WI0600234_Permit (Issuance)_20211207

UNDERGROUND STORAGE TANK SECTION
April 16 2018
Mr. Hassan Osman
Hydrogeologist
DWM/UST Section
1637 Mail Service Center
Raleigh, NC 27699-1637
Dear Mr. Osman
RE: Former Country Store and Feed
7828 Deep Branch Road
Pembroke, Robeson County, North Carolina
Incident Number: 7605
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 assessment and/or remediation of the groundwater
and/or soils under the authority of G.S. 143-215.94G.
I am/We are granting permission to the lands we own or control 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. Any damages will be restored by the Department or its contractor to as close to the pre -work
condition as practicably possible.
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 will notify,the land owners
48 hours prior to entry and 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.

n Ilse acii u». to be carried out by the Department or its contractor arc 11.-ir the primary benctit of the
[jep:uurienl and of the Stare of North Carolina. no! be cny onstrued d tofits nbet�rt agent' employee. the owner are incidental.
The Department or its contractor is not and shall
contractor of the landowner. No representations or warranties. either expressed or implied, have been
made to rne/by the Depanment, the State of North Carolina, or its/their contractor(s) regarding the
results that may be obtained or the quality of work to be performed.
1/We agree not to interfere with, remove or any ways damage the Department's well(s) or its
contractor's well(s) and equipment during the investigation.
Sincerely,
--E--p_py OvENibmic
Type/Print Nanie of Owner or Agent
�0- 7 -3 6-IS
Phone Number `
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Address
City/State/ ,ip Code
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Date
RE: Former Country Store and Feed
7828 Deep Branch Road
Pembroke, Robeson County, North Carolina
Incident Number; 7605