Instrument Prepared By: RaleighCity Attorney’s Office
Brief Description for Index:______
Property I.D. Number:______
Mail After Recording To:City of Raleigh
DevelopmentServicesCustomerServiceCenter
PO Box 590
Raleigh, NC 27602
RELEASE, CONSENT, AND NOTICE
NON-STANDARD SANITARY SEWER INSTALLATION
THIS RELEASE, CONSENT, AND NOTICEis made and given this ____ day of ______, 20___, by ______
______, hereinafter referred to as the “Owners”, to the City of Raleigh, a North Carolina Municipal Corporation.
WITNESSETH:
WHEREAS, the Owners are the ownersof property located at ______
______, having the legal description as follows: ______; and
WHEREAS, the Owners desire to install or have installed, at the building or buildings located at the above referenced address, weirs of traps from plumbing fixtures or drains which are lower than the elevation which is 1 foot above the top of a sewer main manhole located upstream from the building sewer connection serving the traps (the “plumbing installation” or “installation”); and
WHEREAS, pursuant to §10-6084 of the Raleigh City Code, such installation does not conform to the standards of the City of Raleigh and, accordingly, will not be allowed unless and until a Release, in recordable form, is executed and given to the City by the Owners; and
WHEREAS, upon execution by the Owners and recordation of this instrument by the City, the Owners may make and use such plumbing installation, subject to terms and conditions set forth herein.
NOW, therefore, in consideration of the premises, the mutual benefits accruing hereunder to the City, the Owners, and the public, and for other good and valuable consideration, the Owners do hereby RELEASE AND DISCHARGE the City of Raleigh, it’s officers, employees, and agents, from any and all liability for claims, damages and causes of action which may result from sewage backflow from the Owners’ premises identified above.
IT IS FURTHER ACKNOWLEDGED AND AGREED by the City, upon acceptance and recordation of this instrument, that the plumbing installationmay be installedand/or continued in use, as applicable, by the Owner, their heirs, successors and assigns, subject to terms and conditions hereof. Accordingly, for so long as the plumbing installation continues in service, these covenants shall run with the above-described property, and be binding upon the Owners’ heirs, successors and assigns.
APPLICATION AND RELEASE APPROVED:
BY:(INSPECTOR)______(DATE)______
IN WITNESS WHEREOF, Grantor has duly executed the foregoing instrument by the signature(s) of its Managing Members(s), under seal, with proper authority, and as the act and deed of the LLC, the day and year first above written.
______
(NAME OF COMPANY)
A Limited Liability Company
BY:______(SEAL)
Managing Member
BY:______(SEAL)
Managing Member
BY:______(SEAL)
Managing Member
APPROVED AS TO FORM:
______
(Deputy) City Attorney
STATE OF ______
COUNTY OF ______
I, ______, a Notary Public in and for the County and State aforesaid, certify that ______, personally appeared before me this day and acknowledged that he/they is/are the Managing Member of, ______, a limited liability company, personally appeared before me this day and acknowledged the due execution of the foregoing instrument on behalf of the company.
WITNESS my hand and notarial seal this the ______day of ______, ______.
______
(Notary Seal)______, Notary Public Notary’s printed or typed name
My Commission Expires:______