Contaminated soil poses several health risks to workers on the site, local residents, as well as the population at large. By obtaining an LPC-662 certification from the source operator where you will get the soil, or completing an LPC-663 certification on the soil you receive, you can prove that the soil you intend to use is appropriate. 

LPC-662 Info

The LPC-662 is used for project sites that are not “Potentially Impacted Properties (PIP)".  A Potentially Impacted Property is one that is close to an environmental concern. 

If you are not sure if your project site is a PIP, please feel free to call 815-893-9321 for assistance.

There is important information about your project site you should know before you complete a LPC-662 form.  This includes:

  • A  complete and accurate address for your project site. 
  • The form asks for the latitude and longitude of the property. (You can obtain this from Google Maps)
  • Name and contact information for the site owner AND the site operator.
  • Knowledge of past and current use of the property. This can be done by:
  • EDR (Environmental Data Resources)
  • Talking with the owner
  • Speaking with local municipality offices
  • Doing a sight inspection of the property.
  • pH Test of the soil and a description of how those results were reached.       For example, you should describe what lab or make/model of pH meter was used in determining the pH level of the soil. (We can assist with pH testing)

For additional information or assistance with your LPC-662 Form, please call 815-893-9321 for assistance. 

  **You may have to save pdf files to your device and open with pdf viewer. They are not supported in most browsers.**

LPC-662 Form

LPC-663 Info

  

The IEPA’s LPC-663 form should be completed by either a Professional Engineer or Professional Geologist.  This form requires that the Professional Engineer or Geologist certify that the soil is uncontaminated.  The sampling frequency and tests required need to be approved beforehand.  Please call 815-893-9321 before sampling is conducted.
When submitting a Fill Application using a 663 Form, please be sure to include the following:
· A copy of the lab analytical reports
· Chain of custody control forms
· A map of any and all soil samples in certification.
· A map of the project site.

For P.E.’s and P.G.’s needing additional information or assistance with an LPC-663 form, please call 815-893-9321.

  **You may have to save pdf files to your device and open with pdf viewer. They are not supported in most browsers.** 

LPC-663 form

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