New Submission

Current Corrective Action Cost Form -
For Financial Assurance Requirements
The information requested within this form is based on the requirements of the Current Corrective Action Program and the Financial Assurance Program under the purview of the Solid Waste Section.
The Current Corrective Action Program ensures protection of public heath and the environment from potential groundwater contaminants. This form will allow for a clear understanding to the owner/operator and the Section as to how this will be achieved.
The Financial Assurance Program ensures there is enough funding in place to the benefit of the State to take on the described tasks should the owner/operator not be able to do so. This will ensure the environmental burden is not on the residence of North Carolina.
This form will allow an owner/operator undergoing a corrective action program to submit an initial itemized cost estimate, increase for annual inflation, as well as request an annual change in cost for approval.
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These websites may provide additional program material:
Division of Waste Management - Solid Waste Section Financial Assurance Website
Division of Waste Management - Solid Waste Section Environmental Monitoring Branch Website
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Should you have any questions or concerns during the submittal of this form, feel free to reach out to Sarah Moutos at 919-707-8287 or Sarah.Moutos@deq.nc.gov

Permit Information

This Section requests information that is based on the Owner/Operator's solid waste permit, approved ACM, and approved CAP

Key Information to Complete Form
Definitions to Assist with Completion of this Form
Permit Numberfield type drop-down
If Other, enter Permit Numberfield type single line
XXXX-PrimaryOperation-YYYY
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Laserfiche Folder Namefield type single line
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If Other, Laserfiche Folder Namefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
This field contains a calculation error.
References: If Other, enter Permit Number

Owner / Operator (Legal Entity)*

Owner/Operator Contact Email*

Facility Name*

Remedial Actions Approved to Conduct*

Timeframe for Approved Remedial Action*

Years to Complete Remedial Action

Plume Stability Evaluation*

Contingency Action(s)*

Year of Next CAER Submittal*

This form does not include the General Statute required Potential Assessment and Corrective Action (PACA) estimate. The PACA annual estimate based on facility type may be found at: https://deq.nc.gov/about/divisions/waste-management/solid-waste-section/financial-assurance-for-solid-waste-management-facilities#potential-assessment-and-corrective-action-(paca)
After detailed review of your current corrective action cost estimate, the Section will reach out to you to either further discuss, approve, or deny the request.

Should you have any questions regarding completion of this form or the status of your request, feel free to reach out to Sarah Moutos at 919-707-8287 or Sarah.Moutos@deq.nc.gov.
Preparer's Signature*field type signature
Date*field type date
Printed Name*field type single line
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Title*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Company Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Phone Number*field type single line
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Email*field type email

Permit Information

List of Duties Performed to Decrease Cost Estimate