Download:
pdf |
pdf Authorization ID: #AUTH_ID#
Contact ID: #GRANTEE_ID#
Use Code: #USE_CODE#
FS-2700-9h (XX/202X)
OMB No. 0596-0082
U.S. DEPARTMENT OF AGRICULTURE
Forest Service
PRIVATE ROAD EASEMENT
AUTHORITY:
National Forest Roads and Trails Act, 16 U.S.C. 532-538
T
This private road easement (hereinafter “easement”), dated ______, is granted by the United States, acting
through the United States Department of Agriculture, Forest Service (hereinafter ”grantor”), to [name], of the State
of _______ (hereinafter “grantee”).
R
AF
The grantor hereby grants to the grantee and its successors and assignees, subject to existing easements and
other valid existing rights, a non-exclusive, permanent easement for use of a private road that accesses private
property owned or controlled by the grantee (hereinafter “private road”). The grantee shall record this easement
within 90 days of the date it is granted and shall provide a copy of the recorded easement to the authorized
officer.
In consideration of this permanent easement, the grantor has granted to the grantee [a reciprocal permanent road
easement of substantially similar value/a lump-sum payment of $______.
D
This easement is located on National Forest System lands in the County of __________ State of
__________.This easement is ____feet wide and ___ feet long and covers approximately ____ acres in the
#TOWNSHIP_SECT_RANGE# #FIRST_DIVISION# #FIRST_DIV_NAME_NUMBER#, #SECOND_DIVISION#
#SECOND_DIV_NAME_NUMBER#, #THIRD_DIVISION# #THIRD_DIV_NAME_NUMBER# (“the easement
area”), as shown on the map attached as Appendix A to this easement. This and any other appendices are
hereby incorporated into this easement.
The private road is more specifically delineated in a centerline description, which is attached as Appendix B to this
easement.
This easement covers _____ feet on either side of the centerline of the private road, with additional width as
required to accommodate and protect cuts and fills.
I. GENERAL TERMS
A. AUTHORITY. This easement is issued pursuant to the National Forest Roads and Trails Act, 16 U.S.C. 532538, and 36 CFR Part 212, Subpart A, and 36 CFR Part 251, Subpart B, as amended, and is subject to their
provisions.
Page 1 of 9
B. AUTHORIZED OFFICER. The authorized officer is the Regional Forester or Forest or Grassland Supervisor
with delegated authority pursuant to Forest Service Manual 2700.
C. AMENDMENT. This easement may be amended at any time by written agreement of the grantor and the
grantee. Any amendments to this easement must be in writing. If amendments are deemed necessary to reflect
changing laws, regulations, directives, and conditions, they must be signed and dated by the authorized officer. If
amendments are agreed to by the grantor and the grantee, they must be signed and dated by both parties.
D. COMPLIANCE WITH LAWS, REGULATIONS, AND OTHER LEGAL REQUIREMENTS. In exercising the
rights and privileges granted by this easement, the grantee shall comply with all present and future federal laws
and regulations and all present and future state, county, and municipal laws, regulations, and other legal
requirements that apply to the easement area, to the extent they do not conflict with federal law, regulation, or
policy. The grantor assumes no responsibility for enforcing laws, regulations, and other legal requirements that
fall under the jurisdiction of other governmental entities.
T
E. RESERVATIONS. All rights not specifically and exclusively granted to the grantee are reserved to the
grantor, including:
1. The right of access to the easement area, including a continuing right of physical entry to the easement area
for inspection, monitoring, or any other purpose consistent with any right or obligation of the United States under
any law or regulation.
R
AF
2. The right to administer and dispose of all natural resources, including timber, in the easement area, subject to
the grantee’s right to cut vegetation under clause III.D.
3. The right to use or cross upon, over, or under the private road or allow others to use or cross upon, over, or
under the private road in any way that is not inconsistent with the grantee's rights and privileges under this
easement, after consultation with the grantee, provided that:
(a) When the grantor uses the private road for commercial hauling, other than removal of timber cut during
construction or maintenance of the private road or other occasional incidental use, the grantor shall pay or
perform its pro-rata share of maintenance and construction costs of the private road;
(b) The grantor shall require users to pay the grantee or perform their pro-rata share of the current replacement
cost of the private road, less depreciation, to reconstruct the private road as necessary to accommodate their use
and perform road maintenance commensurate with their use.
F. ASSIGNMENT. This easement is fully assignable, subject to the following conditions:
D
1. The assignee must have title to the non-National Forest System lands or improvements served by the private
road.
2. The grantee must be in compliance with all the terms of this easement.
3. The grantee shall give the authorized officer written notice of the assignment, including documentation of the
assignment and the name of and contact information for the assignee.
4. The authorized officer may modify the terms of this easement, and the assignee shall agree in writing to
comply with the terms of the easement as modified.
II. IMPROVEMENTS
A. LIMITATIONS ON USE. Nothing in this easement gives or implies permission to build or maintain any
structure or facility or to conduct any activity unless specifically provided for in this easement. Any use not
specifically authorized by this easement must be proposed in accordance with 36 CFR 251.54 and 251.61.
Approval of such a proposed use through issuance of a new easement or easement amendment is at the sole
discretion of the authorized officer.
Page 2 of 9
B. DRAWINGS. All drawings for construction or reconstruction of the private road, as well as revisions to those
drawings, must be prepared by a professional engineer, architect, landscape architect, or other qualified
professional acceptable to the authorized officer. These drawings and drawing revisions must have written
approval from the authorized officer before they are implemented. The authorized officer may require the grantee
to furnish as-built drawings, maps, or surveys upon completion of the work.
C. RELOCATION. This easement is granted with the express understanding that should future location of
federally owned improvements or road rights-of-way require relocation of the private road, the relocation will be
conducted by and at the expense of the grantee within a reasonable period specified by the authorized officer.
III. OPERATIONS
T
A. USE OF THE PRIVATE ROAD. The grantee shall have the right to use the private road without cost, other
than the consideration provided for in this easement, for all purposes deemed necessary or desirable by the
grantee in connection with the protection, administration, management, and utilization of the grantee's lands and
other property.
R
AF
B. TRAFFIC CONTROL RULES AND OTHER REQUIREMENTS FOR RESIDENTIAL ACCESS. The rights
conveyed by this easement do not include the right to use the private road for access to developments for shortor long-term residential purposes, unless and until the grantor and the grantee agree upon traffic control rules and
other provisions to accommodate that use of the private road.
C. RESOURCE PROTECTION DURING ROAD MAINTENANCE. The grantee shall conduct any maintenance
of the private road so as to avoid damaging adjacent National Forest System lands. The grantee shall construct
and maintain lead-off drainage and water barriers as necessary to prevent erosion.
D. CUTTING, DISPOSAL, AND PLANTING OF VEGETATION. This easement does not authorize the cutting
of trees, brush, shrubs, and other plants (“vegetation”). Vegetation may be cut, destroyed, or trimmed only after
the authorized officer or the authorized officer's designated representative has approved in writing and marked or
otherwise identified what may be cut, destroyed, or trimmed. The grantee shall notify the authorized officer when
approved cutting, destruction, or trimming of vegetation has been completed. The Forest Service shall determine
in advance of felling the method of disposal of trees felled in the easement area that meet utilization standards.
Disposal may be by sale or without charge per 36 CFR Part 223, as may be most advantageous to the United
States. Debris from felling that does not meet utilization standards shall also be disposed of according to
methods determined by the Forest Service. Planting of vegetation in the easement area must have prior written
approval from the authorized officer.
D
E. PESTICIDE USE
1. Authorized Officer Concurrence. Pesticides may not be used in the easement area to control pests, including
undesirable woody and herbaceous vegetation (including aquatic plants), insects, birds, rodents, or fish without
prior written concurrence of the authorized officer. Only those products registered or otherwise authorized by the
U.S. Environmental Protection Agency and appropriate State authority for the specific purpose planned shall be
authorized for use within areas on National Forest System lands.
2. Pesticide-Use Proposal. Requests for concurrence of any planned uses of pesticides shall be provided in
advance using the Pesticide-Use Proposal (form FS-2100-2). Annually the grantee shall, on the due date
established by the authorized officer, submit requests for any new, or continued, pesticide usage. The PesticideUse Proposal shall cover a 12-month period of planned use. The Pesticide-Use Proposal shall be submitted at
least 60 days in advance of pesticide application. Information essential for review shall be provided in the form
specified. Exceptions to this schedule may be allowed, subject to emergency request and approval, only when
unexpected outbreaks of pests require control measures which were not anticipated at the time a Pesticide-Use
Proposal was submitted.
3. Safety Plan. Before applying pesticides in the easement area, the grantee shall submit to the authorized
officer a safety plan that includes, at a minimum, a precise statement of the treatment objectives; a description of
equipment, materials, and supplies to be used, including pesticide formulation, quantities, and application
Page 3 of 9
methods; a description of the lines of responsibility for project planning, project monitoring, and after-action
review; a description of any necessary interagency coordination; a copy of the current Pesticide-Use Proposal for
the easement; a description of the process by which treatment effectiveness will be determined; and a spill plan,
communications plan, security plan, and, when required by applicable local requirements, a provision for prior
notification to sensitive individuals.
4. Reporting. By September 30th annually, the grantee shall submit to the authorized officer a written report of
each pesticide application project completed during the previous 12-month period. The report shall contain
information pertaining to the pesticide application projects as requested by the authorized officer.
5. Labeling, Laws, and Regulations. Label instructions and all applicable laws and regulations shall be strictly
followed in the application of pesticides and disposal of excess materials and containers. No pesticide waste,
excess materials, or containers shall be disposed of in any area administered by the Forest Service.
T
F. MONITORING BY THE FOREST SERVICE. The Forest Service shall monitor the grantee's operations and
reserves the right to inspect the easement area and authorized facilities and improvements at any time for
compliance with the terms of this easement. The grantee shall comply with inspection requirements deemed
appropriate by the authorized officer. The grantee’s obligations under this easement are not contingent upon any
duty of the Forest Service to inspect the easement area or authorized facilities or improvements. A failure by the
Forest Service or other governmental officials to inspect is not a justification for noncompliance with any of the
terms of this easement.
R
AF
G. FEDERAL SURVEY MONUMENTS, CORNERS, and BOUNDARY MARKERS. The grantee 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 grantee 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 grantee 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 grantee 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.
H. ARCHAEOLOGICAL AND PALEONTOLOGICAL DISCOVERIES. The grantee 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 grantee shall leave these discoveries intact and in place until otherwise directed by the
authorized officer.
D
I. NATIVE AMERICAN GRAVES PROTECTION AND REPATRIATION (NAGPRA). In accordance with 25
U.S.C. 3002(d) and 43 CFR 10.4, if the grantee inadvertently discovers human remains, funerary objects, sacred
objects, or objects of cultural patrimony on National Forest System lands, the grantee shall immediately cease
work in the area of the discovery and shall leave the discoveries intact and in place. The grantee 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 grantee 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.
IV. RIGHTS AND LIABILITIES
A. VALID EXISTING RIGHTS. This easement is subject to all valid existing rights. Valid existing rights include
those derived from mining and mineral leasing laws of the United States. The grantor is not liable to the grantee
for the exercise of any such right.
Page 4 of 9
B. ABSENCE OF THIRD-PARTY BENEFICIARY RIGHTS. The parties to this easement do not intend to confer
any rights on any third party as a beneficiary under this easement.
C. NO WARRANTY OF ACCESS, AREA SUITABILITY, OR SERVICES. This easement authorizes the use
and occupancy of National Forest System lands for the purposes identified in this easement. The Forest Service
does not make any express or implied warranty of access to the easement area, of the suitability of the easement
area for the authorized uses, or for the furnishing of road or trail maintenance, other than as expressly provided
for in this easement; water; fire protection services; search and rescue services; or any other services by a
government agency, utility, association, or individual.
T
D. RISK OF LOSS. The grantee assumes all risk of loss to the easement area, in whole or in part, due to public
health and safety or environmental hazards. Loss of use and occupancy of the easement area may result from
but is not limited to theft, vandalism, fire and any fire-fighting activities (including prescribed burns), environmental
contamination, avalanches, rising waters, winds, falling limbs or trees, and other forces of nature. If the
authorized officer determines that any portions of the easement area cannot be safely occupied due to a public
health or safety or environmental hazard, this easement shall terminate as to those portions of the easement
area. Termination under this clause shall not give rise to any claim for damages, including lost profits, by the
grantee against the Forest Service.
R
AF
E. DAMAGE TO UNITED STATES PROPERTY. The grantee has an affirmative duty to protect from damage
the land, property, and other interests of the United States associated with the use and occupancy authorized by
this easement. Damage includes but is not limited to destruction of or damage to National Forest System lands,
fire suppression costs, and destruction of or damage to federally owned improvements.
1. The grantee shall be liable for all injury, loss, or damage, including fire suppression costs, prevention and
control of the spread of invasive species, and the costs of rehabilitation or restoration of natural resources,
resulting from the grantee’s use and occupancy of the easement area. 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.
2. The grantee shall be liable for damage to all roads and trails of the United States caused by use of the
grantee or the grantee's heirs, assignees, agents, employees, or contractors to the same extent as provided
under clause IV.E.1, except that liability shall not include reasonable and ordinary wear and tear.
F. ENVIRONMENTAL PROTECTION
D
1. Compliance with Environmental Laws. The grantee shall in connection with the use and occupancy
authorized by this easement comply with all applicable federal, state, and local environmental laws and
regulations, including but not limited to those established pursuant to the Comprehensive Environmental
Response, Compensation, and Liability Act (CERCLA), as amended, 42 U.S.C. 9601 et seq., the Resource
Conservation and Recovery Act, as amended, 42 U.S.C. 6901 et seq., the Federal Water Pollution Control Act, as
amended, 33 U.S.C. 1251 et seq., the Oil Pollution Act, as amended, 33 U.S.C. 2701 et seq., the Clean Air Act,
as amended, 42 U.S.C. 7401 et seq., the Toxic Substances Control Act, as amended, 15 U.S.C. 2601 et seq., the
Federal Insecticide, Fungicide, and Rodenticide Act, as amended, 7 U.S.C. 136 et seq., and the Safe Drinking
Water Act, as amended, 42 U.S.C. 300f et seq.
2. Definition of Hazardous Material. For purposes of clause IV.F, "hazardous material" shall mean (a) any
hazardous substance under section 101(14) of CERCLA, 42 U.S.C. 9601(14); (b) any pollutant or contaminant
under section 101(33) of CERCLA, 42 U.S.C. 9601(33); (c) any petroleum product or its derivative, including fuel
oil, and waste oils; and (d) any hazardous substance, extremely hazardous substance, toxic substance,
hazardous waste, ignitable, reactive or corrosive materials, pollutant, contaminant, element, compound, mixture,
solution or substance that may pose a present or potential hazard to human health or the environment under any
applicable environmental laws.
3. Oil Discharges and Release of Hazardous Materials. The grantee shall immediately notify all appropriate
response authorities, including the National Response Center and the authorized officer or the authorized officer’s
designated representative, of any oil discharge or of the release of a hazardous material in the easement area in
Page 5 of 9
an amount greater than or equal to its reportable quantity, in accordance with 33 CFR Part 153 and 40 CFR Part
302. For the purposes of this requirement, “oil” is as defined by section 311(a)(1) of the Clean Water Act,
33 U.S.C. 1321(a)(1). The grantee shall immediately notify the authorized officer or the authorized officer’s
designated representative of any release or threatened release of any hazardous material in or near the
easement area which may be harmful to public health or welfare or which may adversely affect natural resources
on federal lands.
4. Remediation of Release of Hazardous Materials. The grantee shall remediate any release, threat of release,
or discharge of hazardous materials that occurs in connection with the grantee’s activities in the easement area,
including activities conducted by the grantee's agents, employees, or contractors and regardless of whether those
activities are authorized under this easement. The grantee shall perform remediation in accordance with
applicable law immediately upon discovery of the release, threat of release, or discharge of hazardous materials.
The grantee shall perform the remediation to the satisfaction of the authorized officer and at no expense to the
United States. Upon revocation or termination of this easement, the grantee shall deliver the easement area to
the Forest Service in compliance with all applicable laws and regulations and free and clear of contamination.
R
AF
T
G. INDEMNIFICATION OF THE UNITED STATES. The grantee shall indemnify, defend, and hold harmless the
United States for any costs, damages, claims, liabilities, and judgments arising from past, present, and future acts
or omissions of the grantee in connection with the use and occupancy authorized by this easement. This
indemnification and hold harmless provision includes but is not limited to acts and omissions of the grantee or the
grantee’s heirs, assignees, agents, employees, or contractors in connection with the use and occupancy
authorized by this easement which result in (1) violations of any laws and regulations which are now or which may
in the future become applicable; (2) judgments, claims, demands, penalties, or fees assessed against the United
States; (3) costs, expenses, and damages incurred by the United States; or (4) the release or threatened release
of any hazardous material into the environment. The authorized officer may prescribe terms that allow the
grantee to replace, repair, restore, or otherwise undertake necessary curative actions to mitigate damages in
combination with or as an alternative to monetary indemnification.
V. REVOCATION, SUSPENSION, AND TERMINATION
A. REVOCATION. The authorized officer may revoke all or part of this easement:
1. By condemnation; or
D
2. Based on a finding of abandonment of the easement after a continuous 5-year period of non-use, provided:
(a) The easement or segment of the easement is not being preserved for prospective future use;
(b) The authorized officer gives the grantee written notice of the revocation; and
(c) If the grantee administratively appeals the revocation within 60 days of receipt of the notice, the revocation is
upheld on appeal.
B. IMMEDIATE SUSPENSION. The authorized officer may immediately suspend this easement in whole or in
part when necessary to protect public health or safety or the environment. The suspension decision shall be in
writing. The grantee may request an onsite review with the authorized officer’s superior of the adverse conditions
prompting the suspension. The authorized officer’s superior shall grant this request within 48 hours. Following
the onsite review, the authorized officer’s superior shall promptly affirm, modify, or cancel the suspension.
C. APPEALS AND REMEDIES. Written decisions by the authorized officer relating to administration of this
easement, other than revocation or suspension decisions, are subject to administrative appeal pursuant to
36 CFR Part 214, as amended. Revocation of this easement for non-use is subject to administrative appeal
pursuant to 7 CFR Part 1, Subpart H, as amended, provided the grantee files an appeal within 60 days of receipt
of the notice of revocation. Immediate suspension under clause V.B is subject to administrative appeal pursuant
Page 6 of 9
to 7 CFR Part 1, Subpart H, as amended. Revocation or suspension of this easement shall not give rise to any
claim for damages by the grantee against the grantor.
D. TERMINATION. This easement shall terminate when by its terms a fixed or agreed upon condition, event, or
time occurs without any action by the authorized officer. Termination of this easement shall not require notice, a
decision document, or any environmental analysis or other documentation. Termination of this easement is not
subject to administrative appeal and shall not give rise to any claim for damages by the grantee against the
grantor. This easement shall terminate:
1. If the grantee does not record this easement in each county where the lands underlying this easement are
located within 90 days of the date this easement is granted;
2. All or in part, upon the written agreement of the grantor and the grantee;
3. If a subsequent easement is granted by the United States to a public road agency for operation of the private
road as a public highway; or
R
AF
VI. MISCELLANEOUS PROVISIONS
T
4. If the grantor assumes jurisdiction over the private road. The grantor shall issue a replacement easement to
the grantee for the road using the appropriate standard Forest Service form. If the private road was constructed
by the grantee under a special use authorization, the grantor shall pay its pro rata share of the current
replacement cost of the road, less depreciation, to the grantee.
A. MEMBERS OF CONGRESS. No member of or delegate to Congress or resident commissioner shall benefit
from this easement either directly or indirectly, except to the extent the authorized use provides a general benefit
to a corporation.
B. CURRENT ADDRESSES. The grantor and the grantee shall keep each other informed of current mailing
addresses.
D
C. MERGER CLAUSE. This easement, and any appendices incorporated into this easement by reference,
constitute the complete understanding of the parties to this easement as to the rights, duties, and obligations of
each party as of the date of issuance of this easement. If there are any inconsistencies between any of the
preceding clauses and any subsequent clauses, the preceding clauses shall govern.
Page 7 of 9
THIS EASEMENT IS GRANTED SUBJECT TO ALL ITS TERMS.
BEFORE THIS EASEMENT IS GRANTED TO AN ENTITY, DOCUMENTATION MUST BE PROVIDED TO THE
AUTHORIZED OFFICER OF THE AUTHORITY OF THE SIGNATORY FOR THE ENTITY TO BIND IT TO THE
TERMS OF THIS EASEMENT.
On [date], I, the grantee, have read, understood, and accepted the terms of this easement.
_____________________________________________________________________________________
[NAME AND TITLE OF PERSON SIGNING ON BEHALF OF GRANTEE,
DATE
IF GRANTEE IS AN ENTITY]
#GRANTEE_NAME#
T
STATE OF [_________]
[_________] COUNTY
On [date], before me, a notary public in the State of [________], personally appeared [name of grantee], known to me to
be the person who signed this easement as the grantee.
R
AF
______________________________________
Notary Public for the State of [___________]
My commission expires [__________]
On [date], the United States, through the United States Department of Agriculture, Forest Service, has executed
this easement pursuant to delegations of authority in 7 CFR 2.60(a)(2), 36 CFR 251.52, and FSM 2732.04c.
UNITED STATES OF AMERICA
D
_____________________________________________________________________________________
#AUTHORIZED OFFICER NAME#
DATE
#TITLE#
_____________ National Forest
USDA Forest Service
STATE OF [_________]
[_________] COUNTY
On [date], before me, a notary public in the State of [________], personally appeared [name of Forest Service
authorized officer], known to me to be the person who signed this easement as the grantor.
______________________________________
Notary Public for the State of [___________]
My commission expires [__________]
PAPERWORK REDUCTION ACT STATEMENT
Page 8 of 9
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 National Forest Roads and Trails
Act, 16 U.S.C. 532-538. 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, SM.FS.InfoCollect@usda.gov, 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 National Forest Roads and Trails Act, 16 U.S.C. 532-538.
T
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.
R
AF
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, 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 State or local Agency that administers the program or contact USDA through the
Telecommunications Relay Service at 711 (voice and TTY). 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. 202509410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.
D
USDA is an equal opportunity provider, employer, and lender.
Page 9 of 9
File Type application/pdf File Title PRIVATE ROAD EASEMENT File Modified 2025-06-24 File Created 2024-08-20