RA-1554_9861_C_NRP_20220406

Revised January 15, 2013

1
NOTICE OF RESIDUAL PETROLEUM

Perry’s Auto Service , Wilson County, North Carolina
(Site name)

The property that is the subject of this Notice (hereinafter referred to as the “Site”) contains
residual petroleum and is an Underground Storage Tank (UST) incident under North Carolina’s
Statutes and Regulations, which consist of N.C.G.S. 143-215.94 and regulations adopted thereunder.
This Notice is part of a remedial action for the Site that has been approved by the Secretary (or
his/her delegate) of the North Carolina Department of Environment and Natural Resources (or its
successor in function), as authorized by N.C.G.S. Section 143B-279.9 and 143B-279.11. The North
Carolina Department of Environmental Quality shall hereinafter be referred to as “DEQ”.

NOTICE

Petroleum product was released and/or discharged at the Site. Petroleum constituents remain on
the site, but are not a danger to public health and the environment, provided that the restrictions
described herein, and any other measures required by DEQ pursuant to N.C.G.S. Sections 143B-
279.9 and 143B-279.11, are strictly complied with. This "Notice of Residual Petroleum" is composed of
a description of the property, the location of the residual petroleum and the land use restrictions on the Site.
The Notice has been approved and notarized by DEQ pursuant to N.C.G.S. Sections 143B-279.9 and 143B-
279.11 and has/shall be recorded at the Wilson County Register of Deeds’ office Book ____, Page ____.
(name of county)

Any map or plat required by DEQ has been/shall be recorded at the Wilson County Register of (name of county)
Deeds’ office Book ____, Page ____, and has been/shall be incorporated into the Notice by this reference.

Source Property

Ralph B. Perry, Donald B. Perry Jr., and Laura A. Gooch of Wilson, NC is the owner in fee
(owner’s name) (city & state of homeowner)
simple of all or a portion of the Site, which is located in the County of Wilson, State of North Carolina, and
is known and legally described as:

See Attachment A
Revised January 15, 2013

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For protection of public health and the environment, the following land use restrictions required by
N.C.G.S. Section 143B-279.9(b) shall apply to all of the above-described real property. These restrictions
shall continue in effect as long as residual petroleum remains on the site in excess of unrestricted use
standards and cannot be amended or cancelled unless and until the _Wilson_County Register of Deed
receives and records the written concurrence of the Secretary (or his/her delegate) of DEQ (or its successor
in function).
PERPETUAL LAND USE RESTRICTIONS

Soil: The Site shall be used for industrial/commercial use only. Industrial/commercial use
means a use where exposure to soil contamination is limited in time and does not involve
exposure to children or other sensitive populations such as the elderly or sick. The real
property shall not be developed or utilized for residential purposes including but not
limited to: primary or secondary residences (permanent or temporary), schools, daycare
centers, nursing homes, playgrounds, parks, recreation areas and/or picnic areas.

ENFORCEMENT

The above land use restriction(s) shall be enforced by any owner, operator, or other party
responsible for the Site. The above land use restriction(s) may also be enforced by DEQ through any of the
remedies provided by law or by means of a civil action, and may also be enforced by any unit of local
government having jurisdiction over any part of the Site. Any attempt to cancel this Notice without the
approval of DEQ (or its successor in function) shall be subject to enforcement by DEQ to the full extent of
the law. Failure by any party required or authorized to enforce any of the above restriction(s) shall in no
event be deemed a waiver of the right to do so thereafter as to the same violation or as to one occurring
prior or subsequent thereto.

IN WITNESS WHEREOF, Allison Ward has caused this Notice to be executed pursuant to
N.C.G.S. Sections 143B-279.9 and 143B-279.11, this _____ day of _____ ______,20_ .

Edna G. Perry
(name of responsible party if agent is signing)
By: ___________________________________________
(signature of responsible party, attorney or other agent if there is one)
DWM, UST Section, Hydrogeologist
(Title of agent for responsible party if there is one)
Signatory’s name typed or printed: Allison Ward

NORTH CAROLINA
_____________________COUNTY
(Name of county in which acknowledgment was taken)

I certify that the following person personally appeared before me this day, acknowledging to me that he or
she signed the foregoing document:_____________________________.

Date: ________________________
________________________________
(Official Seal) (signature of Notary Public)
________________________________
(printed or typed name of Notary Public)
Notary Public

My commission expires:_____________

Revised January 15, 2013

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Approved for the purposes of N.C.G.S. 143B-279.11

_________________________
(signature of Regional Supervisor)
Sylvia Newsom-Hunneke , Regional Supervisor
(printed name of Regional Supervisor)

Washington Regional Office
UST Section
Division of Waste Management
Department of Environmental Quality

NORTH CAROLINA
_____________________COUNTY
(Name of county in which acknowledgment was taken)

I certify that the following person(s) personally appeared before me this day, each acknowledging to me
that he or she signed the foregoing document: ____________ ___ (full printed name of Regional Supervisor)

Date: ________________________
________________________________
(Official Seal) (signature of Notary Public)
________________________________
(printed or typed name of Notary Public)
Notary Public

My commission expires:_____________