Fillable Form 2.: PERMISSION TO ENTER PROPERTY NON-SOURCE 1. (Department of Environmental Protection)

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Form 2.: PERMISSION TO ENTER PROPERTY NON-SOURCE 1. (Department of Environmental Protection)

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BROWSE DEPARTMENT OF ENVIRONMENTAL PROTECTION (FL) FORMS

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PERMISSION TO ENTER PROPERTY
NON-SOURCE
1. The Parties. The undersigned real property owner,
, ("Owner"),
hereby give(s) permission to the State of Florida, Department of Environmental Protection
("Department") and it’s Contractor, subcontractors, and vendors (“Contractor”) to enter the
Owner's property ("the Property") (see next paragraph).
2.
The Property. Owner owns the certain parcel(s)
of real property located at , Florida
(the “Property”), depicted on the attached legal description as “Exhibit A.” Attach a legal
description of the Property from the most current deed and/or survey sketch/map of the property
with GPS or other locational information.
3.
Permissible Activities. This Permission to Enter Property (“Permission”) is limited to
activities which may be performed by the Department or its Contractors pursuant to Chapter
62-780 or 62-730, Florida Administrative Code (“F.A.C.”), without cost to the Owner (unless
required in a separate agreement) to locate contamination, determine contamination levelsand,
when necessary, remove and remediate contamination which may be performed by the
Department and its Contractor. The following activities are included in this Permission but are
not limited to this list:
• conduct soil, surface, subsurface, and groundwater investigations,
including but not limited to entry by a drill rig vehicle and/or support
vehicles;
• install and remove groundwater monitoring wells;
• use geophysical equipment;
• use an auger for collecting soil and sediment samples;
• locate existing wells;
• collect waste, soil, and watersamples;
• remove, treat and/or dispose of contaminated soils and water;
• remove contaminated soil by digging with backhoes, large diameter augers
and similar equipment;
• install, operate, and remove remedial equipment;
• install and remove utility connections;
• trench for connection of remediation wells to equipment; and
• conduct surveys, prepare site sketches, and take photographs.
4.
The Source: The suspected source of the contamination is located at:
parcel number #
FDEP Facility/Project #
Page 1 of 4
5.
Duration and Termination of Access. This Permission is granted, without any fee or
charge to the Department or Contractor, for so long as is necessary to assess, remove, monitor
and remediate the contamination on the Property. Access shall be allowed for the Department
and Contractor immediately upon the execution of this Agreement. This Permission shall
continue until the Department’s entry of a site rehabilitation completion order pursuant to Rule
62-780.680, Florida Administrative Code or low-scored site initiative no further action order
pursuant to Section 376.3071(12)(b), Florida Statutes (“Order”). At which time the Owner shall
be provided a copy of the Order and this Permission shall be automatically terminated.
6.
Work Performed during Business Hours. The Department and Contractor may enter the
Property during normal business hours and may also make arrangements to enter the Property at
other times after agreement from the Owner.
7.
Activities Comply with Applicable Laws. The Department and Contractor agree that any
and all work performed on the Property and in association with this Permission shall be done in a
good, safe, workmanlike manner, and in accordance with applicable federal and state statutes,
rules and regulations.
8.
Proper Disposal of Contaminated Media. The Department and Contractor shall ensure
that soil cuttings, any work materials, and water generated shall be disposed of in accordance
with Environmental Laws. All soil cuttings, waste materials and development water generated
shall be promptly removed from the Property.
9.
Well Permits. The Owner authorizes the Department and its Contractor to act as its agent
in signing all required forms and documents necessary for obtaining applicable permits related to
well construction, repair, maintenance, modification, and abandonment pursuant to Chapter 373,
Florida Statutes.
10.
Equipment Ownership. The monitoring wells and remedial equipment installed pursuant
to this agreement are the property of the Department. The Owner is responsible for replacing any
Department property that may be damaged or lost due to any actions by the owner.
11.
Owner’s Non-Interference. The Owner shall not interfere with the Department or
Contractor when performing the Permissible Activities. Owner shall not damage any equipment
including wells, piping, and remediation system that may be located on the Property. Owner
shall notify the Department 90 days prior to commencement of any construction, demolition or
other work on the Property that may damage or destroy any part of the equipment installed under
this Permission so that such equipment can be either properly removed, secured or abandoned.
12.
Owner’s Use of Property. The Owner retains the right to use the Property, and the
Department and its Contractors will work with the Owner regarding minimizing activities that
may interfere with the Owner’s management and use of the Property. However, neither the
Department nor the Contractor are responsible for any inconvenience, economic injury, or
business damage that Owner may suffer due to the performance of any Permissible Activity.
This agreement does not modify any legal right the parties may have regarding negligent acts.
13.
Property Restoration. The Department shall pay the reasonable costs of restoring the
Property as nearly as practicable to the conditions which existed before activities associated with
contamination assessment or remedial action were taken.
Page 2 of 4
14.
No Admission. The granting of this Permission by the Owner is not intended, nor should
it be construed, as an admission of liability on the part of the Owner for any contamination
discovered on the Property.
15.
Injury to Department. The Owner shall not be liable for any injury, damage or loss on
the Property suffered by the Department, Department employees or Contractors not caused by
the negligence or intentional acts of the Owner's agents or employees.
16.
Sovereign Immunity. The Department acknowledges and accepts its responsibility under
applicable law (Section 768.28, Florida Statutes) for damages caused by the acts of its employees
while on the Property.
17.
Public Records. All documents created or received associated with the Permissible
activities are a public record pursuant to Chapter 119, Florida Statutes. The Owner may retrieve
any documents or other information related to the Permissible Activities online using the facility
or project number referenced above in paragraph 4.
http://depedms.dep.state.fl.us/Oculus/servlet/login?action=login
18.
Entire Agreement. This Permission shall constitute the entire agreement between the
Department and the Owner regarding this grant of access to the Department as stated herein. No
modification, amendment or waiver of the terms and conditions of this Permission shall be
binding upon Department unless approved in writing by an authorized representative of Owner
and Department.
19.
Governing Law and Venue. This Permission shall be governed by and construed in
accordance with the laws of the State of Florida. Venue for any action or proceeding arising from
or relating to this Permission shall be in the appropriate Florida court having jurisdiction located
in Leon County, Florida.
20.
Severability. Any provision of this Permission that is prohibited or unenforceable shall
be ineffective to the extent of such prohibition or unenforceability without invalidating the
remaining provisions hereof.
21.
No Third-Party Beneficiaries. This Permission is solely for the benefit of the parties
hereto and their respective successors and assigns and shall not be deemed to confer upon third
parties any remedy, claim, liability, or reimbursement, claim of action or other right.
22.
Contact. Any questions regarding this access agreement please contact the following:
For the Contractor:
(Name, Email, Phone)
For the Department:
(Name, Email, Phone)
Page 3 of 4
Are additional requirements attached to this agreement? Note: Additional requirements must be
on a separate page titled “Exhibit B” and include the project number or facility ID# and owner
signature on the page.
YES NO
Signature of each Property Owner
Print Name Date
Mailing Address
Telephone or Cell Phone Number
E-mail Address
Signature of Witness
Print Name Date
Accepted by Contractor on behalf of the State of Florida Department of Environmental
Protection:
Signature of Contractor Signature of Witness
Print Name – Contractor Date Print Name
Contractor Company Name
Contractor Mailing Address
Contractor City, State, Zip Code
Contractor Telephone or Cell Phone Number
Contractor Contact Email Address
Attachments: Exhibit A- Legal description of the Property.
FDEP Coordinates (Degrees Minutes Seconds) for
Project # or Facility Id.#: __________________________________
Latitude: ________________________________________________
Longitude: ______________________________________________
EC: OCULUS
Date
Page 4 of 4
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Form 2.: PERMISSION TO ENTER PROPERTY NON-SOURCE 1. (Department of Environmental Protection)

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Completed 25 February 2022

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