HomeMy WebLinkAbout04012_Smith Property_LURU Model_20170913NC BROWNFIELDS
LAND USE RESTRICTIONS (“LUR”) UPDATE
Year Certification Made: 2017
Name: Smith Property
Project #: 04012-00-023
Address: 309-321 Campbell Street
County: Cleveland
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, and groundwater at the Property shall not be accessed or used for any purpose.
☐ In compliance ☐ Out of compliance
Remarks: ______________________________________________________________
No mining activities may be conducted on or under 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 human 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 basements and 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 without the approval
of DEQ.
☐ In compliance ☐ Out of compliance
Remarks: ______________________________________________________________
None of the contaminates known to be present in groundwater at the Property, as listed in Paragraph (2).a. of the Notice of Brownfields Property (“Notice”), shall be used or stored on
the Property.
☐ In compliance ☐ Out of compliance
Remarks: ______________________________________________________________
Within seven (7) days of each anniversary of the effective date of the Brownfields Agreement (“Agreement”), the owner of each portion of the Property shall submit a notarized Land Use
Restriction Update to DEQ certifying that the Notice containing these land use restrictions remains recorded at the Cleveland County Register of Deeds office, that the land use restrictions
are being complied with, and that parking lot is being maintained as required in Paragraph 10.b. of the Agreement.
☐ 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 Cleveland 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: _________________