1ST A TE O F N O RTH C ARO LIN A P IN N O . COUNTY OF C O NSE R VATIO N E A SE M EN T THIS CONSERVATION EASEMENT ("Conservation Easement") is made on
this day of
by and between
with an address at: (“Grantor”) and
[Name of the Land Trust], a non-profit corporation
organized and existing under the laws of State of North Carolina with an address at
[Street Name and Number],
[Name of Town or City], North Carolina Zip Code (“Grantee” ).
REC IT A LS & C O NSE R VATIO N P U RPO SE S A. Grantor is the sole owner in fee simple of the property containing acres more
or less, located in [Township], County,
North Carolina, and more particularly described in an instrument recorded in Book ,
Page , [Name of County Registry] (hereinafter the
“Property”) and further described in Exhibit A attached hereto and by this reference
incorporated herein; and
B. W HER EA S, G ra n to r a n d G ra n te e h av e a g re ed t o s e t a sid e a cre s o f t h e
P ro perty ( a s d esc rib ed h ere in b elo w a n d h ere in afte r r e fe rre d t o a s t h e “ E ase m en t A rea ”), f o r
th e p urp ose o f c re atin g a C onse rv atio n E ase m en t t o p re se rv e, e n han ce, r e sto re , a n d m ain ta in t h e
na tu ra l f e atu re s a n d r e so urc e s o f t h e E ase m en t A re a, t o p ro vid e h ab ita t f o r n ativ e p la n ts a n d
an im als , t o i m pro ve a n d m ain ta in w ate r q uality , a n d t o c o ntr o l r u noff o f s e d im en t ( h ere in afte r
th e “ C on se rv atio n V alu es” ).
C. The Easement Area is depicted on a survey dated month
day year, revised [month day year], entitled "
" [“Name of Survey”], prepared by
[Name of Surveyor], and further described in Exhibit B
attached hereto and by this reference incorporated herein; and
D.Grantee is a non-profit organization established for the purpose of promoting the
preservation of ecologically valuable lands, natural and wildlife habitat, and lands with
significant natural and open space values in the State of North Carolina for charitable,
scientific, educational and aesthetic purposes. E.Grantor and Grantee recognize that the Easement Area is located adjacent to the
[Name of Water] and its tributaries, and the
Easement Area has been deemed by the State of North Carolina to qualify as a riparian
buffer, addressing the cleanup and prevention of pollution of the State’s surface waters,
and the establishment of a network of riparian buffers. Moreover, Grantor and Grantee
recognize that the Easement Area has other conservation values including fish and wildlife
conservation, open space and scenic values.
F. The Clean Water Management Trust Fund, (“Fund”) with an address at 1651 Mail
Service Center, Raleigh, North Carolina 27699-1651 is an agency of the State of North
Carolina (“State”), with an address at c/o State Property Office, 1321 Mail Service Center,
Raleigh, North Carolina 27699-1321, and is authorized by Article 13A, Chapter 113 of the
General Statutes of North Carolina to finance projects and to acquire land and interests in
land, including conservation easements for riparian buffers for the purposes of providing
environmental protection for surface waters and urban drinking water supplies; and G. Grantee has received a grant from the Fund identified as Grant Agreement No. (“Grant Agreement”) for acquisition of a Conservation
Easement in consideration of which Grantor has agreed that the Easement Area will be
conserved and managed in a manner that will protect the quality of waters of the
2 [Name of Water] and otherwise promote the public purposes
authorized by Article 13A, Chapter 113 of the North Carolina General Statues
(“N.C.G.S.”)
H. The Grantor, Grantee, State and Fund (collectively referred to herein as the “Parties”)
hereto intend that the conservation values of the Easement Area will be preserved and
managed pursuant to the terms and conditions of said Grant Agreement entered into
between the Grantee and the Fund on the day
month
year, incorporated herein by reference, and available for inspection in the offices of the
North Carolina Department of Environment and Natural Resources, the Grantor and Fund.
The Parties further acknowledge and agree that Grantee will accept this Conservation
Easement; that the State will be the ultimate Grantee and Holder of this Conservation
Easement; and, that Grantor has received consideration for granting this easement to the
Grantee and restricting the uses of the Easement Area; and
I.Grantor and Grantee acknowledge that the characteristics of the Easement Area, its
current use and state of improvement are described in Exhibit C, which is the appropriate
basis for monitoring compliance with the objectives of preserving the conservation and
water quality values; and that the Exhibit C is not intended to preclude the use of other
evidence (e.g. surveys, appraisals) to establish the present condition of the Easement Area
if there is a controversy over its use.
NOW, THEREFORE, in consideration of the premises and the mutual benefits recited
herein, together with other good and valuable consideration, the receipt and sufficiency of
which is hereby acknowledged by the parties hereto, the Grantor hereby unconditionally
and irrevocably gives, grants and conveys forever and in perpetuity to the Grantee, its
successors and assigns, and the Grantee hereby accepts, a Deed of Conservation Easement
of the nature and character and to the extent hereinafter set forth in, over, through and
across the Easement Area, together with the right to preserve and protect the conservation
values thereof as described in the Recitals herein. The purposes of this Conservation Easement are to provide environmental protection for
surface waters and to protect the wildlife and natural heritage values and it shall be so held,
maintained, and used therefore. It is the further purpose of this Conservation Easement to
prevent any use of the Easement Area that will significantly impair or interfere with the
preservation of said conservation values. Grantor intends that this Conservation Easement
will restrict use of the Easement Area to such activities as are consistent with the
conservation values described in the Recitals herein.ARTICLE I. DURATION OF EASEMENT This Conservation Easement shall be perpetual. It is an easement in
gross, runs with the land, and is enforceable by Grantee against Grantor, its
representatives, successors, assigns, lessees, agents and licensees. ARTICLE II. RIGHTS RESERVED TO GRANTOR Grantor reserves certain rights accruing from fee simple ownership of the Easement
Area, including the right to engage in or permit others to engage in uses of the Easement
Area that are not inconsistent with the purpose(s) of this Conservation Easement. All rights
reserved by Grantors are reserved for Grantors, their representatives, successors, and
assigns, and are considered to be consistent with the conservation purposes of this
Conservation Easement. The following rights are expressly reserved: FOR EXAMPLEA. Passive Recreational Use. Grantor reserves the right to engage and permit others to engage in passive recreational uses of the Easement Area, requiring no surface
alteration of the land and posing no threat to conservation values, including, without
limitation, walking, fishing, or animal and plant observation; and any other purpose
consistent with maintaining the conservation values of this Conservation Easement.
3B. Pedestrian Traffic. Grantor reserves the right to construct and maintain naturally surfaced walking and hiking trails to increase and enhance public exposure to the
Easement Area to the public in its natural and scenic condition while preserving the
conservation values of the Easement Area. Any trails must be constructed with pervious
materials, except where boardwalks, ramps and handrails are required by the terrain, and
must be located at a minimum of fifteen (15) feet from the top of the bank of Name of
Water and in a manner that does not materially diminish the wooded, open space character
and scenic and natural qualities of the Easement Area as compared to those conditions
existing on the date of this Conservation Easement. C. Canoe Access. Grantor reserves the right to construct, maintain and repair a canoe access site with launch and chute within the Easement Area to be located on the bank of
the Name of Water, provided said access site is connected to the walking and hiking trails
permitted herein. Notwithstanding the foregoing, Grantor and Grantee have no right to agree to any activity
that would result in the termination of this Conservation Easement. ARTICLE III. PROHIBITED AND RESTRICTED ACTIVITIES Any activity on, or use of, the Easement Area inconsistent with the purposes of this
Conservation Easement is prohibited. The Easement Area shall be maintained in its
natural, scenic, wooded and open condition and restricted from any development or use
that would impair or interfere with the conservation purposes of this Conservation
Easement set forth above. Except for those rights specifically reserved to Grantor in Article II and
without limiting the generality of the foregoing, the following activities and uses are
expressly prohibited or restricted. A. In dustr ia l a n d C om merc ia l U se . I n dustr ia l a n d c o m merc ia l a ctiv itie s a n d a n y r ig ht o f
p assa g e f o r s u ch p urp ose s a re p ro hib ite d o n t h e E ase m en t A re a.
B . Agric u ltu ra l, T im ber H arv estin g, G ra zin g a n d H ortic u ltu ra l U se . A gric u ltu re , tim ber
h arv estin g, gra zin g, hortic u ltu ra l an d an im al husb an d ry opera tio ns are pro hib ite d on th e
Ea se m en t A re a.
C . Dis tu rb an ce o f N atu ra l F eatu re s, P la n ts a n d A nim als . T here s h all b e n o c u ttin g o r
r e m oval o f t r e es, o r t h e d is tu rb an ce o f o th er n atu ra l f e a tu re s w ith in t h e E ase m en t A re a e x cep t
fo r th e fo llo w in g: (1 ) as in cid en ta l to b oundary m ark in g, fe n cin g, sig nag e, (2 ) s e le ctiv e
cu ttin g an d p re sc rib ed b urn in g o r cle arin g o f v eg eta tio n an d th e ap plic atio n o f m utu ally
ap pro ved pestic id es fo r fir e co nta in m en t an d pro te ctio n, dis e ase co ntr o l, re sto ra tio n of
hy dro lo gy, w etla n ds e n han cem en t a n d/o r c o ntr o l o f n on-n ativ e p la n ts ; s u bje ct h ow ev er, t o t h e
prio r ap pro val of Fund, an d (3 ) h untin g an d fis h in g purs u an t to ap plic ab le ru le s an d
reg ula tio ns.
D. Construction of Buildings and Recreational Use. There shall be no constructing or
placing of any building, mobile home, asphalt or concrete pavement, billboard or other
advertising display, antenna, utility pole, tower, conduit, line, pier landing, dock or any
other temporary or permanent structure or facility on or above the Easement Area except
for the following: placement and display of no trespassing signs, local, state or federal
traffic or similar informational signs, for sale or lease signs, boundary fencing, signs
identifying the conservation values of the Easement Area, and/or signs identifying the
Grantor as owner of the Property and State as holders of this Conservation Easement and
Fund as the source of funding for the acquisition of the Conservation Easement,
educational and interpretative signs, identification labels or any other similar temporary or
permanent signs, reasonably satisfactory to the Fund.
E. Mineral Use, Excavation, Dredging. There shall be no filling, excavation,
dredging, mining or drilling; no removal of topsoil, sand, gravel, rock, peat, minerals or
4other materials, and no change in the topography of the land in any manner except as
necessary for the purpose of combating erosion or incidental to any conservation
management activities otherwise permitted in the Easement Area. F.Wetlands and Water Quality. There shall be no pollution or alteration of water
bodies and no activities that would be detrimental to water purity or that would alter
natural water levels, drainage, sedimentation and/or flow in or over the Easement Area or
into any surface waters, or cause soil degradation or erosion nor diking, dredging,
alteration, draining, filling or removal of wetlands, except activities to restore natural
hydrology or wetlands enhancement as permitted by state and any other appropriate
authorities.
G. Dumping . Dumping of soil, trash, ashes, garbage, waste, abandoned vehicles,
appliances, or machinery, or other materials on the Easement Area is prohibited.
H. Conveyance and Subdivision. The parties recognize that Grantor may wish to
subdivide, partition and convey the Property, subject to the ordinances and regulations of
the State of North Carolina, [Name of County], and
[Name of Town or City]. While the Easement Area itself
cannot be subdivided or otherwise separated from the Property, the parties acknowledge
that the Easement Area may be divided among the several lots that would be created
through a proper subdivision of the Property.
OR H. Conveyance and Subdivision . The Property may not be subdivided, partitioned
nor conveyed, except in its current configuration as an entity or block of property.
I. Mitigation. There shall be no use of the Easement Area or any portion thereof to
satisfy compensatory mitigation requirement under 33 U.S.C. Section 1344 or N.C.G.S.
143-214.11.
ARTICLE IV. ENFORCEMENT AND REMEDIES A. Enforcement. To accomplish the purposes of this Conservation Easement, Grantee
is allowed to prevent any activity on or use of the Easement Area that is inconsistent with
the purposes of this Conservation Easement and to require the restoration of such areas or
features of the Easement Area that may have been damaged by such activity or use. Upon
any breach of the terms of this Conservation Easement by Grantor that comes to the
attention of the Grantee, the Grantee shall, except as provided below, notify the Grantor in
writing of such breach. The Grantor shall have ninety (90) days after receipt of such notice
to correct the conditions constituting such breach. If the breach remains uncured after
ninety (90) days, the Grantee may enforce this Conservation Easement by appropriate legal
proceedings including damages, injunctive and other relief. The Grantee shall also have the
power and authority, consistent with its statutory authority: (a) to prevent any impairment
of the Easement Area by acts which may be unlawful or in violation of this Conservation
Easement; (b) to otherwise preserve or protect its interest in the Easement Area; or (c) to
seek damages from any appropriate person or entity. Notwithstanding the foregoing, the
Grantee reserves the immediate right, without notice, to obtain a temporary restraining
order, injunctive or other appropriate relief if the breach of the term of this Conservation
Easement is or would irreversibly or otherwise materially impair the benefits to be derived
from this Conservation Easement. The Grantor and Grantee acknowledge that under such
circumstances damage to the Grantee would be irreparable and remedies at law will be
inadequate. The rights and remedies of the Grantee provided hereunder shall be in addition
to, and not in lieu of, all other rights and remedies available to Grantee in connection with
this Conservation Easement, including, without limitation, those set forth in the Grant
Agreement under which this Conservation Easement was obtained.
B. Right of Entry and Inspection. Grantee, its employees and agents and its successors and assigns, have the right, with reasonable notice, to enter the Property and
Easement Area at reasonable times for the purpose of inspecting the Easement Area to
5determine whether the Grantor, Grantor’s representatives, or assigns are complying with
the terms, conditions and restrictions of this Conservation Easement. C. Condemnation. Whenever all or part of the Property is taken by exercise of eminent
domain by public, corporate or other authority, or by negotiated sale in lieu of
condemnation, so as to abrogate the restrictions imposed by this Conservation Easement,
the Grantor shall immediately give notice to Grantee, State and the Fund, and shall take all
appropriate actions at the time of such taking or sale to recover the full value of the taking
and all incidental or direct damages resulting from the taking. The Grantee, its successors
and assigns, shall be entitled to a portion of the proceeds of such sale, exchange,
involuntary conversion of the Property, or any damage award with respect to any judicial
proceeding. Such portion shall be equal to the fair market value of the Grantee’s, its
successors and assigns, interest in the Property on the date of the recording of this
Conservation Easement. “Proceeds of Sale” shall mean the cash value of all money and
property paid, transferred or contributed in consideration for, or as otherwise required as a
condition to the sale, exchange or involuntary conversion of the Conservation Area, or any
damages otherwise awarded as a result of judicial proceeding, minus the Grantor’s
expenses from such transaction or proceeding.
D. Changed Conditions. When a change in conditions gives rise to the extinguishment
of this Conservation Easement or a material term or provision hereof by judicial
proceeding, the Grantee, its successor and assigns, shall be entitled to a portion of the
proceeds of such sale, exchange, involuntary conversion of the Property, or any damage
award with respect to any judicial proceeding. Such portion shall be equal to the fair
market value of the Grantee’s, its successors and assigns, its interest in the Property on the
date of the recording of this Conservation Easement. “Proceeds of Sale” shall mean the
cash value of all money and property paid, transferred or contributed in consideration for,
or as otherwise required as a condition to the sale, exchange or involuntary conversion of
the Conservation Area, or any damages otherwise awarded as a result of judicial
proceeding, minus the Grantor’s expenses from such transaction or proceeding.
E. Acts Beyond Grantor’s Control. Nothing contained in this Conservation Easement
shall be construed to entitle Grantee to bring any action against Grantor for any injury or
change in the Easement Area caused by third parties, resulting from causes beyond the
Grantor’s control, including, without limitation, fire, flood, storm, and earth movement, or
from any prudent action taken in good faith by the Grantor under emergency conditions to
prevent, abate, or mitigate significant injury to life, damage to Easement Area or harm to
the Easement Area resulting from such causes.
F. Costs of Enforcement. Any costs incurred by Grantee in enforcing the terms of this Conservation Easement against Grantor, including, without limitation, any costs of
restoration necessitated by Grantor’s acts or omissions in violation of the terms of this
Conservation Easement, shall be borne by Grantor. G. No Waiver . Enforcement of this Conservation Easement shall be at the discretion of
the Grantee and any forbearance by Grantee to exercise its rights hereunder in the event of
any breach of any term set forth herein shall not be deemed or construed to be a waiver by
Grantee of such term or of any subsequent breach of the same or of any other term of this
easement or of Grantee’s rights. No delay or omission by Grantee in exercise of any right
or remedy shall impair such right or remedy or be construed as a waiver.
ARTICLE V. DOCUMENTATION AND TITLE A. Easement Area Condition. The parties acknowledge that the Easement Area is
undeveloped, with no improvements other than as described in Exhibit C and easements
and rights of way of record.
B. Title. The Grantor covenants and represents that the Grantor is the sole owner and
is seized of the Easement Area in fee simple and has good right to grant and convey the
aforesaid Conservation Easement; that there is legal access to the Property and the
Easement Area, that the Easement Area is free and clear of any and all encumbrances,
6except easements of record, none of which would nullify, impair or limit in any way the
terms or effect of this Conservation Easement; Grantor shall defend its title against the
claims of all persons whomsoever, and Grantor covenants that the Grantee, its successors
and assigns, shall have the right to monitor and defend the terms of the aforesaid
Conservation Easement. ARTICLE VI. MISCELLANEOUS A. Subsequent Transfers of the Fee. Grantor agrees for itself, its successors and
assigns, that in the event it transfers the Property, or any portion thereof, to include the
Easement Area described herein, to notify the Grantee and the State in writing of the
names and addresses of any party to whom the Property is to be transferred at or prior to
the time said transfer is consummated. Grantor, for itself, its successors and assigns,
further agrees to make specific reference to this Conservation Easement in a separate
paragraph of any subsequent lease, deed, or other legal instrument by which any interest in
the Property or Easement Area is conveyed according to Article III.,H. herein.
B. Subsequent Transfers of the Conservation Easement. The Parties hereto recognize
and agree that the benefits of this Conservation Easement are in gross and assignable. The
Parties hereby covenant and agree, that in the event this Conservation Easement is
transferred or assigned, the transferee or assignee of the Conservation Easement will be a
qualified organization as that term is defined in Section 170(h)(3) of the Internal Revenue
Code of 1986, as amended, or any successor section, and the regulations promulgated
thereunder (the “Internal Revenue Code”) which is organized or operated primarily for one
of the conservation purposes specified in Section 170(h)(4)(A) of the Internal Revenue
Code. The Parties further covenant and agree that the terms of the transfer or the
assignment will be such that the transferee or assignee will be required to continue to carry
out in perpetuity the conservation purposes that the contribution was originally intended to
advance as set forth in the Recitals herein. Grantee, its successors or assigns, hereby
covenants and agrees to monitor and observe the Easement Area in perpetuity for such
purposes set forth by this Conservation Easement and Grant Agreement, and to report to
the Fund and the State any observed violations on the Easement Area.
C. Existing Responsibilities of Grantor and Grantee Not Affected. Other than as
specified herein, this Conservation Easement is not intended to impose any legal or other
responsibility on the Grantee, or in any way to affect any existing obligation to the Grantor
as owner of the Property, which includes the Easement Area. Among other things, this
shall apply to:
(1) Taxes . The Grantor shall continue to be solely responsible for payment of all taxes and
assessments levied against the Property. If the Grantee is ever required to pay any taxes or
assessments on its interest in the Easement Area, the Grantor will reimburse the Grantee
for the same.
(2) Upkeep and Maintenance . The Grantor shall continue to be solely responsible for the
upkeep and maintenance of the Easement Area, to the extent it may be required by law.
The Grantee shall have no obligation for the upkeep or maintenance of the Easement Area.
(3) Liability and Indemnification. If the Grantee is ever required by a court to pay
damages resulting from personal injury or property damage that occurs on the Easement
Area, the Grantor shall indemnify and reimburse the Grantee for these payments, as well as
reasonable attorneys’ fees and other expenses of defending itself, unless the Grantee has
committed a deliberate act that is determined to be the sole cause of the injury or damage.
In addition, Grantor warrants that Grantee shall be maintained as an additional insured on
Grantor’s liability insurance policies covering the Property.
D.Conservation Purpose. (1) Grantor and Grantee, for itself, its successors and assigns, agrees that this
Conservation Easement shall be held exclusively for conservation purposes set forth by the Grant Agreement, this Conservation Easement and as specified in Section 170(h)(4)(A)
7(2) Unless otherwise specifically set forth in this Conservation Easement, nothing herein
shall convey to or establish for the public a right of access over the Property and Easement
Area. (3) This Conservation Easement shall be construed to promote the purposes of the North
Carolina enabling statute set forth in N.C.G.S. 121-34 et. Seq. which authorizes the
creation of Conservation Easements for purposes including those set forth in the Recitals
herein, and the conservation purposes of this Conservation Easement, including such
purposes as are defined in Section 170(h)(4)(A) of the Internal Revenue Code.
E.Recording. Grantee shall record this instrument and any amendment hereto in
timely fashion in the official records of [Name of County],
North Carolina, and may re-record it at any time as may be required to preserve Grantee's
rights.
F.Notices. All notices, requests or other communications permitted or required by
this Agreement shall be sent by registered or certified mail, return receipt requested,
addressed to the parties as set forth above, or to such other addresses such party may
establish in writing to the other. All such items shall be deemed given or made three (3)
days after being placed in the United States mail as herein provided. In any case where the
terms of this Conservation Easement require the consent of any party, such consent shall
be requested by written notice. Such consent shall be deemed denied unless, within ninety
(90) days after receipt of notice, a written notice of approval and the reason therefore has
been mailed to the party requesting consent.
G.Amendments. Grantor and Grantee are free to jointly amend this Conservation
Easement to meet changing conditions, provided that no amendment will be allowed that is
inconsistent with the purposes of this Conservation Easement or affects the perpetual
duration of this Conservation Easement. Such amendment(s) require the written consent of
both Grantor and Grantee and shall be effective upon recording in the public records of
[Name of County], North Carolina.
H.Environmental Condition of Easement Area. The Grantor warrants, represents and
covenants to the Grantee that to the best of its knowledge after appropriate inquiry and
investigation that: (a) the Easement Area described herein is and at all times hereafter will
continue to be in full compliance with all federal, state and local environmental laws and
regulations, and (b) as of the date hereof there are no hazardous materials, substances,
wastes, or environmentally regulated substances (including, without limitation, any
materials containing asbestos) located on, in or under the Easement Area or used in
connection therewith, and that there is no environmental condition existing on the
Easement Area that may prohibit or impede use of the Easement Area for the purposes set
forth in the Recitals and the Grantor will not allow such uses or conditions.
I.Entire Agreement. This instrument sets forth the entire agreement of the parties
with respect to the Conservation Easement and supersedes all prior discussions,
negotiations, understandings or agreements relating to the Conservation Easement. If any
provision is found to be invalid, the remainder of the provisions of this Conservation
Easement, and the application of such provision to persons or circumstances other than
those as to which it is found to be invalid, shall not be affected thereby. The party (ies)
hereto intend this document to be an instrument executed under seal. If any party is an
individual, partnership or limited liability company, such party hereby adopts the word
"SEAL” following his/her signature and the name of the partnership or limited liability
company as his/her/its legal seal. The Recitals set forth above and the Exhibits attached
hereto are incorporated herein by reference.
J. Indemnity. The Grantor agrees to the fullest extent permitted by law, todefend, protect, indemnify and hold harmless Grantee from and against all claims, actions,
liabilities, damages, fines, penalties, costs and expenses suffered as a direct or indirect
result of any violation of any federal, state, or local environmental or land use law or
regulation or of the use or presence of hazardous substance, waste or other regulated
material in, on or under the property. K. Interpretation. This Conservation Easement shall be construed and interpreted
8under the laws of the State of North Carolina, and any ambiguities herein shall be resolved
so as to give maximum effect to the conservation purposes sought to be protected herein. L. Parties. Every provision of this Conservation Easement that applies to the Grantors
or to the Grantee shall likewise apply to their respective heirs, executors, administrators,
assigns, and grantees, and all other successors in interest herein.
M.Merger. The parties agree that the terms of this Conservation Easement shall
survive any merger of the fee and easement interest in the Property and Easement Area.
N.Subsequent Liens. No provisions of this Conservation Easement shall be construed
as impairing the ability of Grantors to use this Easement Area for collateral for borrowing
purposes, provided that any mortgage or lien arising therefrom shall be subordinated to this
Conservation Easement.
TO HAVE AND TO HOLD unto THE STATE OF NORTH CAROLINA , its successors
and assigns, forever. The covenants agreed to and the terms, conditions, restrictions and
purposes imposed as aforesaid shall be binding upon Grantor, Grantor’s representatives,
successors and assigns, and shall continue as a servitude running in perpetuity with the
Easement Area. IN WITNESS WHEREOF, Grantor has hereunto set his/her hand and seal, or if corporate,
has caused this instrument to be signed in its corporate name by its duly authorized officers
and its seal to be hereunto affixed by authority of its Board of Directors, the day and year
first above written. GRANTOR SignatureDate (Seal) GRANTEE SignatureDate(Seal) I, , a Notary Public of County and State of, certify that
[Names of Grantor] personally appeared before me this day and
acknowledged the execution of the foregoing instrument. Witness my hand and official
stamp or seal, this day of
, 20 .
My Commission Expires: Notary Public [Notarial Seal] STATE OF NORTH CAROLINA COUNTY OF
9 NAME SignatureDate The foregoing certificate of , Notary Public, is certified to
be correct.
This day of , 20 . Register of Deeds This instrument prepared by Clean Water Management Trust Fund and by
Name of Attorney or Agent for the Land Trust or Grantee
10 EXHIBIT A Legal description of Property: Attach the description from the current Deed Book
and Page to include Map Book and Page or reference to survey, if any. Also include
the PIN NUMBER or TAX MAP IDENTIFICATION NUMBER
IF APPLICABLE:Together with the right of ingress, egress and regress as provided by that certain Access
Agreement provided by and recorded in Book , Page
,
Name of County Registry.
11EXHIBIT B Legal Description of the Easement Area may be described by reference to a recorded
survey with the a recited Map/Plat Book and Page, which survey has been approved
by the Fund
Or By a metes and bounds description with reference made to a survey which has been
approved by the Fund.
IFAPPLICABLE:Together with the right of ingress, egress and regress over, upon and across the Property to
and from the Easement Area.
12EXHIBIT C Characteristics of the Property and Easement Area, its current use, state of
improvements, water quality sensitive species, including rare and endangered species.
Conditions
