Form SFN3473 "Application for Open Burning Variance of Clean Wood at Landfills" - North Dakota

What Is Form SFN3473?

This is a legal form that was released by the North Dakota Department of Health - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2014;
  • The latest edition provided by the North Dakota Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN3473 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health.

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Download Form SFN3473 "Application for Open Burning Variance of Clean Wood at Landfills" - North Dakota

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APPLICATION FOR OPEN BURNING VARIANCE
Telephone:
701-328-5166
OF CLEAN WOOD AT LANDFILLS
Fax Number: 701-328-5200
NORTH DAKOTA DEPARTMENT OF HEALTH
Website: www.ndhealth.gov/wm
DIVISION OF WASTE MANAGEMENT
SFN 3473 (12-2014)
Clear Fields
Instructions: (1) Complete both sides of this form, (2) Obtain signatures of approval from appropriate health unit or North Dakota
Department of Health inspector and fire department personnel, and (3) Send completed form to the address listed below.
Applicant’s Name:
Company Name:
Telephone Number:
Mailing Address:
City:
State:
ZIP Code:
Location of burn site:
1/4 Section:
Section:
Township:
Range:
County:
Description of materials to be burned:
The North Dakota Air Pollution Rules, North Dakota Administrative Code (NDAC) Chapter 33-15-01-07 allows variances in instances of “exceptional
circumstances” as follows:
1. Whereupon written application of the responsible person or persons the department finds that by reason of exceptional circumstances strict conformity
with any provisions of this article would cause undue hardship, would be unreasonable, impractical, or not feasible under the circumstances, the
department may permit a variance from this article upon such conditions and within such time limitations as it may prescribe for prevention, control, or
abatement of air pollution in harmony with the intent of the state and any applicable federal laws.
2. No variance may permit or authorize the creation or continuation of a public nuisance, or a danger to public health or safety.
Due to considerations on pollution, the Department encourages better management for wood wastes, such as waste reduction, reuse of wood materials (such as
lumber, pallets, use as firewood for heating, etc.), grinding the materials to make a mulch or compost medium, and/or utilizing a permitted air curtain destructor.
Routine trade waste (pallets, manufacturing waste, etc.) may not be allowed. Additional guidance is available from the Department.
To obtain a variance under these provisions, the Department requests that applicants state what the “exceptional circumstances” are that
necessitate a variance. We also request a description of what actions are being taken to reduce the need for variances. For our consideration of any
variance request, please describe the justification and the waste reduction measures below (narrative may also be attached to variance application):
Exceptional circumstance for variance:
Measures taken and/or planned to reduce, reuse or recycle waste:
TOWNS OR OCCUPIED RESIDENCES WITHIN ONE MILE:
Name of Occupant
Direction From Burn Site
Distance From Burn Site
Burning will be supervised by:
Amount of time needed to complete burn:
APPLICANT AND COORDINATION SIGNATURES:
I, the undersigned, understand that approval to conduct open burning does not exempt or excuse any person from the consequences, damages, or injuries
which may result from it. I also agree to comply with the conditions of Chapter 33-15-04 of the North Dakota Air Pollution Control Rules and conditions listed on
the Variance Approval to Open Burn if granted by the Department:
Name:
Date:
District Health Unit or NDDoH Inspector Approval:
Title:
Date:
City or Rural Fire Department Approval:
Title:
Date:
Send completed application to:
North Dakota Department of Health - Division of Waste Management
918 E. Divide Ave. - 3rd Floor
Bismarck, ND 58501-1947
APPLICATION FOR OPEN BURNING VARIANCE
Telephone:
701-328-5166
OF CLEAN WOOD AT LANDFILLS
Fax Number: 701-328-5200
NORTH DAKOTA DEPARTMENT OF HEALTH
Website: www.ndhealth.gov/wm
DIVISION OF WASTE MANAGEMENT
SFN 3473 (12-2014)
Clear Fields
Instructions: (1) Complete both sides of this form, (2) Obtain signatures of approval from appropriate health unit or North Dakota
Department of Health inspector and fire department personnel, and (3) Send completed form to the address listed below.
Applicant’s Name:
Company Name:
Telephone Number:
Mailing Address:
City:
State:
ZIP Code:
Location of burn site:
1/4 Section:
Section:
Township:
Range:
County:
Description of materials to be burned:
The North Dakota Air Pollution Rules, North Dakota Administrative Code (NDAC) Chapter 33-15-01-07 allows variances in instances of “exceptional
circumstances” as follows:
1. Whereupon written application of the responsible person or persons the department finds that by reason of exceptional circumstances strict conformity
with any provisions of this article would cause undue hardship, would be unreasonable, impractical, or not feasible under the circumstances, the
department may permit a variance from this article upon such conditions and within such time limitations as it may prescribe for prevention, control, or
abatement of air pollution in harmony with the intent of the state and any applicable federal laws.
2. No variance may permit or authorize the creation or continuation of a public nuisance, or a danger to public health or safety.
Due to considerations on pollution, the Department encourages better management for wood wastes, such as waste reduction, reuse of wood materials (such as
lumber, pallets, use as firewood for heating, etc.), grinding the materials to make a mulch or compost medium, and/or utilizing a permitted air curtain destructor.
Routine trade waste (pallets, manufacturing waste, etc.) may not be allowed. Additional guidance is available from the Department.
To obtain a variance under these provisions, the Department requests that applicants state what the “exceptional circumstances” are that
necessitate a variance. We also request a description of what actions are being taken to reduce the need for variances. For our consideration of any
variance request, please describe the justification and the waste reduction measures below (narrative may also be attached to variance application):
Exceptional circumstance for variance:
Measures taken and/or planned to reduce, reuse or recycle waste:
TOWNS OR OCCUPIED RESIDENCES WITHIN ONE MILE:
Name of Occupant
Direction From Burn Site
Distance From Burn Site
Burning will be supervised by:
Amount of time needed to complete burn:
APPLICANT AND COORDINATION SIGNATURES:
I, the undersigned, understand that approval to conduct open burning does not exempt or excuse any person from the consequences, damages, or injuries
which may result from it. I also agree to comply with the conditions of Chapter 33-15-04 of the North Dakota Air Pollution Control Rules and conditions listed on
the Variance Approval to Open Burn if granted by the Department:
Name:
Date:
District Health Unit or NDDoH Inspector Approval:
Title:
Date:
City or Rural Fire Department Approval:
Title:
Date:
Send completed application to:
North Dakota Department of Health - Division of Waste Management
918 E. Divide Ave. - 3rd Floor
Bismarck, ND 58501-1947
SFN 3473 (12-2014)
Page 2 of 2
Use this area for comments, remarks,
diagrams and maps if necessary.
N
1 mile
Instructions
Locating the burn site at the center, identify all occupied
residences that are located within one mile of the burn site..
A VARIANCE APPROVAL TO OPEN BURN IS SUBJECT TO THE FOLLOWING:
1.
Oil, rubber, asphalt, asphalt shingles, upholstered furniture, plastics, fabrics, insulation, foam, treated wood,
electronics, appliances, household waste, hazardous materials, batteries, chemicals, and other materials
which produce unreasonable amounts of air contaminants may not be burned.
2.
Grass and leaves which smolder and do not burn readily shall not be burned. The material must be dry enough
to burn cleanly and shall not contain noncombustible matter or items such as metal, glass, plaster, sheetrock,
concrete, brick etc.
3.
Care must be used to minimize the amount of dirt on the material being burned.
4.
The initial burning may begin only between three hours after sunrise and three hours before sunset, and
additional fuel may not be intentionally added to the fire at times outside those limits.
5.
The burning must be conducted in such a manner to ensure that the fire will not spread to any material not
approved for burning.
6.
Prevailing winds at the time of burning at the above location must be away from any nearby city or occupied
residence and must be away from any airport or landing strip within one mile (1.61 kilometers).
7.
The burning may not be conducted adjacent to any highway or public road so as to create a traffic hazard.
8.
The burning may not be conducted in such proximity to any Class I area that the visibility of such area is
adversely impacted, as defined in Chapter 33-15-19 of the North Dakota Air Pollution Control Rules.
9.
The local/appropriate fire department must be notified at least two (2) hours prior to burning.
10.
Notification to the Department is required prior to starting the burn.
11.
Burning activities must be attended and supervised at all times burning is in progress.
12.
Burning is prohibited if the fire index is in the “extreme” category as issued by the National Weather Service.
13.
If state or local fire officials determine conditions to be unsafe for open burning, such burning must cease until
conditions are deemed to be safe by such officials.
14.
The variance must be utilized within sixty (60) days of the Department approval date.
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