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Home My WebLink About04010_Airport Exxon_LURU Model_20170913NC BROWNFIELDS LAND USE RESTRICTIONS (“LUR”) UPDATE Year Certification Made: 2017 Name: Airport Exxon Project #: 04010-00-034 Address: 3305 North Liberty Street County: Forsyth Property Owner (In part or whole): ____________________________ Read the following LURs and mark each restriction accordingly. Additional remarks may be added for compliance status clarification. Attach any required or supplemental documentation, sign, notarize and submit to the following address: NC Division of Waste Management Attn: Brownfields Program Staff 1646 Mail Service Center Raleigh, NC 27699-1646 No use may be made of the Brownfields Property other than as a convenience store and gas station, or, with prior written Department of Environmental Quality (“DEQ”) approval, other commercial purposes. Within the meaning of this LUR, “commercial” refers to an enterprise carried on for profit by the owner, lessee or licensee. ☐ In compliance ☐ Out of compliance Remarks: ______________________________________________________________ No activities that encounter, expose, remove or use groundwater (for example, installation of water supply wells, fountains, ponds, lakes or swimming pools, or construction or excavation activities that encounter or expose groundwater) may occur on the Brownfields Property without prior sampling and analysis of groundwater to the written satisfaction of DEQ in any areas proposed for such activities, and submittal of the analytical results to DEQ. If such results disclose to DEQ contamination in excess of North Carolina’s groundwater quality standards, the proposed activities may not occur without the prior written approval of DEQ on such conditions as DEQ imposes, including at a minimum compliance with plans and procedures, approved pursuant to applicable law, to protect public health and the environment during the proposed activities. ☐ In compliance ☐ Out of compliance Remarks: ______________________________________________________________ Soil at the Brownfields Property at a depth greater than ten (10) feet may not be exposed without a minimum of seven (7) business days advance written notice to DEQ, unless DEQ states otherwise in writing in advance. At the time such soil is exposed, DEQ may inspect and sample, or require sampling of, the exposed soil for contaminants. If soil contamination is discovered that DEQ determines would likely contaminate groundwater even if capped, or that may pose an imminent threat to public health or the environment if exposed, as much soil as DEQ reasonably requires shall be removed and disposed of in accordance with applicable law, and any other actions that DEQ reasonably requires to make the Brownfields Property suitable for the uses specified in the Brownfields Agreement while fully protecting public health and the environment shall be taken. If soil contamination is discovered that DEQ determines would not likely contaminate groundwater if capped, or likely pose an imminent threat to public health or the environment if exposed, as much soil as DEQ reasonably requires shall be removed and disposed of in accordance with applicable law or capped to the written satisfaction of DEQ. ☐ In compliance ☐ Out of compliance Remarks: ______________________________________________________________ No mining may be conducted on or under the Brownfields Property, including, without limitation, extraction of coal, oil, gas or any other minerals or non-mineral substances. ☐ In compliance ☐ Out of compliance Remarks: ______________________________________________________________ No basements may be constructed on the Brownfields Property unless they are, as determined in writing by DEQ, vented in conformance with applicable building codes. ☐ In compliance ☐ Out of compliance Remarks: ______________________________________________________________ None of the contaminants known to be present in the environmental media at the Brownfields Property, including those listed in Tables A and B of the Notice of Brownfields Property (“Notice”), may be used or stored at the Brownfields Property without the prior written approval of DEQ, except in de minimis amounts for cleaning and other routine housekeeping activities. ☐ In compliance ☐ Out of compliance Remarks: ______________________________________________________________ The Brownfields Property may not be used as a park or for sports of any kind, including, but not limited to, golf, football, soccer and baseball, without the prior written approval of DEQ. ☐ In compliance ☐ Out of compliance Remarks: ______________________________________________________________ The Brownfields Property may not be used as a playground, or for child care centers or schools. ☐ In compliance ☐ Out of compliance Remarks: ______________________________________________________________ No party conducting environmental assessment or remediation at the Brownfields Property at the direction of, or pursuant to a permit or order issued by, DEQ may be denied access to the Brownfields Property for purposes of conducting such assessment or remediation. ☐ In compliance ☐ Out of compliance Remarks: ______________________________________________________________ During January of each year after the year in which the Notice is recorded, the then current owner of any part of the Brownfields Property shall submit a notarized Land Use Restrictions Update to DEQ certifying that the Notice containing these land use restrictions remains recorded at the Forsyth County Register of Deeds office, and that the land use restrictions are being complied with, and stating: the name, mailing address, telephone and facsimile numbers, and contact person’s e-mail address of the owner submitting the LURU if said owner acquired any part of the Brownfields Property during the previous calendar year. ______________________________________________________________ the transferee’s name, mailing address, telephone and facsimile numbers, and contact person’s e-mail address, if said owner transferred any part of the Brownfields Property during the previous calendar year. ______________________________________________________________ ☐ In compliance ☐ Out of compliance Remarks: ______________________________________________________________ Notarized signing and submittal of this Land Use Restrictions Update constitutes certification that the Notice of Brownfields Property remains recorded at the Forsyth County Register of Deeds office and that the Land Use Restrictions are being complied with. This Land Use Restrictions Update is certified by _____________, owner of at least part of the Brownfields Property on this ___ day of _________, 20__. Name typed or printed of party making certification: __________________ [Note: additional entities or owners may be added if appropriate (i.e. multiple managing members/entities)] By: __________________________ (signature) Name typed or printed: __________________ Title typed or printed: ___________________ NORTH CAROLINA __________ COUNTY I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated: ______________________. Date: ____________ ___________________________________ Official Signature of Notary ____________________________________ Notary’s printed or typed name, Notary Public (Official Seal) My commission expires: _________________