Connecticut Administrative Code › Title 22a - Environmental Protection › 133q - Remediation Standard › Section 22a-133q-app1 - Appendix 1

Current through July 10, 2024
Appendix 1 to Section 22a-133q-l to Section 22a-133q-9 of the
				Regulations of Connecticut State Agencies Application Form of Environmental
				Land Use Restriction (ELUR) for Commissioner Approval or Licensed Environmental
				Professional's (LEP'S) Approval
Instructions: Any ELUR pursuant to the Environmental
						  Use Restriction Regulations ("EUR regulations") shall be in the following form.
						  This form shall be used for any ELUR approved by the Commissioner or a LLP
						  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 ENVIRONMENTAL LAND USE RESTRICTION AND GRANT OF
				EASEMENT
This Declaration of Environmental Land Use Restriction
				("ELUR") and Grant of Easement is made this {day} day of {month}, {year},
				between {Grantor's legal name} (the "Grantor") and the Commissioner of the
				Department of Energy and Environmental Protection of the State of Connecticut
				(the "Grantee").
WITNESSETH:
WHEREAS, Grantor is the Owner 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,
				which is made a part hereof; and
WHEREAS, this Declaration of Environmental Land Use
				Restriction and Grant of Easement ("ELUR") and associated exhibits identified
				herein, collectively represent the ELUR for the subject property, and
WHEREAS, the Grantee has the authority to enter into this ELUR
				pursuant to sections 22a-5, 22a-6, and 22a-133o et seq. of the Connecticut
				General Statutes and Section
				22a-133q-1
				to 22a-133q-9, inclusive, of the Regulations of Connecticut State Agencies
				("EUR regulations"); and
{Instructions: Select the language for Commissioner approval or
				for LEP approval, if eligible pursuant to section 22a-133y of the Connecticut
				General Statutes and 22a-133q-2(f) of the Regulations of Connecticut State
				Agencies, and delete the non-applicable option.}
{Language for Commissioner approval}
WHEREAS, the Grantee has determined that the ELUR set
						  forth below is consistent with regulations adopted pursuant to section 22a-133k
						  of the Connecticut General Statutes; and
WHEREAS, the Grantee has determined that this ELUR will
						  effectively protect human health and the environment from the hazards of
						  pollution on the property; and
WHEREAS, the Grantee's written acceptance of this ELUR
						  is evidenced by the signature of the Commissioner or Commissioner's designee
						  below.
{Language for LEP approval pursuant to section 22a-133y
						  of the Connecticut General Statutes and 22a-133q-2(f) of the Regulations of
						  Connecticut State Agencies}
WHEREAS, section 22a-133y of the Connecticut General
						  Statutes includes provisions for the approval of an ELUR by a LEP;
WHEREAS, the LEP whose signature appears below has
						  determined that the ELUR set forth below is consistent with the EUR
						  regulations, section
						  22a-133q-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 Grantee's written approval of this ELUR 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 ELUR 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 ELUR (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 Grantor desires to impose certain
				restrictions upon the use, occupancy, and activities of and at the Subject
				Area, and to grant this ELUR to the Grantee on the terms and conditions set
				forth below; and
WHEREAS, Grantor intends that such restrictions shall run with
				the land and be binding upon and enforceable against Grantor and Grantor's
				successors and assigns;
NOW, THEREFORE, Grantor agrees as follows:
1. Purpose. In accordance with the EUR opinion, the purpose of
				this ELUR is to assure that the use and activity at the Property and the
				Subject Area is restricted, obligations are carried out, and conditions
				maintained in accordance with the requirements of the EUR opinion, attached
				hereto as Exhibit B.
2. Restrictions and Obligations Applicable to the Subject Area.
				In furtherance of the purposes of this ELUR, Grantor shall assure that use,
				occupancy, and activity of and at the Subject Area are conducted in accordance
				with the EUR opinion attached hereto as Exhibit B. The Grantor shall fulfill
				the obligations and maintain the conditions necessary to meet the objectives of
				the ELUR 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 a 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 Grantor:
i. Immediately notifies the Grantee 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 the Grantee, on a schedule approved by the Grantee, 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 ELUR.
5. Release of ELUR; Temporary Allowable Disturbance. Except as
				provided in paragraph 4, the Grantor 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 ELUR 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 by the Grantee in accordance
				with section 22a-133q-7 of the Regulations of Connecticut State
				Agencies.
6. Grant of Easement to the Grantee. Grantor hereby grants and
				conveys to the Grantee, the Grantee's agents, contractors, and employees, and
				to any person performing pollution remediation activities under the direction
				thereof, a non-exclusive easement (the "Easement") over the Subject Area and
				over such other parts of the Property as are necessary for access to the
				Subject Area or for carrying out any actions to abate a threat to human health
				or the environment associated with the Subject Area. Pursuant to this Easement,
				the Grantee, the Grantee's agents, contractors, and employees, and any person
				performing pollution remediation activities under the direction thereof, may
				enter upon and inspect the Property and perform such investigations and actions
				as the Grantee deems necessary for any one or more of the following purposes:
i. Ensuring that use, occupancy, and activities of and at the
				Property are consistent with this ELUR;
ii. Ensuring that any remediation implemented complies with
				sections
				22a-133k-1 to
				22a-133k-3,
				inclusive, of the Regulations of Connecticut State Agencies;
iii. Performing any additional investigations or remediation
				necessary to protect human health and the environment;
iv. Ensuring that the Grantor is fulfilling the obligations of
				the ELUR and maintaining the conditions necessary to meet the purposes of the
				ELUR; and
v. Ensuring the structural integrity of any engineered controls
				described in Exhibit B and their continuing effectiveness in containing
				pollutants and limiting human exposure to pollutants.
7. Notice and Time of Entry onto Property. Entry onto the
				Property by the Grantee pursuant to this Easement shall be upon reasonable
				notice and at reasonable times, provided that entry shall not be subject to
				these limitations if the Grantee determines that immediate entry is necessary
				to protect human health or the environment.
8. Notice to Lessees and Other Holders of Interests in the
				Property. Grantor, or any future holder of any interest in the property, shall
				cause any lease, grant, or other transfer of any interest in the Property to
				include a provision expressly requiring the lessee, grantee, or transferee to
				comply with this ELUR. The failure to include such provision shall not affect
				the enforceability, validity or applicability to the Property of this
				ELUR.
9. At least 30 days prior to transferring an interest in the
				property, the Grantor 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 ELUR 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 ELUR is invalid or
				unenforceable, such provision shall be deemed to have been modified
				automatically to conform to the requirements for validity and enforceability as
				determined by such court. In the event that the provision invalidated is of
				such nature that it cannot be so modified, the provision shall be deemed
				deleted from this instrument as though it had never been included herein. In
				either case, the remaining provisions of this instrument shall remain in full
				force and effect. Further, in either case, the Grantor shall submit a copy of
				this restriction and of the Judgment of the Court to the Grantee.
12. Binding Effect. All of the terms, covenants and conditions
				of this ELUR shall run with the land and shall be binding on the Grantor, the
				Grantor's successors and assigns, and any other party entitled to possession or
				use of the Property during such period of ownership or possession.
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 said sections existed on
				the date of execution of this ELUR.
14. Burden of Proof With respect to any claim or cause of
				action asserted by the Grantee against the Grantor under this ELUR, the Grantor
				shall bear the burden of proving that any activities at the subject area do not
				or will not violate the restrictions imposed by this ELUR, that the obligations
				of the ELUR have been carried out, and that conditions at the Subject Area have
				been maintained in accordance with the requirements of the EUR opinion. The
				Grantor, or its successors in interest, shall be responsible for demonstrating
				that use on the property is in conformity with the ELUR.
15. Inspections. The Grantor 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 ELUR, the Grantor or its
				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 Grantee at any
				time to require performance of any term of this ELUR shall be taken or held to
				be a waiver of such term or in any way affect the Grantee's rights to enforce
				such term.
17. Nothing in this ELUR shall affect the Grantee'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 ELUR. If at any time the Grantee
				determines that the ELUR does not protect human health and the environment from
				the hazards of pollution, the Grantee may institute any proceeding, or take any
				action to require further investigation or further action to prevent or abate
				pollution. The approval of this ELUR relates only to pollution or contamination
				identified in the EUR opinion attached hereto as Exhibit B of this ELUR.
18. The Grantor shall retain copies of all documents related to
				this ELUR as required by section 22a-133q-9 of the Regulations of Connecticut
				State Agencies.
19. DEEP Contact Information. Any document required to be
				submitted to DEEP pursuant to this ELUR 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}}
Signature Page Follows
By signing below the undersigned certifies that:
i. He or she is fully authorized to sign this ELUR.
ii. The Grantor has the power and authority to enter into this
				ELUR, to grant the restrictions, fulfill the obligations, and maintain the
				conditions necessary to meet the objectives of the ELUR in accordance with the
				requirements of the EUR opinion attached hereto and made a part hereof as
				Exhibit B.
In witness whereof, the undersigned has/have executed this ELUR
				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 Grantor}
{Printed or typed name of witness 1}
{Printed or typed name of Grantor}
{Signature of witness 2}
{Printed or typed name of witness 2}
If for an entity
:
Witnessed by:
{Grantor'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 Grantor Acknowledgement - select
				appropriate notarization language from one of the choices below and delete the
				non-applicable notarization language.}
If the Grantor 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 Grantor 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 Grantor 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 Grantor is any other type of entity, provide
				appropriate language for the Grantor Entity below:
{insert appropriate certification language for an
				Acknowledgement as specified in Section 1-34 of the Connecticut General
				Statutes}
{Grantee Signature Block - select one of the two choices
				below, as applicable and delete the non- applicable option.}
{This choice is used for all ELURs except those approved
				pursuant to section 22a-133y of the Connecticut General
				Statutes.}
Grantee:
The Grantee, the
Commissioner of Energy and Environmental Protection or
						  by the Commissioner's designee, {name and title.}
By: {signature of the Commissioner or the
						  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 ELUR approved pursuant to
				section 22a-133y of the Connecticut General Statutes}
Grantee:
The Grantee, the Commissioner of
						  Energy and Environmental Protection, by the undersigned LEP as authorized
						  pursuant to section 22a-133y of the Connecticut General Statutes.
LEP, duly authorized, for Grantee, 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-133y of
						  the Connecticut
General Statutes
Grantee 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}}
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 {date}