HomeMy WebLinkAbout04011_Cotton Mill Square_LURU Model_20170913NC BROWNFIELDS
LAND USE RESTRICTIONS (“LUR”) UPDATE
Year Certification Made: 2017
Name: Cotton Mill Square
Project #: 04011-00-041
Address: 801 Merritt Drive
County: Guilford
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 water supply wells may be installed or used at the Property.
☐ In compliance ☐ Out of compliance
Remarks: ______________________________________________________________
No mining activities may be conducted on the Property.
☐ In compliance ☐ Out of compliance
Remarks: ______________________________________________________________
No activities which result in direct exposure to or removal of groundwater (for example, construction or excavation activities which encounter or expose groundwater) may be conducted
on the Property without prior sampling and analysis of groundwater in the area where such activities are to be conducted, submittal of the analytical results to the Department of Environmental
Quality (“DEQ”) or its successor in function along with plans and procedures to protect public health and the environment during those activities, and approval of those activities by
DEQ or its successor in function.
☐ In compliance ☐ Out of compliance
Remarks: ______________________________________________________________
No fountains, ponds, lakes, swimming pools or other items which are supplied, in whole or in part, by groundwater may be constructed on the Property.
☐ In compliance ☐ Out of compliance
Remarks: ______________________________________________________________
During January of each year after the year in which the Notice referenced in paragraph 12 of the Brownfields Agreement is recorded, the owner of any part of the Property as of January
1st of that year shall submit a notarized Land Use Restrictions Update (“LURU”) to DEQ, and to the chief public health and environmental officials of Guilford County, certifying that,
as of said January 1st, the Notice of Brownfields Property containing these land use restrictions remains recorded at the Guilford 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 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 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 Guilford 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: _________________