Form SFN51098 "Waste Disposal Variance Application" - North Dakota

What Is Form SFN51098?

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 March 1, 2007;
  • 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 SFN51098 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 SFN51098 "Waste Disposal Variance Application" - North Dakota

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FOR STATE USE ONLY
WASTE DISPOSAL VARIANCE APPLICATION
File
NORTH DAKOTA DEPARTMENT OF HEALTH 
DIVISION OF WASTE MANAGEMENT
Clear Fields
County
SFN 51098 (3-2007)
Please read the Department's Waste Disposal Variance Guideline before completing this variance application. In addition, applicable portions
of the state solid waste management regulations should be referenced in completing the applications. The source, type, and characteristics of
your waste will determine which rules apply. Applications must be thorough and complete to be considered. A written Waste Disposal
Variance must be received from the Department before disposal may begin. Please call the Department's Solid Waste Program at (701) 328-
5166 to coordinate your application with a Department staff member.
1. Waste Description
Approximate Waste Volume
Waste Source
Waste Type
General Geographic Location
Section
Township
Range
County
Legal Description
Responsible Party
Telephone
Address
City
State
Zip Code
2. Proposed Waste Disposal Location
Township
Range
County
of Section:
Total Acreage
Property Owner
Telephone
Address
City
State
Zip Code
Future Land Use
Present Land Use
3. Contractor For Waste Disposal
Name
Contact
Address
City
State
Zip Code
Telephone
Mobile Telephone
Equipment Used For Waste Disposal
4. Maps
Indicate which maps accompany the application (see Instructions in Disposal Site Selection of guideline): 
Published Soil Survey Map
Unpublished Soil Survey Map
CFSA Map
Topographic Map
5. Disposal Site And Soil Characteristic
Distance to Surface Water (feet)
Site Slope (percent)
Depth to Seasonal High Water Table (feet)
Soil Type and Texture
FOR STATE USE ONLY
WASTE DISPOSAL VARIANCE APPLICATION
File
NORTH DAKOTA DEPARTMENT OF HEALTH 
DIVISION OF WASTE MANAGEMENT
Clear Fields
County
SFN 51098 (3-2007)
Please read the Department's Waste Disposal Variance Guideline before completing this variance application. In addition, applicable portions
of the state solid waste management regulations should be referenced in completing the applications. The source, type, and characteristics of
your waste will determine which rules apply. Applications must be thorough and complete to be considered. A written Waste Disposal
Variance must be received from the Department before disposal may begin. Please call the Department's Solid Waste Program at (701) 328-
5166 to coordinate your application with a Department staff member.
1. Waste Description
Approximate Waste Volume
Waste Source
Waste Type
General Geographic Location
Section
Township
Range
County
Legal Description
Responsible Party
Telephone
Address
City
State
Zip Code
2. Proposed Waste Disposal Location
Township
Range
County
of Section:
Total Acreage
Property Owner
Telephone
Address
City
State
Zip Code
Future Land Use
Present Land Use
3. Contractor For Waste Disposal
Name
Contact
Address
City
State
Zip Code
Telephone
Mobile Telephone
Equipment Used For Waste Disposal
4. Maps
Indicate which maps accompany the application (see Instructions in Disposal Site Selection of guideline): 
Published Soil Survey Map
Unpublished Soil Survey Map
CFSA Map
Topographic Map
5. Disposal Site And Soil Characteristic
Distance to Surface Water (feet)
Site Slope (percent)
Depth to Seasonal High Water Table (feet)
Soil Type and Texture
SFN 51098 (3-2007)
Page 2 of 2
6. Disposal Site Design
Base Grade
Linear Design
Final Cover Design
Leachate Collection System (if applicable)
Diagrams Enclosed of These Components
Yes
No
7. Supplemental Application Forms
Indicate which supplemental forms are completed and attached to the application: 
Application for Open Burn Variance
Notification of Demolition and Renovation
8. Local Zoning Approval
Waste disposal must not conflict with local zoning ordinances. Consult with representatives of the applicable zoning jurisdiction (county,
township or city) to determine waste disposal compliance with zoning ordinances. A representative of the local zoning jurisdiction must sign the
application.
I, the undersigned, certify that waste disposal at the location described on this application does not conflict with local zoning ordinances. 
Printed Name
Date
Signature
Printed Name
Date
Zoning Jurisdiction
9. Signatures
Signatures are required by the following: the party responsible for the waste and/or owner of the property scheduled for demolition; the
contractor; and owner of waste disposal site. 
Party Responsible for Waste: The waste and/or the structure scheduled for demolition has been inspected. Prohibited waste or materials
described in the Department's Waste Disposal Variance Guideline will not be disposed and/or will be removed from the structure prior to
demolition.
Printed Name
Date
Signature
Contractor: The waste disposal site will be operated and closed according to Department's Waste Disposal Variance Guideline.
Printed Name
Date
Signature
Disposal Site Owner: A notification of inert waste disposal will be filed with the County Register of Deeds. The notification will be completed
according to the Department's Waste Disposal Variance Guideline. Closed solid waste management units may not be used for cultivated crops,
heavy grazing, buildings, or any other use which might disturb the protective vegetative and soil cover. The Department will be provided with a
certified copy of the notice within thirty (30) days of filing.
Printed Name
Date
Signature
ND Department of Health
Mail this application and supplemental forms to:
Division of Waste Management 
918 E. Divide Ave., 3rd Fl.
Bismarck, ND 58501-1947
Telephone: 701-328-5166 · Fax: 701-328-5200 · Website: www.ndhealth.gov/wm
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