WM0401274_Monitoring Well Permit Application Agreement_20210128

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Director
NORTH CAROLINA
Environmental Quality
PROPERTY ACCESS CONSENT
This document may not be modified without the Program's approval.
If you have questions on how to fill out this form or about the activities
at this site, please contact the Dry -Cleaning Solvent Cleanup Act
(DSCA) Program 's contractor for this project Sam Martin with Hart & Hickman, P.C. at
[e-mail] or [phone]. If you still have questions after contacting Mr.
Martin with H&H, please contact the DSCA Program Project Manager, Mr. Mike Cunningham
at [e-mail] or [phone].
For DSCA Use Only
DSCA ID No.
DC410035
Please Print
State of North Carolina, allocated to The University of North Carolina at Greensboro (the
"University")
Name of Property Owner
904 Union Street; PIN # 7864220614 (the "Property)
Street Number and Street Name of Property
Greensboro, Guilford County, 27403
(City or Town in Which Property Is Located) / (County in Which Property is Located) / (Zip
Code)
The University voluntarily consents to the Division of Waste Management (Division) and its
independent contractors (Contractors) entering and having continued access to the Property for the
following limited purposes:
1) Installation of one monitoring well on the Property at the approximate location shown on
Exhibit A;
2) Taking such soil, groundwater and/or air samples and making repairs to the monitoring
well as may be necessary;
3) Taking other actions related to the investigation of surface or subsurface conditions (with
additional written permission from the University);
4) Taking response actions necessary to mitigate any threat to human health or the
environment (with additional written permission from the University).
-DEW
North Carolina Department of Environmental QuaIuIy I Division of Waste Management
217 Welt Jones Street 1 1646 Mall Service Center I Raleigh North Catalina 276991646
919107.8200

This Property Access Consent is in the nature of a revocable, non -transferable, time -limited license
agreement and is hereby granted pursuant to the following requirements:
1. This Property Access Consent is made subject to any prior conveyances of record and shall remain
in place from February 1, 2021 through January 31, 2031. The University shall have the right to
terminate this Property Access Consent at its sole and absolute discretion if the Property is to be
sold, redeveloped or reconfigured by giving the Division ninety (90) days prior written notice. The
University shall also have the right to immediately terminate this Property Access Consent without
prior written approval in the event that the Division or its contractors violate the terms of this
Property Access Consent.
2. The Division or its contractors will make reasonable attempts to notify the University at least
48 hours prior to entering the Property for any purpose. In situations that the Division
determines to be of an emergency nature, the Division or its contractors shall have immediate
access to the Property but shall notify the University as soon as practicably possible.
3. The Division and its Contractors agree to comply with all applicable laws and regulations and is
responsible for obtaining a necessary federal, state, and local permits or approvals to conduct its
improvement project.
4. The Division or its Contractors may use the Construction Staging Area located at 842 W. Gate City
Boulevard and designated in Exhibit A for parking vehicles and store equipment during the initial
installation period for the monitoring well, which is anticipated to take approximately 3-4 days.
Contractor parking or equipment storage outside of this area is prohibited.
5. The Division and its Contractors shall perform any activities at the Property in a manner that
minimizes interference with use of the Property. Further, the Property must be well maintained
during the period of work, including debris removal and protection of existing walks, landscaping
and utilities.
6. All matters related to security and liability for the Division's employees, contractors,
equipment, and material is wholly the Division's responsibility. The University does not
carry insurance to cover the Division's activities or property. The Division shall require
all contractors and sub -contractors to carry commercial general liability insurance.
7. The Division and its Contractors shall remove any equipment, debris, mud, dirt, etc. from the
Property to the University's satisfaction immediately after the conclusion of the well installation.
They shall further repair any damage done to the Property as a direct result and consequence of the
use of this Property Access Consent to the greatest extent reasonably possible.
8. On January 31, 2031, on conclusion of all activities, or at such time as the University terminates
this Property Access Consent, whichever is sooner, the Division and its contractors shall, to the
extent practicable, restore the Property to the original condition it was in prior to any activities
conducted by the Division or its Contractors. All monitoring wells will be properly abandoned
North Carolina Department of Environmental Quality I Division of Waste Management
217 West Jones Street i 1b46 Mail Service Center ; Raleigh. North Carolina 27b99•164b
919.707.8200

in accordance with applicable laws and regulations, unless other arrangements are agreed to by
the University.
9. While this Property Access Consent is in effect, the University shall not willingly destroy,
damage, remove, pave over or cover any monitoring wells at the site without prior consent of
the Division.
By signing this Property Access Consent, I acknowledge that I am the legal property owner
that has the authority to allow this work on the Property.
01/20/2021
Signature of Property Owner (Date)
Scott L. Milman, Associate Vice Chancellor for Campus Enterprises and Real Estate on behalf of
UNC Greensboro
University Contact: Alex Ashton, 336.334.5056
(Telephone Number for Property Owner for scheduling work/notification)
[e-mail]
(Email Address for Property Owner if you prefer to be contacted via email)
Agreed to and accepted this 20th day of January , 2021
North Carolina Department of Environmental Quality, Division of Waste Management Dry -
Cleaning Solvent Cleanup Act (DSCA) Program
By:
Position:
Superfund Section Chief
Please return form to:
Sam Martin
Hart & Hickman, PC
2923 S. Tryon Street, Suite 100
Charlotte, NC 28203
Or via email to: [e-mail]
-1:11EW
North Carolina Department of Environmental Quality I Divislonof Waste Management
217 West Jones street 1 1b46 Mil Service Center ; Raleigh. North Carolina 27699.164t
919.707.8200

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