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Iiillll IIIIII III IINI IIIII IIIII IIIII IIIII IIIII IIIII IIIII 111111111 nl111111 illi
Doc ID: 010941000001 Type: CRP
Kind: NOTICE
Recorded: 06/17/2010 at 02:02:06 PM
Fee Amt: $14.00 Page 1 of i
Rowan, NC
J.E.Brindle Register of Deeds
BK 116 3 PG4 31
Prepared by: Scott T. Slusser, Assistant Attorney General for NCDOT
Return to: Scott T. Slusser, Assistant Attorney General
1 South Wilmington Street
Raleigh, NC 27601
ROWAN COUNTY
NORTH CAROLINA
STATEMENT OF USE OF COAL COMBUSTION BY-PRODUCTS
I, Keith E. Raulston, pursuant to 15A North Carolina Administrative Code 13B.1707
does hereby state that the North Carolina Department of Transportation is the owner of the
following parcels of land in which a total of 15,485.30 cubic yards of coal combustion by-
products have been utilized as fill material. The coal combustion by-products have been utilized
on the following parcels of land:
Being the property as described in Deed Book 775, Page 186; Deed Book 736, Page 175; Deed
Book 714, Page 178; Deed Book 734, Page 506; Deed Book 714, Page 639; Deed Book 714,
Page 640; Deed Book 737, Page 78; Deed Book 737, Page 79; Deed Book 740, Page 139; Deed
Book 735, Page 743; and Deed Book 731, Page 008, Rowan County Registry.
Note: Coal combustion by-products were placed in the roadway embankment for —L- from
station 41+00 to 45+00 for a total distance of 400 feet +/-. Reference NCDOT project
8.2631502, U-0613, Jake Alexander Boulevard, Salisbury, North Carolina.
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
BY: )
Keith E. Raulston, Division Construction Engineer
I, 'ACt jl a Notary Public of &,� o� County, North Carolina
do hereby c rtify that Keith E. Raulston personally came before me this day and acknowledged
that he is a Division Construction Engineer for the North Carolina Department of Transportation,
an agency of the State of North Carolina, and that by authority duly given, he executed the
foregoing instrument. Witness my hand and official seal this the i S day of
2010
My Commission Expires:
/D-IG- lam.
(NOTARIAL STAMP OR SEAL)
Notary Public
OFFICIAL SEAL
Nciary Public, North Carolina
CCUNTY OF DAVIDSON
JERI SUITS HARRIS
My Comrn:ssion Expires
The Register of deeds in accordance with G. S. 161-14 shall record the notarized statement and index it in
the Grantor Index under the name of the owner(s) of the land.
Book: 1163 Page: 431 Page 1 of 1