AS-1596_17662_M_DENR_20231129_AccessAgmtRequest

Sharon Ghiold DWM UST Section 1646 Mail Service Center Raleigh, NC 27699-1646
Dear Ms. Ghiold: RE: Site Access Agreement Former Black Rock Trading Co.
13 Woodfin Rd Balsam, Jackson County, NC (ARO STF Incident #17662 Risk/Rank: Unknown
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 Environmental Quality (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.

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 land owner.

Former Black Rock Company
STF #17662
November 29, 2023 Page 2
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.

_________________________________ Signature

_________________________________ Type/Print Name of Owner or Agent

__________________________________ Phone Number

_________________________________ Address

_________________________________ City/State/Zip Code

_________________________________ Date

_________________________________ Email