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Home My WebLink AboutIH2262_20240103_Access RequestPIN Location Address Owner Mailing Address City and ZipWater Meter/Account (Y/N) Sampled8657‐01‐5277 54 BRIARWOOD LNBRUMMITT, BERNIE BRYANT III 191 BRIARWOOD LN CANTON, NC 28716‐4271N8657‐01‐1255117 RADIO HILL RD BRUMMITT, BERNIE BRYANT III 74 RADIO HILL RD CANTON, NC 28716N8657‐10‐0484158 PUTNAM RD CORBIN, JONATHAN PAUL 158 PUTNAM RD CANTON, NC 28716N8657‐01‐5037 922 NEW CLYDE HWYFIRST TWO LLC PO BOX 1369 CANTON, NC 28716‐1369Y8647‐91‐4096 168 HARKINS COVE RDGADDIS, WILLARD LEE JR 168 HARKINS COVE RD CANTON, NC 28716N8647‐91‐1360265 HARKINS COVE RD GENTRY, FREDDIE ALLEN HEIRS 260 HARKINS COVE RD CANTON, NC 28716‐4262N8657‐00‐2575198 GOODWIN RD GOODWIN, JEAN BPO BOX 694 CANTON, NC 28716N8657‐11‐0830 175 GREENBERRY ST HARKINS, GARY DOUGLAS/O'SHEA, ELIZABETH 202 SUMMERSHADE CT ASHEVILLE, NC 28806‐8534N8657‐01‐5870129 JOE PRESSLEY DR NOLAND, BRIAN KEITH/Stephanie G63 DOGWOOD RISE TER WAYNESVILLE, NC 28785‐8995N9/8/20038647‐90‐8995 71 HARKINS COVE RDROGERS, TIM/Tammy 71 HARKINS COVE RD CANTON, NC 28716‐4246N9/15/20038647‐90‐6816 121 HARKINS COVE RDROGERS, TIM/Tammy 71 HARKINS COVE RD CANTON, NC 28716‐4247N8657‐10‐437795 PUTNAM RD WHITLEY, ARLEEN V/ VENABLE, PAUL O 135 HILLBROOK DR SPARTANBURG, SC 29307N8647‐91‐7389 167 RADIO HILL RDWILSON, EUNICE A 1880 LOGAN LN DENVER, NC 28037N Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Bernie Brummitt, III 191 Briarwood Lane Canton, NC 28716 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Bernie Brummitt: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 54 Briarwood Lane in Canton, Haywood County, NC; Property Identification Number: 8657-01-5277. The Town of Canton, Water Department, indicates the property is not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Tim Rodgers 71 Harkins Cove Road Canton, NC 28716 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Tim Rodgers: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your properties located at 71 and 121 Harkins Cove Road in Canton, Haywood County, NC; Property Identification Numbers: 8647-90-8995, and 8647-90-6816. The Town of Canton, Water Department, indicates the properties are not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Arleen Whitley 135 Hillbrook Drive Spartanburg, SC 29307 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Arleen Whitley: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 95 Putnam Road in Canton, Haywood County, NC; Property Identification Number: 8657-10-4377. The Town of Canton, Water Department, indicates the property is not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Bernie Brummitt, III 74 Radio Hill Road Canton, NC 28716 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Bernie Brummitt: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 117 Radio Hill Road in Canton, Haywood County, NC; Property Identification Number: 8657-01-1255. The Town of Canton, Water Department, indicates the property is not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Tim Rodgers 121 Harkins Cove Road Canton, NC 28716 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Tim Rodgers: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your properties located at 71 and 121 Joe Pressley Drive in Canton, Haywood County, NC; Property Identification Numbers: 8647-90-8995, and 8647-90-6816. The Town of Canton, Water Department, indicates the properties are not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Brian Noland 63 Dogwood Rise Terrace Waynesville, NC 28785 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Brian Noland: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 129 Joe Pressley Drive in Canton, Haywood County, NC; Property Identification Number: 8657-01-5870. The Town of Canton, Water Department, indicates the property is not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Jonathan Corbin 158 Putnam Road Canton, NC 28716 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Johnathan Corbin: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 158 Putnam Road in Canton, Haywood County, NC; Property Identification Number: 8657-10-0484. The Town of Canton, Water Department, indicates the property is not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Eunice Wilson 1880 Logan Lane Denver, NC 28037 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Eunice Wilson: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 167 Radio Hill Road in Canton, Haywood County, NC; Property Identification Number: 8647-91-7389. The Town of Canton, Water Department, indicates the property is not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Gary Harkins 202 Summershade Court Asheville, NC 28806 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Gary Harkins: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 175 Greenberry Street in Canton, Haywood County, NC; Property Identification Number: 8657-11-0830. The Town of Canton, Water Department, indicates the property is not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Willard Gaddis 168 Harkins Cove Road Canton, NC 28716 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Willard Gaddis: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 168 Harkins Cove Road in Canton, Haywood County, NC; Property Identification Number: 8647-91-4096. The Town of Canton, Water Department, indicates the property is not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Jean Goodwin P.O. Box 694 Canton, NC 28716 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 Dear Jean Goodwin: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 198 Goodwin Road in Canton, Haywood County, NC; Property Identification Number: 8657-00-2575. The Town of Canton, Water Department, indicates the property is not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Freddy Gentry, Heirs 260 Harkins Cove Road Canton, NC 28716 Re: Water Supply Well Sampling Pantry 421 Former Canton, NC IHSB ID NONCD0002262 To whom it may concern: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 265 Harkins Cove Road in Canton, Haywood County, NC; Property Identification Number: 8647-91-1360. The Town of Canton, Water Department, indicates the property is not supplied by city water. The purpose of this letter is to request your permission to access your property, to sample your water supply well if one exists. This sampling will be performed by Division staff or the Division's contractor at no cost to you. You do not have to be present to have your well sampled. Samples will be collected from either a faucet at the water supply well or on the exterior of your home/building. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your well, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. If you do not wish to grant permission to sample your well, we advise you to consider having it tested for volatile organic compounds by a private laboratory or the local health department. The private lab or health department will likely charge a fee for this sampling. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at _____________________________________ □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. _X__ Potable Well. Does your well have a treatment system (Yes/No) ___ Soil ___ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 Request for Water Supply Well Information Incident Number:Incident Name: Address: Name, email, and telephone number of the person completing the survey: Name:Email: Address:Email Alt.: Phone No.: City/Town County feet feet feet by 1) E-mail: 2) Mail to: 3) Fax to: 4) Telephone: Incident Manager:Email:Brett.Engard@deq.nc.gov Phone Number: 5) 6) Is there a water supply well on this property? Yes / No If "Yes", is it "in Use"? Yes / No 1)4) Does an off-Site water supply well, supply water to this property? Yes / No What is the address of the water Supply Well, or other residences connected to the supply well? (list supply well address first) If "Yes", is it used for (circle all that apply): Drinking Water Garden/Agriculture Commercial Other:___________________ A release, or storage, of regulated material is near the property receiving this survey. This survey is being conducted as required by the State of North Carolina in Title 15A North Carolina Administrative Code 2L .0101(b) to assess groundwater quality. Please Provide the Following Information (to the best of your knowledge) NONCD0002262 / UST Incident #22470 Pantry 421 Former / The Pantry #421 922 New Clyde Highway, Canton, NC What is the source of drinking water for this property? (Circle One Below) Public Water / a on-Site Private Water Supply Well / Stream Intake / Spring / Other (please explain below) What is the screen interval(s) of the wells(s)? If you have any questions, please contact the consultant indicated above or the NC DEQ, Division of Waste Management, IHSB Incident Manager Listed Below: Brett Engard 10/31/2023 Date well(s) was/were installed? 2) 3) Additional water supply well information: What is the volume and frequency of water usage from the well(s)? 828-296-4500 Please return completed the survey to:Brett Engard Company/Organization:NCDEQ - IHSB 2090 U.S. Highway 70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov 828-299-7043 828-296-4500 How deep is/are the well(s)? What is the casing depth(s) of the well(s)? January 3, 2024 Michael Singleton C/O First Two LLC P.O. Box 1369 Canton, NC 28716 Re: Groundwater Monitoring Well Sampling T he Pantry #421 Canton, NC UST Incident Nos. 22470, 28597, and 48758 IHSB Incident No. NONCD0002262 Dear Michael Singleton: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 922 New Clyde Highway in Canton, Haywood County, NC; Property Identification Number: 8657-01-5037. As you may know there are two closed Underground Storage Tank Incidents at the subject Site; however, we believe the groundwater monitoring wells were not abandoned. The purpose of this letter is to request your permission to access your property, to sample the existing groundwater monitoring wells and if needed abandon the groundwater monitoring wells at a later date. This sampling will be performed by Division staff or the Division's contractor at no cost to you and you do not have to be present. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your wells, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at 922 New Clide Highway. Canton, NC, which is UST Facility ID: 00-0-0000013095. Groundwater Monitoring Well Sampling □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. Groundwater Monitoring Well Abandonment □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and abandon the groundwater monitoring wells. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and abandon the groundwater monitoring wells. Proposed Sampling ___ Soil _X_ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form to: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262 January 3, 2024 Michael Singleton C/O First Two LLC 6738 Cruso Road Canton, NC 28716 Re: Groundwater Monitoring Well Sampling The Pantry #421 Canton, NC UST Incident Nos. 22470, 28597, & 48758 IHSB Incident No. NONCD0002262 Dear Michael Singleton: The North Carolina Department of Environmental Quality, Division of Waste Management (Division) will be conducting groundwater sampling and analysis in the area of your property located at 922 New Clyde Highway in Canton, Haywood County, NC; Property Identification Number: 8657-01-5037. As you may know there are two closed Underground Storage Tank Incidents at the subject Site; however, we believe the groundwater monitoring wells were not abandoned. The purpose of this letter is to request your permission to access your property, to sample the existing groundwater monitoring wells and if needed abandon the groundwater monitoring wells at a later date. This sampling will be performed by Division staff or the Division's contractor at no cost to you and you do not have to be present. The laboratory results will be forwarded to you as soon as possible. If you are willing to provide permission to sample your wells, please sign the attached permission form and return it to our office, or email the form, to the contact person(s) provided below. Please contact me at (828) 767-2424 or by email at Brett.Engard@deq.nc.gov if you have any questions. Regards, Brett Engard Hydrogeologist Inactive Hazardous Sites Branch PROPERTY ACCESS & SAMPLING PERMISSION I am the owner of the property located at 922 New Clide Highway. Canton, NC, which is UST Facility ID: 00-0-0000013095. Groundwater Monitoring Well Sampling □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples as indicated below from my property. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and collect samples from my property. Groundwater Monitoring Well Abandonment □ YES. I grant the Division of Waste Management and/or its contractor’s permission to access my property and abandon the groundwater monitoring wells. □ NO. I do not grant the Division of Waste Management and/or its contractor’s permission to access my property and abandon the groundwater monitoring wells. Proposed Sampling ___ Soil _X_ Groundwater ___ Surface Water Analyses: VOCs:_X__ SVOCs:____ Metals:____ Pesticides:____ Other:_____ (Print Name) (Telephone Number) (Signature) (Date) (e-Mail) Please return this signed form to: Brett Engard Division of Waste Management Inactive Hazardous Sites Branch 2090 US-70 Swannanoa, NC 28778 Brett.Engard@deq.nc.gov Pantry 421 Former, 922 New Clyde Highway Canton, Haywood County IHSB ID NOCD0002262