WS-4276_13936_G_ACCLTR_20110118

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF WASTE MANAGEMENT Beverly Eaves Perdue, Governor Dee Freeman, Secretary Dexter R. Matthews, Director UNDERGROUND STORAGE TANK SECTION
1637 MAIL SERVICE CENTER, RALEIGH, NORTH CAROLINA 27699-1637 2728 CAPITAL BLVD, RALEIGH, NC 27605 PHONE: [phone] \ FAX: [phone] AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED/10% POST-CONSUMER PAPER

January 18, 2011 CERTIFIED MAIL RETURN RECEIPT REQUESTED
7008 1300 0000 1108 7880
Ogburn Properties PO Box 20189 Winston-Salem, NC 27120
RE: Home Real Estate Property 500 Waughtown Street Winston-Salem/Forsyth County Incident #: 13936
To Whom It May Concern: The Winston-Salem Regional Office (WSRO) has referred the subject site to the State Underground Storage Tank (UST) Trust Fund Branch, State-Lead Program for inclusion on the
list of sites awaiting cleanup. In May 1992, a release of petroleum was detected during the removal of three USTs. To date, the required assessment and remedial requirements have not been completed due to the dissolution of the former tank owner. Because of the potential presence of groundwater users within 1500 feet of the site and based on the confirmation of contamination remaining at the site, the subject property is being accepted by the State for
inclusion to the list of sites awaiting State-Lead cleanup and/or UST removal. According to the information on file you are not considered the current/former owner or operator of the former UST system pursuant to G.S. 143-215.94A. At this time, the risk of this site is "Low" and a remedial investigation will be conducted as soon
as funds are available to determine the potential impacts to the environment and human health. The UST Section will need to access your property in order to take all reasonable and necessary action(s) to conduct assessment and remedial activities necessary to protect human health and the environment. Please sign the enclosed site access agreement and return to the address indicated on the letter. A stamped, self-addressed envelope is included for your convenience. Please
understand that failure to allow access to the property could potentially make you responsible for the cleanup under other State and Federal regulations. You will be notified when assessment and/or remedial activities begin.
Home Real Estate Property January 18, 2011
Page 2

Should there be any questions concerning this action, please feel free to contact the project
manager, Linda Blalock, at 919-733-1314 or via e-mail at [e-mail] .
Sincerely,

George C. Matthis, Jr. Trust Fund Branch Head Enclosures

cc: Cindy Rintoul, WSRO Dr. Tim Monroe Forsyth County Health Director
PO Box 686
Winston-Salem, NC 27102-0686 J. Dudley Watts, Jr. Forsyth County Manager
201 North Chestnut St
Winston-Salem, NC 27101 The Honorable Allen Joines, Mayor City of Winston-Salem
PO Box 2511
Winston-Salem, NC 27102-2511

Ms. Linda Blalock DWM UST Section
1637 Mail Service Ctr Raleigh, NC 27699-1637 Dear Ms. Blalock:
RE: Site Access Agreement Home Real Estate Property 500 Waughtown Street Winston-Salem, Forsyth County, NC Incident #: 13936
I am/We are the owner(s) of a parcel of property, located at or near the incident in question, and hereby permit the Department of Environment and Natural Resources (Department) or its contractor to enter upon said property for the purpose of conducting an investigation of the groundwaters under the authority of G.S. 143-215.3(a)2.
I am/We are granting permission with the understanding that: 1. The investigation shall be conducted by the UST Section of the Department’s Division of Waste
Management or its contractor.
2. The costs of construction and maintenance of the site and access shall be borne by the Department or its contractor. The Department or its contractor shall protect and prevent damage to the surrounding lands.

3. Unless otherwise agreed, the Department or its contractor shall have access to the site by the shortest feasible route to the nearest public road. The Department or its contractor may enter upon the land at reasonable times and have full right of access during the period of the investigation.

4. Any claims which may arise against the Department or its contractor shall be governed by Article 31 of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State Departments and Agencies, and as otherwise provided by law.
5. The information derived from the investigation shall be made available to the owner upon
request and is a public record, in accordance with G.S. 132-1.
Home Real Estate Property/Incident #: 13936

6. The activities to be carried out by the Department or its contractor are for the primary benefit of the Department and of the State of North Carolina. Any benefits accruing to the owner are
incidental. The Department or its contractor is not and shall not be construed to be an agent,
employee, or contractor of the landowner. I/We agree not to interfere with, remove, or any way damage the Department’s well(s) or its
contractor’s well(s) and equipment during the investigation.
Sincerely,

_________________________________ Signature

_________________________________ Type/Print Name of Owner or Agent
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Address _________________________________
Address
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_________________________________ Date