Connecticut Administrative Code › Title 22a - Environmental Protection › 133q - Remediation Standard › Section 22a-133q-app2 - Appendix 2

Current through July 10, 2024
Appendix 2 to Section
				22a-133q-1
				to Section 22a-133q-9 of the Regulations of Connecticut State Agencies
				Application Form of Notice of Activity and Land Use Restriction (NAUL)
For Commissioner's or Licensed Environmental Professional's
				(LEP's) Approval
Instructions: Any NAUL pursuant to Environmental Use
						  Restriction Regulations ("EUR regulations") shall be in the following
						  application form. This form shall be used for any NAUL approved by the
						  Commissioner or a LEP pursuant to the EUR regulations. The appropriate
						  information shall be inserted into the parentheses "{}".
Instructions which are included in {parenthesis} and
						  non-applicable options shall be deleted prior to signature.
After Recording Return to:
{Instructions- use current contact information -
Connecticut Department of Energy and Environmental
				Protection
Environmental Use Restriction Coordinator
Bureau of Water Protection and Land Reuse
Remediation Division
79 Elm Street
Hartford, Connecticut 06106-5127
Re: {Remediation Division Identification Number}}
DECLARATION OF NOTICE OF ACTIVITY AND USE LIMITATION
This Declaration of Notice of Activity and Use Limitation
				("NAUL") is made this {day} day of {month}, {year}, by {Owner's legal name}
				(the "Owner").
W I T N E S S E T H:
WHEREAS, {Name of property Owner(s)}, is/are the Owner(s) in
				fee simple of certain real property (the "Property") described below:
Street address: {Street address of property}
City/Town: {City or Town of property}
State: Connecticut
Assessor's Map: {Map Designation or Not
						  Applicable}
And/or Assessors' Account Number {Assessors' Account
						  Number or Not Applicable}
Volume and Page of Deed: {Volume and Page of
						  Deed}
A description of the Property is attached hereto as Exhibit A,
				and which is made a part hereof; and
WHEREAS, the NAUL and associated exhibits identified herein,
				collectively represent the NAUL for the Property, and
WHEREAS, the LEP has the authority to sign and seal this NAUL
				pursuant to section 22a-133o of the Connecticut General Statutes and section
				22a-133q-3 of the Regulations of Connecticut State Agencies; and the
				Commissioner of Energy and Environmental Protection ("Commissioner") has the
				authority to sign this NAUL pursuant to sections 22a-5, 22a-6, and 22a-133o of
				the Connecticut General Statutes; and
WHEREAS, remediation of the Property has been conducted in
				accordance with section 22a-133k of the Connecticut General Statutes;
				and
{Instructions: select the language for Commissioner approval or
				for LEP, as applicable and delete the non-applicable option}
{Language for Commissioner approval}
WHEREAS, the Commissioner has determined that the NAUL
						  set forth below is consistent with regulations adopted pursuant to section
						  22a-133k of the Connecticut General Statutes; and
WHEREAS, the Commissioner has determined that this
						  NAUL will effectively protect human health and the environment from the hazards
						  of pollution on the property; and
WHEREAS, the Commissioner's written approval of this
						  NAUL is evidenced by the signature of the Commissioner or the Commissioner's
						  designee below.
{Language for LEP approval}
WHEREAS, the LEP whose signature appears below has
						  determined that the NAUL set forth below is consistent with the EUR
						  regulations, sections 22a-133a-1 to 22a-133q-9, inclusive, of the Regulations
						  of Connecticut State Agencies adopted pursuant to section 22a-133k and section
						  22a-133o of the Connecticut General Statutes; and
WHEREAS, the written approval of this NAUL is evidenced
						  by the signature and seal of the LEP below; and
WHEREAS, the LEP whose signature and seal appears below
						  and in the EUR opinion attached hereto as Exhibit B has determined that this
						  NAUL will effectively protect human health and the environment from the hazards
						  of pollution.
WHEREAS, the EUR opinion attached hereto as Exhibit B which is
				made a part hereof, includes the information required by section 22a-133q-5 of
				the Regulations of Connecticut State Agencies.
WHEREAS, the Property or portion thereof that is subject to
				this NAUL ("the Subject Area") and identified in the survey attached hereto as
				Exhibit C which is made a part hereof, contains pollutants; and
WHEREAS, to prevent exposure to, or migration of, such
				pollutants and to abate hazards to human health and the environment, and in
				accordance with the EUR opinion, the Owner desires to implement a NAUL to
				provide notice of the presence of pollution at the Subject Areas; and
WHEREAS, as required by section 22a-133o of the Connecticut
				General Statutes, the Owner and subsequent Owners of interests in the property
				or those Owners of interests who have signed the NAUL, such Owners' successors
				and assigns, and any person who has a license to use such Property or to
				conduct remediation on any portion of such Property shall adhere to the NAUL;
				and
NOW, THEREFORE, the Owner desires to implement this NAUL as
				follows:
1. Purpose. The provisions of this NAUL are set forth in the
				EUR opinion, attached hereto as Exhibit B.
2. Restrictions and Obligations Applicable to the Subject Area.
				In furtherance of the purposes of this NAUL, the Owner shall assure that use,
				occupancy, and activity of and at the Subject Area are conducted in accordance
				with the requirements of the EUR opinion, attached hereto as Exhibit B. The
				Owner shall fulfill the obligations and maintain the conditions necessary to
				meet the objectives of the NAUL in accordance with the requirements of the EUR
				opinion, attached hereto as Exhibit B. Such restrictions shall remain in effect
				unless and until a release is obtained under paragraph 5 below.
3. Except as provided in paragraphs 4 and 5 below, no action
				shall be taken, allowed, suffered, or omitted if such action or omission is
				reasonably likely to:
i. Create a risk of migration of pollutants or potential hazard
				to human health or the environment; or
ii. Result in a disturbance of the integrity of any engineered
				controls or remedies designed or utilized at the Subject Area to contain
				pollutants or limit human exposure to pollutants.
4. Emergencies. In the event of an unforeseen combination of
				circumstances or the resulting state that calls for immediate action to prevent
				a significant risk to human health or the environment, the destruction of
				property, or the disruption of public utility service, the application of
				paragraphs 2 and 3 above may be suspended, provided such risk cannot be abated
				without suspending said paragraphs and the Owner:
i. Immediately notifies the Department of Energy and
				Environmental Protection ("DEEP") of the emergency;
ii. Limits both the extent and duration of the suspension to
				the minimum reasonably necessary to adequately respond to the emergency;
iii. Implements all measures necessary to limit actual and
				potential present and future risk to human health and the environment resulting
				from such suspension; and
iv. After the emergency is abated, implements a plan approved
				in writing by a LEP or the Commissioner, on a schedule approved by the LEP or
				the Commissioner, to ensure that the Subject Area is remediated in accordance
				with sections
				22a-133k-1 to
				22a-133k-3,
				inclusive, of the Regulations of Connecticut State Agencies and restored to the
				condition described in the NAUL.
5. Release of NAUL; Temporary Allowable Disturbance. Except as
				provided in paragraph 4, the Owner shall not make, or allow or suffer to be
				made, any alteration of any kind in, to, or about any portion of any Subject
				Area inconsistent with this NAUL unless and until, either:
i. A temporary allowable disturbance is implemented in
				accordance with section 22a-133q-6 of the Regulations of Connecticut State
				Agencies, or
ii. A release has been approved in accordance with section
				22a-133q-7 of the Regulations of Connecticut State Agencies.
6. Commissioner's Right of Access. The Owner shall grant access
				to the property to the Commissioner as required by section 22a-133q-9(e) of the
				Regulations of Connecticut State Agencies.
7. Notice and Time of Entry onto Property. Entry onto the
				Property by the Commissioner shall be upon reasonable notice and at reasonable
				times, provided that entry shall not be subject to these limitations if the
				Commissioner determines that immediate entry is necessary to protect human
				health or the environment.
8. Incorporation of NAUL in Other Documents. As required by
				section 22a-133o of the Connecticut General Statutes, upon transfer of any
				interest in or a right to use property, or a portion of property that is
				subject to a NAUL, the Owner of such land, any lessee of such land and any
				person who has the right to subdivide or sublease such property, shall
				incorporate such notice in full or by reference into all future deeds,
				easements, mortgages, leases, licenses, occupancy agreements and any other
				instrument of transfer provided the failure to incorporate such notice shall
				not affect the enforceability, validity or applicability of any such NAUL.
				Within 30 days of transfer of any interest in, or right to use the Property, or
				portion of property subject to a NAUL, the Owner shall submit notice to the
				Commissioner on a form prescribed by the Commissioner.
9. At least 30 days prior to transferring an interest in the
				property, the Owner shall submit to the potential purchaser a complete copy of
				the EUR and copies of all documents required to be retained by the Owner
				pursuant to section 22a-133q-9 of the Regulations of Connecticut State
				Agencies.
10. Persons Entitled to Enforce Restrictions. The restrictions
				in this NAUL on use, occupancy, and activity of and at the Property shall be
				enforceable in accordance with section 22a-133p of the Connecticut General
				Statutes.
11. Severability and Termination. If any court of competent
				jurisdiction determines that any provision of this NAUL is invalid or
				unenforceable, the provisions of section 22a-133q-3 of the Regulations of
				Connecticut State Agencies and section 22a-133r of the Connecticut General
				Statutes shall apply.
12. Binding Effect. All of the terms, covenants and conditions
				of this NAUL shall be binding on those who are bound by the operation of
				section 22a-133o of the Connecticut General Statutes.
13. Terms Used Herein. The definitions of terms used herein
				shall be the same as the definitions contained in sections
				22a-133k-1 and
				22a-133q-1
				of the Regulations of Connecticut State Agencies as such sections existed on
				the date of execution of this NAUL.
14. Burden of Proof With respect to any claim or cause of
				action asserted by the Commissioner against the Owner under this NAUL, the
				Owner shall bear the burden of proving that any activities at the Subject Area
				do not or will not violate the restrictions imposed by this NAUL, that the
				obligations of the NAUL have been carried out, and that conditions at the
				Subject Area have been maintained in accordance with the requirements of the
				EUR opinion. The Owner, or its successors in interest, shall be responsible for
				demonstrating that use on the Property is in conformity with the NAUL.
15. Inspections. The Owner or its successors and assigns shall
				perform or cause to be performed the inspections required by section 22a-133q-8
				of the Regulations of Connecticut State Agencies. If the required inspection
				indicates non-compliance with the NAUL, the Owner or his successors and assigns
				shall take the action required by section 22a-133q-8 of the Regulations of
				Connecticut State Agencies.
16. Non-Waiver. No failure on the part of the Commissioner at
				any time to require performance of any term of this NAUL shall be taken or held
				to be a waiver of such term or in any way affect the Commissioner's rights to
				enforce such term.
17. Foreclosure of a Mortgage, Lien, or other Encumbrance. If a
				NAUL is extinguished by foreclosure of a mortgage, lien or other encumbrance,
				the requirement of section 22a-133o(c)(8) of the Connecticut General Statutes
				shall apply.
18. Nothing in this NAUL shall affect the Commissioner's
				authority to institute any proceeding, or take any action to prevent or abate
				pollution, to recover costs and natural resource damages, and to impose
				penalties for violations of law or violations of this NAUL. If at any time the
				Commissioner determines that the NAUL does not protect human health and the
				environment from the hazards of pollution, the Commissioner may institute any
				proceeding, or take any action to require further investigation or further
				action to prevent or abate pollution. The approval of this NAUL relates only to
				pollution or contamination identified in the EUR opinion attached hereto as
				Exhibit B of this NAUL.
19. The Owner shall retain copies of all documents required by
				section 22a-133q-9 of the Regulations of Connecticut State Agencies.
20. DEEP Contact Information: Any document required to be
				submitted to DEEP pursuant to this NAUL shall, unless otherwise specified in
				writing by DEEP, be directed to:
{Instructions- use current contact information}
{Connecticut Department of Energy and
Environmental Protection Environmental Use Restriction
				Coordinator
Bureau of Water Protection and Land Reuse
Remediation Division
79 Elm Street
Hartford, Connecticut 06106-5127
Re: {Remediation Division Identification Number}}
By signing below, the undersigned certifies that:
a. He or she is fully authorized to sign this NAUL;
b. The Owner has the power and authority to enter into this
				NAUL to grant the restrictions, fulfill the obligations, and maintain the
				conditions necessary to meet the objectives of the NAUL in accordance with the
				requirements of the EUR opinion attached hereto and made a part as Exhibit
				B;
c. The Owner has identified all other parties that hold any
				interest (e.g., encumbrance) in the Property and notified such parties of the
				Owner's intention to enter into this NAUL in accordance with section 22a-133o
				of the Connecticut General Statutes;
In witness whereof, I/we, {Owner's name}, have hereunto set
				my/our hands this {day} day of {month}, {year}.
{Select Applicable Signature Block, and delete the
				non-applicable signature blocks}
If for an individual:
Witnessed by:
{Signature of Witness 1}
{Signature of Owner}
{Printed or Typed Name of Witness 1}
{Printed or Typed Name of Owner}
{Signature of Witness 2}
{Printed or Typed Name of Witness 2}
If for an entity
:
Witnessed by:
{Owner's Name}
By:
{Signature of Witness 1}
{Printed or Typed Name of the Authorized Signatory for
						  the Entity}
{Printed or Typed Name of Witness 1}
Its duly authorized {Title of the Authorized Signatory
						  for the Entity}
{Signature of Witness 2}
{Printed or Typed Name of Witness 2}
Mailing Address:
Street Address: {Street Address}
City/Town: {City or Town}
State and Zip Code {State and Zip Code}
{
Notarization Language for Owner Acknowledgement -
				select appropriate notarization language from one of the choices below and
				delete the non-applicable notarization language.}
If the Owner is an individual:
State of {__________}
County of {__________}
On this {date} day of {month}, {year} before me, {name of
				notary or Commissioner of the Superior Court} the undersigned officer,
				personally appeared {name of individual or individuals}, known to me (or
				satisfactorily proven) to be the person(s) whose name(s) {choose is or are}
				subscribed to the within instrument and acknowledged that {he/she/they}
				executed the same for the purposes therein contained.
In witness whereof I hereunto set my hand.
{Choose Notary Public or Commissioner of the Superior Court}
				Date Commission Expires {date}
OR
If the Owner is a Corporation:
State of {_______}
County of {
____________________
}
On this {date} day of {month}, {year} before me, {name of
				notary or Commissioner of the Superior Court}, the undersigned officer,
				personally appeared {name of officer}, who acknowledged himself /herself to be
				the {title of officer} of {name of corporation}, a corporation, and that
				he/she, as such {title of officer}, being authorized to do so, executed the
				foregoing instrument for the purposes therein contained, by signing the name of
				the corporation by himself/herself as {title of officer}.
In witness whereof I hereunto set my hand.
{Choose Notary Public or Commissioner of the Superior Court}
				Date Commission Expires {date}
OR
If the Owner is a Limited Liability
				Company:
State of {
__________________
}
County of {
____________________
}
On this {date}day of {month}, {year} before me, {name of notary
				or Commissioner of the Superior Court}, the undersigned officer, personally
				appeared {name of officer}, who acknowledged himself/herself to be the {title
				of officer} of {name of limited liability company}, a (member managed or
				manager managed) limited liability company, and that he/she, as such {title of
				officer}, being authorized to do so, executed the foregoing instrument for the
				purposes therein contained, by signing the name of the limited liability
				company by himself/herself as {title of officer}.
In witness whereof I hereunto set my hand.
{Choose Notary Public or Commissioner of the Superior Court}
				Date Commission Expires {date}
OR
{If the Owner is any other type of entity, provide
				appropriate language for the Owner Entity below} {insert appropriate
				certification language for an Acknowledgement as specified in Section 1-34 of
				the Connecticut General Statutes}
{Instructions - DEEP Signature Block - Select one of the
				two choices below, as applicable and delete the non-applicable
				option.}
{This choice is used for NAULs approved by the
				Commissioner}
DEEP:
The Commissioner of Energy and
						  Environmental Protection or by the Commissioner's designee
By: {signature of the Commissioner or Commissioner's
						  designee}
Date: {date of signature}
Name: {printed or typed name of Commissioner or
						  Commissioner's designee}
Its Duly Authorized: {title of Commissioner or
						  Commissioner's designee}
Mailing Address {use current contact
						  information}:
{Connecticut Department of Energy and Environmental
						  Protection
Environmental Use Restriction Coordinator
Bureau of Water Protection and Land Reuse
Remediation Division
79 Elm Street
Hartford, Connecticut 06106-5127
Re: {Remediation Division Identification
						  Number}}
{
This choice is used solely for NAULs approved by a LEP
pursuant to section 22a-133o(c)(5)(B) of the Connecticut General
				Statutes and 22a-133q-3 of the Regulations of Connecticut State
				Agencies
.}
DEEP:
The Commissioner of Energy and
						  Environmental Protection, by the undersigned LEP pursuant to section
						  22a-133o(c)(5)(B) of the Connecticut General Statutes and 22a-133q-3 of the
						  Regulations of Connecticut State Agencies.
LEP, duly authorized, for the Commissioner of Energy
						  and Environmental Protection: By:
{signature of the LEP}
Date: {date of signature}
Name: {printed or typed name of LEP}
LEP, duly authorized, pursuant to section
						  22a-133o(c)(5)(B) of the Connecticut General Statutes and 22a-133q-3 of the
						  Regulations of Connecticut State Agencies.
DEEP Mailing Address:
{Connecticut Department of Energy and Environmental
						  Protection
Environmental Use Restriction Coordinator
Bureau of Water Protection and Land Reuse
Remediation Division
79 Elm Street
Hartford, Connecticut 06106-5127
Re: {Remediation Division Identification
						  Number}}
Information for LEP, duly authorized:
Name: {name of LEP}
License Number: {License Number}
Title, if applicable: {title}
Company, if applicable: {name of Company}
Mailing Address:
Street Address, City/Town, State, Zip Code: {Street
						  Address, City/Town, State, and Zip Code}
Witnesses:
{Signature }
Signature
{Printed/typed name }
Printed/typed name
{Signature }
Signature
{Printed/typed name }
Printed/typed name
Instructions Notarization Language for LEP, duly
						  authorized:
State of {
__________________
}
County of {
____________________
}
On this {date} day of {month}, {year} before me, {name
						  of notary or Commissioner of the Superior Court} the undersigned officer,
						  personally appeared {name of individual or individuals}, known to me (or
						  satisfactorily proven) to be the person(s) whose name(s) {choose is or are}
						  subscribed to the within instrument and acknowledged that {he/she/they}
						  executed the same for the purposes therein contained.
In witness whereof I hereunto set my hand.
{Choose Notary Public or Commissioner of the Superior
						  Court} Date Commission Expires {insert date}
Owner of an Interest:
{Select the following signature block when an Owner of an
				interest signs a NAUL pursuant to section 22a-133o of the Connecticut General
				Statutes and section 22a-133q-3 of the Regulations of Connecticut State
				Agencies and delete the non-applicable signature blocks.}
{Name of Owner} is the Owner of an interest which conflicts
				with the conditions or purposes of this notice, executed on {date} and recorded
				at {volume and page} of the {name of municipality} land records. By signing
				this NAUL, {Name of Owner} hereby agrees to subject such interest to the
				conditions or purposes described herein, pursuant to Conn. Gen. Stat. §
				22a-133o(6).
By signing below, the undersigned certifies that he or she is
				fully authorized to sign this NAUL.
If for an individual:
Witnessed by:
{Signature of Witness 1}
{Signature of Owner}
{Printed or Typed Name of Witness 1}
{Printed or Typed Name of Owner}
{Signature of Witness 2}
{Printed or Typed Name of Witness 2}
OR
If for an entity
:
Witnessed by:
{Owner's Name}
{Signature of Witness 1}
By:
{Printed or Typed Name of Witness 1}
{Printed or Typed name of the Authorized Signatory for
						  the Entity}
Its Duly Authorized {Title of the Authorized Signatory
						  for the Entity}
{Signature of Witness 2}
{Printed or Typed Name of Witness 2}
Mailing Address:
Street Address: {Street Address}
City/Town: {City or Town}
State and Zip Code: {State and Zip Code}
{
Notarization Language for Owner Acknowledgement -
				select appropriate notarization language from one of the choices below and
				delete the non-applicable notarization language.}
If the Owner is an individual:
State of {
__________________
}
County of {
____________________
}
On this {date} day of {month}, {year} before me, {name of
				notary or Commissioner of the Superior Court} the undersigned officer,
				personally appeared {name of individual or individuals}, known to me (or
				satisfactorily proven) to be the person(s) whose name(s) {choose is or are}
				subscribed to the within instrument and acknowledged that {he/she/they}
				executed the same for the purposes therein contained.
In witness whereof I hereunto set my hand.
{Choose Notary Public or Commissioner of the Superior Court}
				Date Commission Expires {date}
OR
If the Owner is a Corporation:
State of {
__________________
}
County of {
____________________
}
On this {date} day of {month}, {year} before me, {name of
				notary or Commissioner of the Superior Court}, the undersigned officer,
				personally appeared {name of officer}, who acknowledged himself /herself to be
				the {title of officer} of {name of corporation}, a corporation, and that
				he/she, as such {title of officer}, being authorized to do so, executed the
				foregoing instrument for the purposes therein contained, by signing the name of
				the corporation by himself/herself as {title of officer}.
In witness whereof I hereunto set my hand.
{Choose Notary Public or Commissioner of the Superior Court}
				Date Commission Expires {date}
OR
If the Owner is a Limited Liability
				Company:
State of {
__________________
}
County of {
____________________
}
On this {date}day of {month}, {year} before me, {name of notary
				or Commissioner of the Superior Court}, the undersigned officer, personally
				appeared {name of officer}, who acknowledged himself/herself to be the {title
				of officer} of {name of limited liability company}, a (member managed or
				manager managed) limited liability company, and that he/she, as such {title of
				officer}, being authorized to do so, executed the foregoing instrument for the
				purposes therein contained, by signing the name of the limited liability
				company by himself/herself as {title of officer}.
In witness whereof I hereunto set my hand.
{Choose Notary Public or Commissioner of the Superior Court}
				Date Commission Expires {date}
OR
{If the Owner is any other type of entity, provide
				appropriate language for the Owner Entity
below:
{insert appropriate certification language for an
				Acknowledgement as specified in Section 1-34 of the Connecticut General
				Statutes}