Authorization ID: #AUTH_ID# FS-2700-9a (XX/20XX)
Contact ID: #HOLDER_ID# OMB No. 0596-0082
Use Code: #USE_CODE#
U.S. DEPARTMENT OF AGRICULTURE
Forest Service
AGRICULTURAL IRRIGATION AND LIVESTOCK WATERING SYSTEM EASEMENT
AUTHORITY:
AUTHORITY:
Title V of the Federal Land Policy and Management Act,
43 U.S.C. 1761-1772
THIS EASEMENT issued this __________ day of ___________ by the UNITED STATES OF AMERICA, acting by and through the Forest Service, Department of Agriculture, hereinafter called the grantor, to #HOLDER_NAME# a ______-____________ of the State of ____________ hereinafter called the holder(s).
The Holder has applied for an easement under Section 501 of the Federal Land Policy and Management Act of October 21, 1976, as amended by P. L. 99-545 (90 Stat. 2743; 43 U.S.C. 1761), for agricultural irrigation or livestock watering system facilities located on lands owned by the United States on the __________ National Forest, in the County(ies) of _____________, State of _____________. The description of the authorized facilities is as follows:
Project Name ______________
Location (legal description) #TOWNSHIP_SECT_RANGE# #FIRST_DIVISION# #FIRST_DIV_NAME_NUMBER#, #SECOND_DIVISION# #SECOND_DIV_NAME_NUMBER#, #THIRD_DIVISION# #THIRD_DIV_NAME_NUMBER
User Note – “Description of Improvements”: (e.g.headgate/diversion/collection box/ditch/pipeline/dam/reservoir; describe materials and physical dimensions of constructed facilities on NFS lands.) Delete these instructions prior to printing.
Description of Improvements: #PURPOSE#
Length of Easement (for linear featured facilities) #LENGTH#
Width of Easement (for linear featured facilities) #WIDTHH#
Area of National Forest Lands Occupied (acres associated with either linear or non-linear features, such as reservoirs): #USE_ACRES#
Upon acceptance of this easement the holder relinquishes all right, title, and interest in and to any easement issued for the same lands by the United States by any previous grant or permit.
The United States does hereby grant, subject to valid existing rights, an easement for occupancy with water conveyance system facilities of lands [………..] contained in Exhibit […………….], attached hereto and incorporated herein, as provided by the holder and hereby accepted by the authorized officer.
This easement is issued subject to the following terms, provisions, and conditions applicable to the holder, its permittees, contractors, assignees, and successors in interest.
1. Authorized Use. This easement authorizes only the right-of-way and water conveyance system facilities as constructed and operated on October 21, 1976, as specified herein.
2. Extensions or Enlargements. This easement does not authorize extensions or enlargements of the water conveyance system.
3. Fees. This easement is issued free of charge.
4. Transferability. This easement is fully transferable provided the water conveyance system facilities are used for agricultural irrigation or livestock watering. The holder shall notify the grantor within sixty (60) days of any address change or change in ownership.
5. Tenure. This easement shall continue for as long as the above-described lands and water conveyance system facilities are used, operated, and maintained in accordance with the terms and conditions herein described.
6. Operation and Maintenance.
a. The holder agrees to operate and maintain the facilities and use the authorized easement in accordance with applicable Federal, State, and local laws, regulations, and standards.
b. The holder shall notify, consult with, and obtain concurrence of the grantor for operation and maintenance of the authorized facilities.
c. The holder agrees to install and maintain an operable headgate at each diversion structure. Such headgate shall be capable of controlling the amount of water entering the system.
d. The holder will not use fire or herbicides on the authorized right-of-way except as permitted in writing by the grantor.
e. Pursuant to the requirements of 36 CFR 251.56(b)(1)(v), the terms and conditions for operation and maintenance set forth in this section, and any operations and maintenance plan incorporated in this easement pursuant to paragraph (f) of this section, may be revised or modified by the authorized officer upon determination that:
1. Modification or revision of such terms and conditions is necessary to comply with the requirements of the Endangered Species Act of 1973 (16 U.S.C. 1531 et seq) or applicable State or Federal law.
2. Terms and conditions contained herein are no longer needed to comply with the requirements of applicable State or Federal law.
USER NOTE: ITEM “f” BELOW IS OPTIONAL.
Selection item 1: Select when operation and maintenance plan is attached.
f. The holder agrees to operate and maintain the facilities and use the authorized easements in accordance with the attached operation and maintenance plan.
Selection item 2: Select this item to avoid having paragraph 6(f) appear in the authorization.
7. Emergency Repairs.
a. Except for emergency repairs required to protect the environment, property of the United States, or public health and safety, the holder may not use materials on National Forest System lands outside the easement prior to obtaining written authorization and paying for the materials to be used. The holder's use of material within the easement is limited to maintenance of the water conveyance system facility.
b. If the water conveyance system facilities authorized by this easement are allowed to deteriorate to the point of threatening persons or property, and the holder, after notification by the grantor, refuses to perform the repairs and maintenance required to remove the threat to persons or property, the grantor shall have the right to undertake such repair and maintenance and to assess the holder for the costs of such repair and maintenance, regardless of whether the grantor had required the holder to furnish a bond or other security.
8. Indemnification.
a. The holder assumes all risk of loss to the authorized improvements.
b. The holder shall indemnify, defend, and hold the United States harmless for any violations incurred under any such laws and regulations or for judgments, claims, or demands assessed against the United States in connection with the holder's use or occupancy of the property. The holder's indemnification of the United States shall include any loss by personal injury, loss of life or damage to property in connection with the occupancy or use of the property. Indemnification shall include, but is not limited to, the value of resources damaged or destroyed; the costs of restoration, cleanup, or other mitigation; fire suppression or other types of abatement costs; third party claims and judgments; and all administrative, interest, and other legal costs. This paragraph shall survive the termination or revocation of this authorization, regardless of cause.
9. Liability. The holder shall be liable for all injury, loss, or damage, including fire suppression, or other costs in connection with rehabilitation or restoration of natural resources associated with the use and occupancy authorized by this easement. Compensation shall include but not be limited to the value of resources damaged or destroyed, the costs of restoration, cleanup, or other mitigation, fire suppression or other types of abatement costs, and all administrative, legal (including attorney's fees), and other costs in connection therewith.
10. Site Restoration. The holder shall, upon termination or revocation of this easement, stabilize the site as required by the grantor. If the holder does not stabilize the site, the holder agrees to pay the costs of such stabilization if undertaken by the grantor.
The foregoing notwithstanding, this easement is granted subject to the following reservations by the grantor, for itself, its permittees, contractors, and assigns.
11. Nonexclusive Use. The grantor reserves the right to use or permit others to use the easement area, provided such use does not unreasonably interfere with the rights and privileges hereby authorized.
12. Revocation and Termination. The grantor may take action to revoke this easement pursuant to 7 CFR 1.130 through 1.151 for noncompliance with applicable statutes or regulations or the terms and conditions of this easement. This easement also may be revoked with the consent of the holder, or if the holder fails to exercise the rights and privileges authorized for any continuous period of five (5) years or more. This easement also terminates according to its terms if the holder uses the water conveyance system for any purpose other than agricultural irrigation or livestock watering.
13. Federal Survey Monuments, Corners, and Boundary Markers. The holder shall protect in place all federal survey monuments, corners, and boundary markers in the easement area. If any federal survey monuments, corners, or boundary markers in the easement area are destroyed or modified, the holder shall ensure that they are reestablished or corrected in accordance with (1) the Manual of Instructions for the Survey of the Public Land of the United States; (2) the applicable county surveyor’s specifications; and (3) the specifications of the Forest Service, as applicable. The holder shall ensure that any official survey records that were affected due to the destruction or modification of any federal survey monuments, corners, or boundary markers are amended in accordance with applicable law. Nothing in this clause shall relieve the holder of liability for the willful destruction or modification of any federal survey monuments, corners, or boundary markers as provided in 18 U.S.C. 1858.
14. Archaeological and Paleontological Discoveries. The holder shall immediately notify the authorized officer of any antiquities or other objects of historic or scientific interest, including but not limited to historic or prehistoric ruins, fossils, or artifacts discovered in connection with the use and occupancy authorized by this lease. The holder shall leave these discoveries intact and in place until otherwise directed by the authorized officer.
15. Native American Graves Protection and Repatriation (NAGPRA). In accordance with 25 U.S.C. 3002(d) and 43 CFR 10.4, if the holder inadvertently discovers human remains, funerary objects, sacred objects, or objects of cultural patrimony on National Forest System lands, the holder shall immediately cease work in the area of the discovery and shall leave the discoveries intact and in place. The holder shall follow the applicable NAGPRA protocols for the undertaking provided in the NAGPRA plan of action or the NAGPRA comprehensive agreement; if there are no such agreed-upon protocols, the holder shall as soon as practicable notify the authorized officer of the discovery and shall follow up with written confirmation of the discovery. The activity that resulted in the inadvertent discovery may not resume until 30 days after the authorized officer certifies receipt of the written confirmation, if resumption of the activity is otherwise lawful, or at any time if a NAGPRA plan of action has been executed by the Forest Service following tribal consultation and any preconditions have been met.
16. Relocation. This easement is issued with the express understanding that should future location of federally owned improvements or road rights-of-way require relocation of the holder’s improvements, the relocation will be conducted by and at the expense of the holder within a reasonable period specified by the authorized officer.
17. Special Provisions.
USER NOTE:
Add additional provisions here to address local conditions. Delete these instructions prior to printing.
#INSERT TERM HERE#
<Use this signature page for individual(s), partnerships, businesses, and all non-corporate entities. Delete this instruction prior to printing.>
ACCEPTANCE On this ________ day of _________________, I, the undersigned Holder have read, understand, and accept the terms and conditions of this easement.
____________________________________________
ACKNOWLEDGMENT
STATE OF )
) ss.
COUNTY OF )
The foregoing instrument was acknowledged before me this day of ,
By:
Notary Public
My commission expires:
The Secretary of Agriculture by the ___________________, Forest Service, has executed this easement pursuant to delegations of authority specified in 7 CFR 2.60 and 36 CFR 251.52 on the day and year written above.
UNITED STATES OF AMERICA
__________________________
__________________________Region
Forest Service, Department of Agriculture
<Use this signature page for all corporate entities. Delete instructions prior to printing.>
ACCEPTANCE On this day of , I, the undersigned holder have read, understand, and accept the terms and conditions of this easement.
Holder
The following certificate shall be executed by the Secretary or Assistant Secretary of the Corporation:
I, , certify that I am the Secretary of the Corporation that accepted the above easement; that , who signed said easement on behalf of said Corporation was then of said Corporation; that I know his/her signature, and that his/her signature on said easement is genuine; and that said easement was duly signed, sealed, and attested to for and on behalf of said Corporation by authority of its governing body.
(CORPORATE SEAL)
(Assistant) Secretary
ACKNOWLEDGMENT
STATE OF )
) ss.
COUNTY OF )
The foregoing instrument was acknowledged before me this day of ,
by .
Notary Public
My commission expires:
The Secretary of Agriculture by the ____________________, Forest Service, has executed this easement pursuant to delegations of authority specified in 7 CFR 2.60 and 36 CFR 251.52 on the day and year written above.
UNITED STATES OF AMERICA
_________________________
_________________________Region
Forest Service, Department of Agriculture
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995, a Federal agency may not conduct or sponsor, and a person is not required to respond to, an information collection request unless it displays a valid Office of Management and Budget (OMB) control number. The valid OMB control number for this information collection request is 0596-0082. Response to this information collection request is required to obtain or retain benefits, specifically, a special use authorization. The authority for this information collection request is the #AUTHORITY NAME#. The time required to complete this information collection request is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, collecting and maintaining the data needed, and completing and reviewing the information collection request. Send comments regarding this burden estimate or any other aspect of this information collection request, including suggestions for reducing the burden, to Forest Service Information Collections Officer, [email protected], with OMB control number 0596-0082 in the subject line.
PRIVACY ACT STATEMENT
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act statement serves to inform you of the following concerning the collection of the information on this form.
Purpose: The Privacy Act of 1974 requires that the Director of Recreation, Heritage, and Volunteer Resources staff and the Director of Lands, Minerals, and Geology Management staff provide the following statements to individuals from whom they request information.
Authority: Collection of this information solicited on this form is authorized by the Title V of the Federal Land Policy and Management Act, 43 U.S.C. 1761-1772
Routine Uses: The information collected will be used by Forest Service officials to ensure that your use of National Forest System lands is administered in accordance with applicable statutes, regulations, and directives. The information collected from you is retained in the Special Uses Data System (SUDS) and is retrieved by the Forest Service create reports for the Agency’s Special Uses Program, generate bills for collection of land use fees for your authorization, monitor compliance with your special use authorization, and other matters pertaining to administration of your special use authorization. SUDS is a component of the Forest Service’s Natural Resources Manager database (NRM). A complete list of the routine uses of NRM can be found in the system of records notice associated with this form, FS-24.
Disclosure: The submission of this information is required to obtain or retain benefits, specifically, a special use authorization.
NONDISCRIMINATION STATEMENT
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible agency or USDA’s TARGET Center at (202) 720-2600 (voice and TYY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit the completed form or letter to USDA by (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected].
USDA is an equal opportunity provider, employer, and lender.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 2024-12-31 |