Material Approval Form PDF Details

The Material Source Approval Request form, employed by the North Dakota Department of Transportation's Office of Environmental and Cultural Resources, serves as a vital procedural document aimed at regulating the extraction and use of materials from specific locations. This comprehensive form, identified by the State Form Number 58466 and last updated in February 2009, necessitates detailed submissions for each material source location. Applicants must provide a wealth of information, including a precise legal description, a pit ID for department use, submission date, and the geographical specifics such as county, township, range, and section. It specifically asks for the type of material or activity intended at the site, ranging from aggregate, borrow, and stockpile areas to rip-rap, plant, and waste sites, alongside the approximate depth of excavation. Each request mandates personal and project-related details, including the name and contact of the project engineer or manager, the consulting engineering firm involved, project numbers, and pertinent contact information for both the applying company and its key contact person. This form underscores a thorough vetting process, highlighted by a requisite map attachment for area approval, promising a systematic and environmentally conscious approval process. Additionally, it underscores the collaborative aspect of the approval process by incorporating a section for the U.S. Fish and Wildlife Service (USFWS), underscoring the importance of considering protected species and habitat. The necessity for at least a 30-day processing period is indicated, alongside instructions for submission, thereby setting clear expectations for all parties involved.

QuestionAnswer
Form NameMaterial Approval Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesmaterial approval request letter, material sample approval form, material approval request template, material approval form

Form Preview Example

MATERIAL SOURCE APPROVAL REQUEST

North Dakota Department of Transportation, ETS - Environmental and Cultural Resources

SFN 58466 (2-2009)

Complete a separate form for each material source location The following information is REQUIRED

(including map file showing boundary of area to be approved)

Legal Description

Pit ID (NDDOT Use Only)

Date Submitted

FEB 25, 2009

County

McLean

Township (number, not name)

149

RangeSection

08335

Material/Activity Check all that apply

Aggregate

 

Staging Area

Borrow

 

Stockpile Area

 

Rip-Rap

 

Plant Site

 

Waste Site

 

 

Approximate Depth of Excavation

15-feet

Source Name

site 1

Project Information

Name (Project Engineer or Project Manager)

 

 

 

 

 

 

Division/District/Consulting Engineering Firm

 

Joe Designer

 

 

 

 

 

 

 

No Name Engineering

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Project Number or Project Location

 

Project Control Number

 

 

Email Address

 

 

 

 

 

 

 

 

 

xx-7-753(182)984

 

 

15151

 

 

jdesigner@noname.com

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applicant

 

Company Name

Contact Person

 

Yankee Excavating

 

Bernie Williams

Address

44 East 16 st St.

Telephone Number

City

State

 

Zip Code

New York

 

NY

 

10451

Email Address

701-555-1212

 

idig@excavating.com

Comments

NENE

Please allow at least 30 days for completion of this process

YOU MUST ATTACH A MAP or the form will be returned to you!

Print or save a copy for your own records!

Submit by email to: materialsource@nd.gov

USFWS Use Only

USFWS Property

T&E Species Further Review Required

USFWS Approval

Date

USFWS

Comments

101°16'W

101°15'W

27

34

5

26

Haul Road

Area to be disturbed

T149N

R 83W

35

MCLEAN

T148N

4

R 83W

 

25

36

3

47°41'N

101°16'W

101°15'W

F

101°16'W

101°15'W

27

34

5

26

Haul Road

Area to be disturbed

T149N

R 83W

35

MCLEAN

T148N

4

R 83W

 

25

36

3

47°41'N

101°16'W

101°15'W

F