Form SFN50278 "Inert Waste Disposal Variance Application" - North Dakota

What Is Form SFN50278?

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 SFN50278 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 SFN50278 "Inert Waste Disposal Variance Application" - North Dakota

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FOR STATE USE ONLY
INERT WASTE DISPOSAL VARIANCE APPLICATION
File
NORTH DAKOTA DEPARTMENT OF HEALTH 
DIVISION OF WASTE MANAGEMENT
Clear Fields
County
SFN 50278 (3-2007)
Please read the Department's Inert 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
Waste Volume
Waste Source
Waste Type
General Geographic Location
County
Legal Description or Street Address
Responsible Party
Telephone
Address
City
State
Zip Code
2. Reason or Justification for Variance
3. Proposed Inert Waste Disposal Location
Township
Range
County
of Section:
Total Acreage
Property Owner
Telephone
Address
City
State
Zip Code
Future Land Use
Present Land Use
4. Contractor For Waste Disposal
Name
Contact
Address
City
State
Zip Code
Telephone
Mobile Telephone
Equipment Used For Waste Disposal
5. 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Unpublished Soil Survey Map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
FOR STATE USE ONLY
INERT WASTE DISPOSAL VARIANCE APPLICATION
File
NORTH DAKOTA DEPARTMENT OF HEALTH 
DIVISION OF WASTE MANAGEMENT
Clear Fields
County
SFN 50278 (3-2007)
Please read the Department's Inert 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
Waste Volume
Waste Source
Waste Type
General Geographic Location
County
Legal Description or Street Address
Responsible Party
Telephone
Address
City
State
Zip Code
2. Reason or Justification for Variance
3. Proposed Inert Waste Disposal Location
Township
Range
County
of Section:
Total Acreage
Property Owner
Telephone
Address
City
State
Zip Code
Future Land Use
Present Land Use
4. Contractor For Waste Disposal
Name
Contact
Address
City
State
Zip Code
Telephone
Mobile Telephone
Equipment Used For Waste Disposal
5. 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
SFN 50278 (3-2007)
Page 2 of 2
6. Disposal Site And Soil Characteristic
Distance to Surface Water (feet)
Site Slope (percent)
Depth to Seasonal High Water Table (feet)
Soil Type and Texture
7. Disposal Site Design (Enclose appropriate diagrams, maps, cross sections, and narrative.)
Site Plan View
One to Two Cross Sections Showing: Trench Depth
Waste Placement
Final Cover Design
Final Vegetation
Diagrams Enclosed of These Components
Yes
No
8. Supplemental Application Forms
Indicate which supplemental forms are completed and attached to the application: 
Application for Open Burn Variance
Notification of Demolition and Renovation
9. Local Zoning Approval
Inert waste disposal must not conflict with local zoning ordinances. Consult with representatives of the applicable zoning jurisdiction (county,
township or city) to determine inert waste disposal compliance with zoning ordinances. A representative of the local zoning jurisdiction must
sign the application.
I, the undersigned, certify that inert 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
10. 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 inert waste disposal site. 
Party Responsible for Waste: The inert waste and/or the structure scheduled for demolition has been inspected. Prohibited waste or materials
described in the Department's “Guideline 22 - Inert Waste Disposal Variance” will not be disposed and/or will be removed from the structure prior
to demolition.
Printed Name
Date
Signature
Contractor: The inert waste disposal site will be operated and closed according to Guideline 22.
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 “Guideline 22 - Inert Waste Disposal Variance.” The Department will be provided with a certified copy of the notice within thirty (30)
days of filing.
Date
Printed Name
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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