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HomeMy WebLinkAbout20140573 Ver 1_Emails_20140731Burdette, Jennifer a From: Burdette, Jennifer a Sent: Thursday, July 31, 2014 11:12 AM To: 'Dana A. Lutheran' Cc: ' scott cayton'; 'David Scibetta' Subject: RE: Grantsboro Mine Pre - Construction Notification (PCN) LM Jennifer Burclette 401/Buffer 401 & Buffer Permitting Unit Wetlands Branch NCDENR — Division of Water Resources 1617 Mail Service Center Raleigh, NC 27699 -1617 (919) 807 -6364 phone 0ennifer.burdette @ncdenr.gov *Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties unless the content is exempt by statute or other regulation. * From: Dana A. Lutheran ,i� uII � ;illluutl� rii;; ir��P1 &, rgu u.s1 Sent: Wednesday, July 30, 2014 12:00 PM To: Burdette, Jennifer a; 'Greer, Emily C SAW' Cc: 'scott cayton'; 'David Scibetta' Subject: RE: Grantsboro Mine Pre - Construction Notification (PCN) Jennifer, Thank you for bringing the wetland impact acreage concern to my attention After returning to the office, I reviewed the site impact map with David Scibetta. He confirmed that the wetland impact total is 4.91 acre. This increases the overall mitigation to impact ratio to 1.33 to 1. 1 have revised Page 3 of the PCN and the Proposed Mitigation Plan, to reflect this correction (see attached). In addition, I have attached the USACE's Draft Declaration of Restrictions, which should be included as part of Appendix D of the Mitigation Plan. As you will notice, when you review the attached Mitigation Plan, I have included a new Appendix D cover sheet, which reflects the inclusion of the Draft language. Please replace previously submitted pages with those attached to this email. Lastly, 4 copies of the permit will be sent via FeclEx to your physical address today. You should have them by tomorrow. Please confirm receipt of the packet. As always, feel free to call if you have any questions or concerns. Dana 50utkern Environmental (,I rouP, Inc:. 53 1 5 �30 Jtk C.oIIege K0a3d, Suite E_ Wilmington, NC.. 28-112 rkone: j 10A 152.271 1 Mokile: j 10.228.18-11 From: Burdette, Jennifer a inn .;ii,llt� � ;i ,ir�u��ru 13u.MuuJeft 1ir�: � w;i q y11 Sent: Tuesday, July 29, 2014 12:07 PM To: Dana A. Lutheran; 'Greer, Emily C SAW' Cc: 'scott cayton'; 'David Scibetta' Subject: RE: Grantsboro Mine Pre - Construction Notification (PCN) fflo We need 4 copies of the application. You may want to correct the acreage of 404 wetland impact reported under Section 11. — A. Objective of the Mitigation Plan from 5.33 to 4.91 acres Raleigh, NC 27699 -1617 (919) 807 -6364 phone 0ennifer.burdette @ncdenr.gov From: Dana A. Lutheran inn ull ; �illuu�I�,wru ir).@s rgu u.s1 Sent: Monday, July 28, 2014 5:54 PM To: Burdette, Jennifer a; 'Greer, Emily C SAW' Cc: 'scott cayton'; 'David Scibetta' Subject: Grantsboro Mine Pre - Construction Notification (PCN) Jennifer/ Emily: Please find attached a copy of the PCN and accompanying attachments. Emily, Do you need a hard copy? Jennifer, How many copies do you need? Please feel free to call if you have any questions or concerns before I mail the hard copies to you. Dana 50utkern Environmental (,I rouP, Inc:. 53 1 5 �30 Jtk C.oIIege KOa3d, Suite E_ Wilmington, NC.. 28-112 rkone: j i O. 152.271 1 Mokile: j 10.228.18-11 .......................... . ..... .......... ..... ..... . .......... 3e. Describe the overall project in detail, including the type of equipment to be used: Trackhoes and front end loaders will be used to remove root mat and woody debris from the minable area. Excavators will then remove the overburden and sand from the pit. The soil will be sifted and sold to private residents and commercial businesses alike. . ...... . . ........... ............ . ..... 4. Jurisdictional Determinations -.--­ . ...... ...... .. W Ha ve jur i sdict ion al wetland or strea m 0 Ye s ❑No ❑Unknown determinations by the Corps or State been Comments: _f2qp2s��.,qr.obtained for this . ..... ........ obtained I proje�, . ...... . .. ..... 4b. If the Corps made the jurisdictional determination, ❑Preliminary ZFinal what type of determination was made? 4c. If yes, who delineated the jurisdictional areas Agency/Consultant Company: Name (if known): David Scibetta SEQ 4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation. Emily Greer verified SEGVs wetland line on 6/2/14. Ms. Jennifer Burdette (NCDWR) was present at the time of the verification. Please see Attachment 4, entitled Grantsboro Mine Mitigation Plan, for a copy of the JD. 5. Project History 5a. Have permits or certifications been requested or ❑Yes NNo ❑Unknown obtained for this project (including all prior phases) in the past? 5b. If yes, explain in detail according to "help file" instructions. NA . . ............ . ..................... 6. Future Project Plans 6a. Is this a phased project? . . . . . .................... ❑Yes ZNo . . . ......... . 6b. If yes, explain. NA C. Proposed Impacts Inventory .................. . ..... - ....... ....... 1. Impacts Summary ------ . . . . . . . ............. . . . . .. ............... . ....... . ............................ . . ....... . . . . . . ........................... .. ........................... I a. Which sections were completed below for your project (check all that apply): ZWetlands Ostreams - tributaries ❑Buffers Zopen waters ❑Pond Construction ........... . ...... . . . .......... . . . ...... . ................... . . .............. 2. Wetland Impacts If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted. 2a. 2b. 2c. 2d. 2e. 2f. Wetland impact Type of impact Type of wetland Forested Type of jurisdiction Area of impact number Permanent Corps (404,10) or (acres) (P) or Temporary (T) DWR (401, other) . . ............................. . . . ......... . . . Temporary J fill Pocosin Yes 404 0.49 -ITmm Permanent Excavation mmm Pocosin Yes 404 4.91 . .......... . . . . . . . ............ ................ 2g. Total Permanent Wetland Impacts: 4.91 ........... . ..... ........ ............ 2h. Comments: The fill is associated with the stock pile locations and access road. These areas will eventually be excavated to]- material. Please see the attached Mitigation Plan for details of the wetland impact areas. ---- . . . ........... - . .... . ..... -- . .......... . . . authern F mAr- ammental Group, Ine. 5315 South College Road, Suite E, 3Wilydngtow, North Carolina 20412 910.452.2711 3/,Fax 910.452.2899 3/b €ieefte i�us www.aegi.ua Grantsboro Mine Wetland Mitigation Plan Prepared for: Cayton Development LLC PO Box 3361 New Bern, North Carolina 28564 252.671.3172 Prepared by: Southern Environmental Group, Inc. 5315 South College Road, Suite E Wilmington, North Carolina 28412 910.452.2711 Date: 28 July 2014 (ZaVton D)MIapmfit Mltlgatlafl plsm (page 11 2) I Table of Contents Section Description Page I Introduction 3 B A. Project Description 3 C B. Mitigation Rule Background Information 3 D C. Mitigation Mechanisms 3 E D. Permittee - Responsible Mitigation Plan Standards 3 II Proposed Permittee Responsible Mitigation Plan 4 A. Objective 4 B. Site Selection 4 C. Baseline Information 5 D. Mitigation Work Plan 5 III Ecologically -based Performance Standards 6 A. Vegetation 6 B. Hydrology 6 IV Monitoring Requirements 6 V Contingency Plan 7 Appendices Appendix Description Page A Grantsboro Mine Wetland Impact Map 8 B USACE Jurisdictional Determination 9 C Grantsboro Mine Mitigation Map 10 D Grantsboro Mine Declaration of Restrictions and Preservation Exhibit 11 E Soil Survey of Pamlico County 12 (Zaytan p)MIOPmfit MNA806fl PI&I (peke 11 3) $M L Introduction A. Project Description Cayton Development, LLC, herein referred to as the "Applicant ", has undertaken sand mining activities, within an area determined to be Section 404 wetlands, by the U.S. Army Corps of Engineers ( USACE), and on property owned by the Applicant. In order to complete the mining and make the project economically practicable, the Applicant will need to fill 0.49 acres and excavate 5.0 acre of Section 404 wetlands (see Appendix A). To complete the work, the Applicant is seeking USACE and Division of Water Resources authorization to utilize Nationwide Permits (NWP) 27 and 44. As part of the permit process, the Applicant is required to propose adequate compensatory mitigation plan, to offset the unavoidable impacts to wetlands. B. Mitigation Rule Background Information In 2008, the U.S. Environmental Protection Agency (EPA) published the "Mitigation Rule ", which is outlined in Part 73, of the Federal Register, Page 19594. The rule establishes one set of standards for all mitigation required under the Clean Water Act's Section 404 regulatory program. The rule combines previous guidance documents, ranks the permissible compensation mechanisms in order of preference, and provides that all of these compensation options must include a mitigation plan with a uniform, required set of components. C. Mitigation Mechanisms There are three (3) approved types of compensatory mitigation and should. They are as follows: • Private Mitigation Banks The first, and preferred option, is for permittees to purchase credits from an approved mitigation bank. A mitigation bank is a wetland, stream, or other aquatic resource area that has been established by a third -party organization. • In -Lieu Fee Programs The second option for mitigating impacts involves payment to an in -lieu fee program that will in turn fund aquatic resource creation, restoration, enhancement, or preservation activities. • Permittee- Responsible Mitigation The final and least desirable option in the USACE' hierarchy allows the permittee itself to restore, establish, enhance, or create aquatic resources. The permittee may implement mitigation measures on -site or within the same river basin as the project site. Note: The mitigation mechanisms have been listed in the order of preference. D. Permittee- Responsible Mitigation Plan Standards Standardized reporting criteria will help the USACE evaluate compliance and success of all mitigation methods used to offset impacts to jurisdictional waters. This is accomplished by addressing the "Twelve Fundamental Components of Mitigation." The rule describes the kind and level of information the USACE must consider under any of the mitigation options. All mitigation plans should include most, if not all, of the 12 fundamental components. They are as follows: (Zaytan D)MIapmfit MINA806fl PI&I (pee IP ¢) Objectives Site selection information Site protection instruments Baseline information A credit determination methodology A mitigation work plan A maintenance plan Ecologically -based performance standards Monitoring requirements A long -term management plan An adaptive management plan Financial assurances II. Proposed Permittee - Responsible Mitigation Plan A. Objective In order to facilitate the mining of sand, 4.91 acres of USACE Section 404 wetlands will need to be impacted. While the preferred method of mitigation is payment to a private mitigation bank or the NC Ecosystem Enhancement Program (EEP), these options are not financially feasible for the Applicant, as a one to one (1:1) mitigation to impact ratio would cost $251,565.00. Therefore, in conjunction with the Applicant's willingness to minimize impacts to wetlands, he also proposes to carry out the following compensatory mitigation: Mitigation Type Proposed Acreage Mitigation to Impact Ratio Enhancement (pond areas) 2.86 .58 to 1 Enhancement (vegetative area) 1.91 .39 to 1 Establishment 1.74 .35 to 1 Total Enhancement & Establishment 6.51 1.33 to 1 Preservation 6.51 1.33 to 1 B. Site Selection 1. Enhancement (Restoration) and Establishment (Creation) Areas The Applicant is proposing to utilize land within the project limits, to fulfill the mitigation plan. Currently, there are two borrow pits on the property. The ponds were excavated prior to the Applicant taking ownership of the property. One of the ponds has been claimed by the USACE, as jurisdictional waters (see Appendix B). Cumulatively, the ponds encompass 2.87 acres. The ponds have been bermed up and are adjacent to wetlands to the south and east. The fringe of the wetland feature to the east of the borrow pits has been cleared of larger trees and shrubs. Utilizing the NC Division of Water Resources Wetland Assessment Method Manual', the adjacent wetlands have been classified as a hardwood flat. These wetlands are typically found in the coastal plain ecoregions, on poorly drained, interstream flats and can transition to Pocosin, Pine Savanna, Pine Flat, and Non - Riverine Swamp Forest. The primary source of water is a high water table resulting from precipitation and overland runoff, are commonly dominated by hardwood tree species. 2. Preservation Areas The proposed preservation areas include the mitigation areas (6.51 AC (see Appendix D)). ' NC Department of Environment and Natural Resources, Wetland Assessment Method v4.1 (Zaytan D)MIOPmfit MINARtlan plon (peke 11 3) I C. Baseline Information Baseline information was collected for the impact and mitigation areas. 1. Impact Area a) Soils According to the ESRI World Imagry, Soil Survey of Pamlico County, soils within the mitigation site have been mapped as Wasda muck (Sd) (see Appendix E). This soil is nearly level and very poorly drained. Typically, the surface layer is black muck 12 inches thick, and the seasonal high water table is at or near the surface. b) Hydrology The seasonal high water table can be found within 12" of the surface. c) Vegetation Vegetation within the impact area consists of Ilex coriacea (Holly, ba- gall), Magnolia virginiana (Magnolia, sweetbay), Acer rubrum (Maple, red), Persea palustris (Bay, red), and Caccinium corymbosum (Blueberry, highbrush). 2. Mitigation Area a) Soils The mitigation area is mapped as having the same soil series as the impact area (i.e., Wd). b) Hydrology Except in those areas where berms have been created, the seasonal high water table is at or near the surface. c) Vegetation As a result of the previous mining activity, very little natural vegetation exists within the mitigation area. D. Mitigation Work Plan 1. Enhancement (Restoration) & Establishment (Creation) The Applicant intends to dewater the existing borrow pits, remove the berms around the north, south and east sides of the pits, and excavate the abutting uplands to an elevation that is equal to the adjacent wetlands (see Appendix Q. Once this has been completed, hydric soil will be brought in and the area planted with hydrophytic vegetation. Vegetation will consist of some, if not all, of the following: Nyssa aquatica (Swamp gum) Acer rubrum (Maple, red) Ulmus americana (American Elm) Taxodium distichum (Bald Cypress) Magnolia virginiana (Magnolia, sweetbay) Q. laurifolia (Oak, laurel) Persea palustris (Bay, red) (Zaytan D)MIapfMfit MINA806fl PI&I (peke 11 6) $M Vegetation will be planted on 15 foot centers. It is expected that natural wetland vegetation will Hydrology will be supplied to the mitigation area, by directing overflow water from the existing pit into the mitigation area. 2. Preservation The Applicant will record the USACE Declaration of Restrictions and accompanying preservation exhibit (see Appendix D), at the Pamlico County Register of Deeds. A copy of the recorded documents will be provided to the USACE and DWR within 30 days of recordation. III. Ecologically -based Performance standards The success criteria of this mitigation site will be based on the 1987 U.S. Army Corps of Engineers Wetland Delineation Manual and The Regulatory Supplement to the Corps of Engineers Wetland Delineation Manual: Atlantic and Gulf Coastal Plain Region (Version 2.0)2. The site can be deemed successful once it meets the three (3) wetland parameters outlined in the manual and as further described in this section. A. Vegetation The success of wetland vegetation planting for the established and enhanced wetland areas will be gauged by stem counts of planted species within the mitigation areas. Species survival must meet or exceed 320 three year old trees after three years and 260 five year old trees after five years. All wetland mitigation areas must be dominated by more than 50% hydrophytic vegetation. Three sampling plots are proposed (see Appendix Q. The permittee will provide a map showing the plot locations of the vegetation sampling areas to the DWR. B. Hydrology The minimum requirement to meet hydrology success criteria for all created and established wetland areas will be saturation within the upper 12 inches of the soil for 12.5 % of the growing season. The minimum requirement to meet hydrology success criteria for the enhanced wetland areas will be saturation within the upper 12 inches of the soil for 6% of the growing season. Two (2) hydrologic monitoring wells will be installed. One (1) well will be installed within the established area and one (1) within the enhancement area of the mitigation site (see Appendix Q. The hydrologic monitoring wells will be installed in accordance with the document titled, "Technical Standard for Water Table Monitoring of Potential Wetlands Sites ", dated June 20053. Monitoring wells will be installed upon completion of all proposed mitigation work. IV. Monitoring Requirements Monitoring reports will be submitted to the USACE and DWR, by December 31 of each year. The monitoring reports will be prepared in accordance with Regulatory Guidance Letter 08 -034 and will include maps, site photographs, vegetation monitoring results and hydrologic monitoring results. The monitoring reports will also include monitoring well data graphs that clearly depict depth to groundwater, precipitation, monitoring dates and monitoring well results. 2 http: / /www.usace. army. mil / Portals /2 /docs /civilworks/ regulatory /reg sunn /AGCP_regsupV2.pdf 'http://www.oregon.gov/dsl/docs/techstan watertable_mes.pdf 4 http:// www .spk.usace.anny.mil/Portals /12/ documents /regulatory /mitigation/ Minimum %2OMonitoring %2OReguirements.pdf (Zaytan D)MIOPmfit MINARtlafl PI&I (peke 11 7) $M V. Contingency Plan In the event that the proposed mitigation does not meet the stated success criteria, the Applicant will take actions to resolve the problem (i.e., additional plantings, introduction of more hydrology into the area, additional grading). Any additional measures taken to improve the vitality of the mitigation area will be discussed and approved by the USACE and DWR prior to work taking place. (Zaytan O)MIOPmfit MINARtian plan (pee 11 11) Appendix D Grantsboro Mine Declaration of Restrictions and Preservation Exhibit MODEL DECLARATION OF RESTRICTIONS August, 2003 STATE OF NORTH CAROLINA Pamlico COUNTY CONSERVATION DECLARATION This DECLARATION of CONSERVATION COVENANTS, CONDITIONS, and RESTRICTIONS (" ") is made on this day of 200, by [NAME AND ADDRESS OF DECLARANT] "Declarant "). RECITALS & CONSERVATION PURPOSES A. Declarant is the sole owner in fee simple of the certain Conservation Property (Property) being approximately 6.51 acres, more particularly described in Exhibit A attached hereto and by this reference incorporated herein [reference to a recorded map showing a survey of the preserved area may be required]; and B. The purpose of this Conservation Declaration is to maintain wetland and /or riparian resources and other natural values of the Property, and prevent the use or development of the Property for any purpose or in any manner that would conflict with the maintenance of the Property in its natural condition. The preservation of the Property in its natural condition is a condition of Department of the Army permit Action ID SAW - 2013 -01288 issued by the Wilmington District Corps of Engineers (Corps), required to mitigate for unavoidable impacts to waters of the United States authorized by that permit, and this Conservation Declaration may therefore be enforced by the United States of America. NOW, THEREFORE the Declarant hereby unconditionally and irrevocably declares that the Property shall be held and subject to the following restrictions, covenants and conditions as set out herein, to run with the subject real property and be binding on all parties that have or shall have any right, title, or interest in said property. ARTICLE I. PROHIBITED AND RESTRICTED ACTIVITIES Any activity on, or use of, the Property inconsistent with the purposes of this Conservation Declaration is prohibited. The Property shall be maintained in its natural, scenic, and open condition and restricted from any development or use that would impair or interfere with the conservation purposes of this Conservation Declaration set forth above. Without limiting the generality of the foregoing, the following activities and uses are expressly prohibited or restricted. A. Disturbance of Natural Features. Any change disturbance, alteration or impairment of the natural features of the Property or any introduction of non - native plants and /or animal species is prohibited. B. Construction. 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 Property. C. Industrial, Commercial and Residential Use. Industrial, residential and /or commercial activities, including any right of passage for such purposes are prohibited. D. Agricultural, Grazin4 and Horticultural Use. Agricultural, grazing, animal husbandry, and horticultural use of the Property are prohibited. E. Vegetation. There shall be no removal, burning, destruction, harming, cutting or mowing of trees, shrubs, or other vegetation on the Property. F. Roads and Trails. There shall be no construction of roads, trails or walkways on the property. G. Sioage. No signs shall be permitted on or over the Property, except the posting of no trespassing signs, signs identifying the conservation values of the Property, signs giving directions or proscribing rules and regulations for the use of the Property and /or signs identifying the Grantor as owner of the property. H. Dumping or Storage. Dumping or storage of soil, trash, ashes, garbage, waste, abandoned vehicles, appliances, machinery or hazardous substances, or toxic or hazardous waste, or any placement of underground or aboveground storage tanks or other materials on the Property is prohibited. L Excavation, Dredging or Mineral Use. There shall be no grading, filling, excavation, dredging, mining or drilling; no removal of topsoil, sand, gravel, rock, peat, minerals or other materials, and no change in the topography of the land in any manner on the Property, except to restore natural topography or drainage patterns. J. Water Quality and Drainage Pattern. There shall be no diking, draining, dredging, channeling, filling, leveling, pumping, impounding or related activities, or altering or tampering with water control structures or devices, or disruption or alteration of the restored, enhanced, or created drainage patterns. In addition, diverting or causing or permitting the diversion of surface or underground water into, within or out of the easement area by any means, removal of wetlands, polluting or discharging into waters, springs, seeps, or wetlands, or use of pesticide or biocides is prohibited. K. Development Rights. No development rights that have been encumbered or extinguished by this Conservation Declaration shall be transferred pursuant to a transferable development rights scheme or cluster development arrangement or otherwise. L. Vehicles. The operation of mechanized vehicles, including, but not limited to, motorcycles, dirt bikes, all - terrain vehicles, cars and trucks is prohibited. M. Other Prohibitions. Any other use of, or activity on, the Property which is or may become inconsistent with the purposes of this grant, the preservation of the Property substantially in its natural condition, or the protection of its environmental systems, is prohibited. ARTICLE II. ENFORCEMENT & REMEDIES A. This Declaration is intended to ensure continued compliance with the mitigation condition of authorizations issued by the United States of America, U.S. Army Corps of Engineers, Wilmington District, and therefore may be enforced by the United States of America. This covenant is to run with the land and shall be binding on all parties and all persons claiming under the Declarant. B. Corps, its employees and agents and its successors and assigns, have the right, with reasonable notice, to enter the Property at reasonable times for the purpose of inspecting the Property to determine whether the Declarant, Declarant's representatives, or assigns are complying with the terms, conditions and restrictions of this Conservation Declaration. C. Nothing contained in this Conservation Declaration shall be construed to entitle Corps to bring any action against Declarant for any injury or change in the Conservation Property caused by third parties, resulting from causes beyond the Declarant's control, including, without limitation, fire, flood, storm, and earth movement, or from any prudent action taken in good faith by the Declarant under emergency conditions to prevent, abate, or mitigate significant injury to life, damage to Property or harm to the Property resulting from such causes. ARTICLE III. PUBLIC ACCESS A. This Conservation Declaration does not convey to the public the right to enter the Property for any purpose whatsoever. ARTICLE IV. DOCUMENTATION AND TITLE A. Conservation Property Condition. The Declarant represents and acknowledges that the Property is currently undeveloped land, with no improvements other than any existing utility lines, Declarations and rights of way. B. Title. The Declarant covenants and represents that the Declarant is the sole owner and is seized of the Property in fee simple and has good right to make the herein Declaration; that there is legal access to the Property, that the Property is free and clear of any and all encumbrances, except Declarations of record. ARTICLE V. MISCELLANEOUS A. Conservation Purpose. (1) Declarant, for itself, its successors and assigns, agrees that this Conservation Property shall be held exclusively for conservation purposes. B. Entire Agreement. This instrument sets forth the entire agreement of the parties with respect to the Conservation Declaration and supersedes all prior discussions, negotiations, understandings or agreements relating to the Conservation Declaration. If any provision is found to be invalid, the remainder of the provisions of this Conservation Declaration, 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. C. Recording. Declarant shall record this instrument and any amendment hereto in timely fashion in the official records of Pamlico County, North Carolina, and may re- record it at any time as may be required to preserve its rights. D. Environmental Condition of Conservation Property. The Declarant warrants and represents that to the best of its knowledge after appropriate inquiry and investigation: (a) the Property 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 Property or used in connection therewith, and that there is no environmental condition existing on the Property that may prohibit or impede use of the Property for the purposes set forth in the Recitals. IN WITNESS WHEREOF, Declarant has hereunto set his hand and seal, the day and year first above written. [Signature of Declarant in proper form]