WS-8004_37353_CA_WSW_20130422_Well Abandonment Rqst Boulware

Division of Waste Management – Underground Storage Tank Section
1637 Mail Service Center, Raleigh, North Carolina 27699-1637
Phone and Fax: [phone] \ Internet: www.wastenotnc.org
An Equal Opportunity \ Affirmative Action Employer
North Carolina Department of Environment and Natural Resources Division of Waste Management
Pat McCrory Dexter R. Matthews John E. Skvarla, III Governor Director Secretary
April 22, 2013
Esther Boulware 4724 Old Rural Hall Road
Winston-Salem, NC 27105
RE: Site Access Agreement Former Baux Mt. 76
4801 Old Rural Hall Road
Winston-Salem, Forsyth County NC DWM Incident#37353
Dear Ms. Boulware:
The North Carolina Division of Waste Management (DWM) is currently assessing the extent of soil and groundwater contamination at the referenced site. Information available to the DWM indicates that an inactive water supply well is located at your property near the referenced site. It
appears that the well is no longer in use and public water is supplied to the property. If you are
connected for public water and the no longer need the well, the DWM respectfully requests permission to abandon the well. The work will be completed at no cost to you. An agreement allowing DWM employees or its contractor access to the property is enclosed for your signature. A return envelope is also attached for your use.

If you have any questions concerning this matter, please contact me at [phone]. Sincerely,

Herb Berger, Jr., PG Hydrogeologist UST Section

Access Agreement

37353 Well Abandonment Rqst Boulware