Form SFN8509 "Application for Open Burning Variance" - North Dakota

What Is Form SFN8509?

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 November 1, 2015;
  • 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 SFN8509 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 SFN8509 "Application for Open Burning Variance" - North Dakota

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APPLICATION FOR OPEN BURNING VARIANCE
North Dakota Department of Health
Division of Air Quality
SFN 8509 (11-15)
Instructions: (1) Complete both pages of this form, (2) obtain signatures of approval from appropriate health unit and fire department personnel, and (3) send
completed application to the address listed on the last page.
Applicant’s Name
Company Name
Telephone Number
Mailing Address
City
State
Zip Code
Location of Burn Site
¼ Section
Section
Township
Range
County
Description of Material To Be Burned
Open burning causes air pollution. The Department encourages waste reduction programs and recycling as practical alternatives to disposing of refuse and other
combustible material by open burning.
The North Dakota Air Pollution Control Rules, North Dakota Administrative Code (NDAC) Chapter 33-15-01-07 allows variances in instances of “exceptional
circumstances” as follows:
“Where upon 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.”
Burning Will Be Supervised By
Explain why this request for a variance should qualify as “exceptional circumstances.” (Continue on
reverse if necessary)
Name:
Organization:
Telephone Number:
Approximate Burning Date(s):
ASBESTOS
In accordance with NDAC 33-15-13, if this request is for the burning of a facility, the facility must be inspected for
Date SFN17987 Form Submitted
asbestos, a Notification of Demolition and Renovation form (SFN17987) must be submitted to this Department
(if applicable)
and all asbestos must be removed prior to burning. In most cases, a facility includes all types of structures
except a single family home or an apartment building having no more than four units.
TOWNS OR OCCUPIED RESIDENCES WITHIN ONE MILE
Name
Direction From Burn Site
Distance From Burn Site
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 therefrom. I also agree to comply with the conditions of Chapter 33-15-04 of the North Dakota Air Pollution Control Rules and the conditions
listed on the Variance Approval to Open Burn, if granted by the Department.
Applicant’s Signature:
Date:
Local or District Health Unit Approval Signature:
Health Unit:
Title:
Date:
Printed:
City or Rural Fire Department Approval Signature:
Fire Department:
Title:
Date:
Printed:
NOTE: Unless your local health unit has final authority, written approval must be received from the North Dakota
Department of Health before burning can take place.
APPLICATION FOR OPEN BURNING VARIANCE
North Dakota Department of Health
Division of Air Quality
SFN 8509 (11-15)
Instructions: (1) Complete both pages of this form, (2) obtain signatures of approval from appropriate health unit and fire department personnel, and (3) send
completed application to the address listed on the last page.
Applicant’s Name
Company Name
Telephone Number
Mailing Address
City
State
Zip Code
Location of Burn Site
¼ Section
Section
Township
Range
County
Description of Material To Be Burned
Open burning causes air pollution. The Department encourages waste reduction programs and recycling as practical alternatives to disposing of refuse and other
combustible material by open burning.
The North Dakota Air Pollution Control Rules, North Dakota Administrative Code (NDAC) Chapter 33-15-01-07 allows variances in instances of “exceptional
circumstances” as follows:
“Where upon 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.”
Burning Will Be Supervised By
Explain why this request for a variance should qualify as “exceptional circumstances.” (Continue on
reverse if necessary)
Name:
Organization:
Telephone Number:
Approximate Burning Date(s):
ASBESTOS
In accordance with NDAC 33-15-13, if this request is for the burning of a facility, the facility must be inspected for
Date SFN17987 Form Submitted
asbestos, a Notification of Demolition and Renovation form (SFN17987) must be submitted to this Department
(if applicable)
and all asbestos must be removed prior to burning. In most cases, a facility includes all types of structures
except a single family home or an apartment building having no more than four units.
TOWNS OR OCCUPIED RESIDENCES WITHIN ONE MILE
Name
Direction From Burn Site
Distance From Burn Site
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 therefrom. I also agree to comply with the conditions of Chapter 33-15-04 of the North Dakota Air Pollution Control Rules and the conditions
listed on the Variance Approval to Open Burn, if granted by the Department.
Applicant’s Signature:
Date:
Local or District Health Unit Approval Signature:
Health Unit:
Title:
Date:
Printed:
City or Rural Fire Department Approval Signature:
Fire Department:
Title:
Date:
Printed:
NOTE: Unless your local health unit has final authority, written approval must be received from the North Dakota
Department of Health before burning can take place.
SFN 8509 (12-01)
Remarks/Comments (if necessary):
A VARIANCE APPROVAL TO OPEN BURN IS SUBJECT TO THE FOLLOWING:
1.
Oil, rubber, asphalt, hazardous materials and other materials which produce unreasonable amounts
of air contaminants may not be burned.
2.
The material must be dry enough to burn cleanly.
3.
Care must be used to minimize the amount of dirt on the material being burned.
4.
The burning must be conducted only when meteorological conditions favor smoke dispersion or air
mixing.
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.
When burning is in progress, winds must not be blowing toward any nearby city or occupied
residence, or toward any airport or landing strip adjacent to the burn location.
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 1 area (Theodore Roosevelt
National Park and Lostwood National Wildlife Refuge) 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 hours prior to burning.
10.
Burning activities must be attended and supervised at all times when burning is in progress.
11.
Burning is prohibited if the fire index is in the “extreme” category as issued by the National Weather
Service.
12.
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.
13.
The variance must be utilized within sixty days of the Department approval date, unless otherwise
approved.
Send completed application to:
North Dakota Department of Health
Division of Air Quality
918 E. Divide, 2nd Floor
Bismarck, ND 58501-1947
Telephone: (701)328-5188
Fax: (701)328-5185
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