ONWASA

❑LAMA / ❑ DREDGE & FILL
` GENERAL PERMIT
❑New ❑Modification []Complete Reissue
❑Partial Reissue
N° 78412 A B C D
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
y ❑ Rules attached.
Applicant Name Project Location: County
i
Address ^ "/ li: t_ (� r ^ Street Address/ State Road/ Lot #(s)
City } I r State,/)f- ZIP,rJ�> i !.- i .,�/P.�✓
Phone # //� t E-Mail Subdivision
Authorized Agent Z C,,, r c•t� City ^ it ZIP
Affected ❑cw ❑EW ❑PTA � ❑Pis Phone# ( ) / River Basin �� ^
AEC(s): ❑OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body Arfa[i C- % E man unkn
❑ PWS:
ORW: yes / no PNA yes:/'no Closest Maj. Wt.. B_d, %) c to �'"� r
■■■■■■MM■■■■
oee■■■■■E■■m■■■■■■■M■e
■■■■■■■■■■■e■e■■■■■■■■■■■■e■■■■e■■■■■■■■
MEMEMEM:■
u■E■
::::::::::: ME
c:::®
■■■ems
MENEM
G:
EiMOMMIN
C�:::
::E:::C0
MEN
■■<IMEE■
■M�ie■■E9�■■�EIF/MEMMe
a
: EMEM
1:■■■■�■■■■■■■■
■■■ �■EMM■M■■EME
a■■■■M■
■■■■■MMM■w
■
ON �EEE■.�■■■E■■Me
ME Mr®M■eEM■2111 "MIUMM■■
IN
M. a■■■UMMEM■
OE■■■■�r�r�es M UNWIEUMM
■e■■■■■..11IM
•e.
■..:IN ME I
■■■
■■■
loom
ME■■EE1■■■■■1,:.■�...■.
:: room■■■
■■■r�M,■nErr,■■■■■■■■■■
■■E■■�M
■
■■MEN
• ■■■■■OEM
MCiMiIMiR■■e■
ni■r�►ii■�■e■■NOSES
e■MEN
ae■■■■■■■■■a�■■■■■■pie■■,■r�ee■■■■
MEN
®■■■■■■■■■■E■■■e■■■{I
u■M■■M■■■■■u■■■■MEMO■■■■aE■■■■■■eMM■■
WE■N■■■■■EEeeMEN
E■M■■E■
■■■■■■■:■■ME�■■■
M■■OE■■■M■
MEMO ■M■■Ee ■■■■E■■■■■M
MEMO eM■■�:ee■■E■■■■■■
■■■
�.:..��..�■:sa
■■■■■■®■
■■■■■■■■� ■■■■■
.■■N.M�
■■■■.
Agent or Applicant Printed Name
PermitOfficer's Printed Name
Sign trereff "Please read compliance statement on back of permit" IOU r oti
pplication Fee(s) Check #
Signature
Issuing D� '�TExpi tion Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar -Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-41RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

MA / ❑ DREDGE & FILL O
• 7841-7 A B C D
GENERAL PERMIT �J Previous permit#
Y09w ❑Modification ❑Complete Reissue ❑Partial Reissue 'VQ.J Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 7151
�
and the Coastal Resources Commission in an area of en ronmental concern pursuant to 15A NCAC / (/ l/
rul
Applicant Name Project Location: County
vn
IJA tl V( JState'mC zip
Phone #
Authorized Agent
Affected CW ElEW ❑ PTA � ❑ PTS
): Ll OFA ❑ HHF ❑ IH ❑ USA ❑ WA
AEC(
❑ PWS:
ORW: yes nc �) PNA yes, no ,
Street
Address/ State Road/ L%t #(s)
,A 6 CAA
Subdivision
City— zip /, , l�J
Phone# O River Basin vV
Adj. Wtr. Body r (f-r. �/man /unkn)
Closest Mal. Wtr. Body AJ5ZtAJ6,ej,
Type of Project/ Activity
MEE
■■■■■■
■■ME■■E■�E ■■■E■
■■■■■■■
■■OEE■■� ■■■■■
ONE
ME
■■■ME
■■
No
MEN
MOONS
ilil/1YI
pr
I■cs/_IE
MlJE111/_I■■■■�
MOMMIN
■■FI■1
r�JJii�'i■■C!�"�
I
ir■IWi7■■�
M■■■■■M■NNEN!
■
No
■ MEME
■■■■
�■■■■■■■■■■H
MEMO!
!25A
�■■■■fI■®��/■IIU1��M
MEMME
W�11
EN
MAP
MEEMMEE1■/f1�.
A/, ENEEM
rd
• Ma■■E■u�iMEMOS
IRS MEMO■■■■a
EE■■E�n■■EEEEu�
MOMMIM
MMMMM1 ■■■�
■EEN■
■■
■■■■M■■■E■■■■�
■aM
0■ ® E■■EEM= MEE■�■
Mims
ONE
Agent or Applicant Printed Name
Si t re ** Pleaseread compliance statement on backofpermit*"
pplica Ion Fee(s) Check#
Signature
Issuing
Date

(-Pv.

A
�I
N
C
e
a
ti
Z
N
to
r O
U U
C
N
E
d a+
0) Q
C �
� U
cc
O �
UD
c
N
o c
ca
'> U
6
U
Z
I
I
w
N
E
O
I
m
Z
LL
Z
N
C
U
V
Q
U
O
¢
a
a
a
m
N
C
Q
cc
a
N
IL
O
d
J
cc
is
TV
CTt
N
LU
c
Q
U

$
r
r
,
I
a
1
I
JI,
I
I
—

C�
ONWASA
November 12, 2019
Mr. Ryan Davenport
NC Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
RE: CAMA General Permit 0.1600 Application
Waterline HDD Interconnects Phase II
Onslow Water and Sewer Authority
Dear Mr. Davenport:
The Onslow Water and Sewer Authority (ONWASA) is currently submitting a
CAMA General Permit application for a public trust waters utility crossing that is
necessary for completion of the ONWASA Waterline HDD Interconnects Phase II project.
This crossing will occur under Northeast Creek at Highway 17 in Jacksonville, NC and
will replace an existing water main aerial crossing that was impacted by floating debris in
flood waters generated by Hurricane Florence. This was one of two aerial crossing
locations damaged during the hurricane, and the project is considered the first in a long-
term program to replace more than fifty (50) similar installations across the ONWASA
distribution system. To mitigate future damage, the aerial crossings will be replaced
through installation of new mains via horizontal directional drill under the water feature at
that location. Replacement mains will be installed within NCDOT Right -of -Way whenever
possible, and ONWASA has obtained the required Encroachment Agreement from NC
DOT for this project.
This application requests CAMA General Permit 0.1600 to authorize the
installation of the new water main underneath Northeast Creek via directional drilling. The
entry and exit points for the directional drill will be located outside of the public trust waters
boundaries and the pipe will be located a minimum of 10' below the bottom of the creek.
Land Management Group (LMG) delineated wetlands within the project area and a site
meeting with Rachel Capito of the US Army Corps of Engineers to review the line has
been requested. No wetland or stream impacts are proposed for this project.
RECEIVED
228 Georgetown Road • Jacksonville, NC 18540 • Tel [phone] • Fox 910.455.2583 • www.onwosa.cNo v 19 ' 0 I
DCM-MHD CITY

Page Two
November 12, 2019
The adjacent riparian landowners to the crossing at the location of the public trust
waters have been notified and copies of the notification letters are included in this
application. The "green card receipts" from these certified mail notifications are enclosed
and the green cards will be forwarded to your office as soon as they are received.
If you have any questions, or would like to discuss the application, please feel free
to contact me directly at [phone] or dmohr(a).onwasa.com .
Sincerely, '
i'� �r E
David M. Mohr, P.E.
Engineering Director
ONWASA
C: Paul Shivers, PE, Highfill Infrastructure Engineering P.C.
Kim Williams, Land Management Group
RECEIVED
NOV 19 2019
DCM-MHD CITY

.o
=,
m_.
oFZ
-
1 l
O
No CD
K OzZ
0m
o
m CD CC
-o o
11
co
CO
3 z
N
n D
O tO
N
a
c=�
m
3�ar
£ (D
Z N
N 3
N aw
(D
3
o
(D
(D
N 0) o
0)
D
CD
(D
00
A113 ®HW-W
N O
Q 6 f
D
C
m`
o,
m -n•;.
03AI303
�a
a
fD
�( =1
Er
oZ=
z
com
o
Eli
C
F
n,m
c q
� N
1 i
n
o~
c
o
Ate'
7
6)N
A
0
z
>cn
CD (D
(D
O
m
\i
,D N
PI)
O
S O
*
O
c 0
s
m
47
p 0
-
N
y�
c �
S
A
w
4
O
-1 O
CD
'w

tLMG
LAND MANAGEMENT GROUP
a DAVEY company
November 12, 2019
TO: Pamela Sue Gayhart
64 Pickett Way
Swansboro, NC 28584
RE: Notification of CAMA General Permit 0.1600 Application
ONWASA Waterline HDD Interconnects Phase II
Applicant: Onslow County Water and Sewer Authority
Dear Ms. Gayhart:
This letter serves to notify you of work proposed by the Onslow County Water and Sewer Authority
(ONWASA) within a NC DOT Right of Way in Jacksonville, NC, adjacent to your property. Specifically,
ONWASA is planning to install a water line under a public trust waterbody, Northeast Creek. Because this
proposed work is located within an Area of Environmental Concern as regulated by the NC Coastal Area
Management Act (CAMA), a CAMA Permit is required. As an adjacent riparian landowner, you are
required by the CAMA permit application process to be notified. I have enclosed the CAMA permit
application materials as they have been submitted to the local Division of Coastal Management office for
your review. Should you have any objections to this proposal, please send your written comments within
10 days of your receipt of this notice to:
Mr. Ryan Davenport
NC Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
[e-mail]
Comments will be considered by the NC Department of Coastal Management in reaching a final decision
on the application. No comment within 10 days of your receipt of this notice will be considered as no
objection. If you have any questions on this project, please call me at 910-452-0001, or e-mail me at
[e-mail].
Sincerely,
J'_�
Kim Williams
Environmental Scientist
Encl.
RECEIVED
Cc: Mr. Ryan Davenport, NC DCM
NOV 19 2019
www.lmgroup.net • [e-mail] • Phone: [phone] • Fax: [phone]
3805 Wrightsville Ave., Suite 15, Wilmington, NC 28403 DCM-MHD CITY

4LMG
LAND MANAGEMENT GROUP
a DAVEA, company
November 12, 2019
TO: Charles and Beverly Riggs
PO Box 1570
Jacksonville, NC 28540
RE: Notification of CAMA General Permit 0.1600 Application
ONWASA Waterline HDD Interconnects Phase II
Applicant: Onslow County Water and Sewer Authority
Dear Mr. and Mrs. Riggs:
This letter serves to notify you of work proposed by the Onslow County Water and Sewer Authority
(ONWASA) within a NC DOT Right of Way in Jacksonville, NC, adjacent to your property. Specifically,
ONWASA is planning to install a water line under a public trust waterbody, Northeast Creek. Because this
proposed work is located within an Area of Environmental Concern as regulated by the NC Coastal Area
Management Act (CAMA), a CAMA Permit is required. As an adjacent riparian landowner, you are
required by the CAMA permit application process to be notified. I have enclosed the CAMA permit
application materials as they have been submitted to the local Division of Coastal Management office for
your review. Should you have any objections to this proposal, please send your written comments within
10 days of your receipt of this notice to:
Mr. Ryan Davenport
NC Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
[e-mail]
Comments will be considered by the NC Department of Coastal Management in reaching a final decision
on the application. No comment within 10 days of your receipt of this notice will be considered as no
objection. If you have any questions on this project, please call me at 910-452-0001, or e-mail me at
[e-mail].
Sincerely,
g—
Kim Williams
Environmental Scientist
Encl.
Cc: Mr. Ryan Davenport, NC DCM RECEIVED
www.lmgroup.net • [e-mail] • Phone: [phone] • Fax: [phone] Nov 19 2019
3805 Wrightsville Ave., Suite 15, Wilmington, NC 28403
1r)r,M-MHD CITY

.j . . I 1� �l -,
o. L i
II P.
A;
1
19,
a t

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
September 23, 2019
Onslow Water and Sewer Authority
228 Georgetown Road
Jacksonville, NC 28540
JAMEs H. TROGDON, III
SECRETARY
SUBJECT: Encroachment Agreement on US17, SR1327, SR1327 (At three different
locations in Onslow)
Onslow County (E031-067-19-000176)
Dear David Mohr
Attached for your files is a copy of Right of Way Encroachment contract properly
executed. This contract covers the following:
Located; (1) On US17. (2) On SR1324 Ramsey Road (3) On SR1327 Kellum Loop Road.
For exact locations see detailed map. Location (1) US17 100 LF of 8" DIP water line by
open cut, 150' of 8" PVC waterline by open cut, 450 LF of 10" DR9 HDPE water line
HHD. (2) On SR1324 Ramsey Road 100 LF of 12" DIP waterline by open cut, 500' of
14" DR9 HDPE waterline by HDD (3) SR1327 Kellum Loop Road 100 LF of 6" DIP
waterline by open cut, 400 LF of 8" DR9 HDPE by HDD. This approval is subject to this
work being done in accordance with the attached plan sheet and special provisions.
• No lane closures shall be allowed between the hours of 6:00 am to 9:00 am, and
4:00 pm. To 7:00 pm, (Peak hours restricted.) Further restrictions may apply due
to traffic conditions. No Lane Closures on weekends.
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
295A WILMINGTON HIGHWAY'
JACKSONVILLE, NC 28540
7dephone:[phone]
Fox: [phone]
Cvsmmer Semm: 1-877-368-4968
IJ'ebsiie: w .nedoLgov
Lo.wm .
295 A WILMINGTON HIGHWAY
JACKSONVILLE, NC 28540
RECEIVED
NOV 19 2019
DCM-MHD CITY

The Continuing Indemnity Bond (ONWASA Bond # 70426672) is posted with
the North Carolina Department of Transportation is hereby obligated to cover
work under this encroachment agreement, the applicant shall notify NCDOT at
910-467-0500 upon completion of the work for a final inspection to be performed
by NCDOT personnel. After the project has been completed for ONE YEAR and
upon request NCDOT personnel will conduct a final inspection. If found
satisfactory the bond will be released.
Slno« saldedby:
Og V'Tac'—me
Asst. District Engineer
For Karen Collette, P.E.
Division Engineer
KEC/DR/wcb
Attachments
cc: David Sawyer, Onslow County Maintenance Engineer (Electronic File)

STATE OF NORTH CAROLINA
ROUTE US-17, SR1327, PROJECT Waterline HOD COUNTY OF ONSLOW
SR1324 Interconnects Phase II
RECEIVE®
NOV 19 2019
�)C m-MHD CITY
DEPARTMENT OF TRANSPORTATION RIGHT OF WAY ENCROACHMENT AGREEMENT
-AND- PRIMARY AND SECONDARY HIGHWAYS
THIS AGREEMENT, made and entered into this the _ day of 20 by and between the Department
of Transportation, party of the first part; and Onslow Water and Sewer Authority
party of the second part,
WITNESSETH
THAT WHEREAS, the party of the second part desires to encroach on the right of way of the public road designated as
Route(s) US-17, SR1327, and SR1324 , located US-17 near Kellum Loop Road Ramsey Road near
Woodlawn Drive and Kellum Loop Road near Willie Kellum Road.
with the construction and/or erection of. US-17 100 LF of 8-Inch DIP water line by open cut, 150 LF of 8-Inch PVC Waterline by open cut, 450 LF
f 10-frich DR9 HOPE Waterline by HDD SR# 1324 (Ramsey Road) 100 LF of 12-inch DIP waterline by opent 50D LF of 144nch DR9 HDPE Waterline
b
HDD SR# 1327 (Kellum Loop Road) 100 LF of 6-Inch DIP watedire by Pon cut,400 LF of 8-inch DR9 HOPE w t.dine by HOD
WHEREAS, it is to the material advantage of the party of the second part to effect this encroachment, and the party of
the first part In the exercise of authority conferred upon it by statute, is willing to permit the encroachment within the limits of the
right of way as indicated, subject to the conditions of this agreement;
NOW, THEREFORE, IT IS AGREED that the party of the first part hereby grants to the party of the second part the right
and privilege to make this encroachment as shown on attached plan sheet(s), specifications and special provisions which are
made a part hereof upon the following conditions, to wit:
That the installation, operation, and maintenance of the above described facility will be accomplished In accordance with the party of
the first parts latest POLICIES AND PROCEDURES FOR ACCOMMODATING UTILITIES ON HIGHWAY RIGHTS -OF -WAY, and such
revisions and amendments thereto as may be in effect at the date of this agreement. Information as to these policies and procedures
may be obtained from the Division Engineer or State Utility Agent of the party of the first part.
That the said party of the second pad binds and obligates himself to install and maintain the encroaching facility in such safe and
proper condition that it will not interfere with or endanger travel upon said highway, nor obstruct nor interfere with the proper maintenance
thereof, to reimburse the party of the first part for the cost incurred for any repairs or maintenance to its roadways and structures
necessary due to (he installation and existence of the facilities of the party of the second part, and if of any time the party of the first part
shall require the removal of or changes in the location of the said facilities, (hat the said party of the second part binds himself, his
successors and assigns, to promptly remove or alter the said facilities, in order to conform to the said requirement, without any cost to the
party of the first pan.
That the party of the second part agrees to provide during construction and any subsequent maintenance proper signs, signal lights,
gagmen and other warning devices for the protection of traffic in conformance with the latest Manual on Uniform Traffic Control Devices
for Streets and Highways and Amendments or Supplements thereto. Information as to the above rules and regulations may be obtained
from the Division Engineer of the party of the first part.
The( the party of the second part hereby agrees to indemnify and save harmless the party of the first pad from all damages and
claims for damage that may arise by reason of the Installation and maintenance of this encroachment.
That the party of the second part agrees to restore all areas disturbed during installation and maintenance to the satisfaction of the
Division Engineer of the party of the first part. The party of the second part agrees to exercise every reasonable precaution during
construclion and maintenance to prevent eroding of soil; silting or pollution of rivers, streams, lakes, reservoirs, other water
impoundments, ground surfaces or other property; or pollution of the air. There shall be compliance with applicable rules and regulations
of the North Carolina Division of Environmental Management, North Carolina Sedimentation Control Commission, and with ordinances
and regulations of various counties, municipalities and other official agencies relating to pollution prevention and control. When any
installation or maintenance operation disturbs the ground surface and existing ground cover, the party of the second part agrees to
remove and replace the sod or otherwise reestablish the grass cover to meet the satisfaction of the Division Engineer of the party of the
first pad.
That the party of the second part agrees to assume the actual cost of any inspection of the work considered to be necessary by the
Division Engineer of the party of the first part.
That the party of the second part agrees to have available at the construction site, at all times during construction, a copy of this
agreement showing evidence of approval by the party of the first part. The party of the first part reserves the right to stop all work unless
evidence of approval can be shown.
Provided the work contained in this agreement is being performed on a completed highway open to traffic; the party of the second part
agrees to give written notice to the Division Engineer of the party of the first part when all work contained herein has been completed.
Unless specifically requested by the party of the first part, written notice of completion of work on highway projects under construction will
not be required.
That in the case of noncompliance with the terms of this agreement by the party of the second pad, the party of the first part reserves
the right to slop all work until the facility has been brought into compliance or removed from the right of way at no cost to the party of the
firs( pad.
That it is agreed by both parties that this agreement shall become void if actual construction of the work contemplated herein is not
begun within one (1) year from the date of authorization by the party of the first part unless written waiver is secured by the party of the
second part from the party of the first part.
During the performance of this contract, the second party, for itself, its assignees and successors in interest (hereinafter referred to as
the 'contractor"), agrees as follows:
a. Compliance with Regulations: The contractor shall comply with the Regulations relative to nondiscrimination in Federally -
assisted programs of the U. S. Department of Transportation, Title 49, Code of Federal Regulations, Part 21, as they may be
amended from time to time, (hereinafter referred to as the Regulations), which are herein incorporated by reference and
made a part of this contract.
b. Nondiscrimination: The contractor, with regard to the work performed by it during the contract, shall not discriminate on the
grounds of race, color, or national origin in the selection and retention of subcontractors, including procurements of materials
FORM R/W 16.1 (Rev. July 1, 1977)

and leases of equipment. The contractor shall not participate either directly or indirectly in the discrimination prohibited by
Section 21.5 of the Regulations, including employment practices when the contract covers a program set forth in Appendix S
of the Regulations.
c. Solicitations for Subcontracts, including Procurements of Materials and Equipment: In all solicitations either by compelilive
bidding or negotiation made by the contractor for work to be performed under a subcontract, including procurements of
materials or leases of equipment, each potential subcontractor or supplier shall be notified by the contractor of the
contractors obligations under this contract and the Regulations relative to nondiscrimination on the grounds of race, color,
or national origin.
d. Information and Reports: The contractor shall provide all information and reports required by the Regulations, or directives
facilities as may be determined by the Department of Transportation or the Federal Highway Administration to be pertinent to
ascertain compliance with such Regulations or directives. Where any information required of a contractor is in the exclusive
possession of another who fails or refuses to furnish this information, the contractor shall so certify to the Department of
Transportation, or the Federal Highway Administration as appropriate, and shall set forth what efforts it has made to obtain
the information.
e. Sanctions for Noncompliance: In the event of the contractors noncompliance with the nondiscrimination provisions of this
contract, the Department of Transportation shall impose such contract sanctions as it or the Federal Highway Administration
may determine to be appropriate, including, but not limited to,
(1) withholding of payments to the contractor under the contract until the contractor complies, and/or
(2) cancellation, termination or suspension of the contract, in whole or in pan.
I. Incorporation of Provisions: The contractor shall include the provisions of paragraphs 'a" through'P in every subcontract,
including procurements of materials and leases of equipment, unless exempt by the Regulations, or directives issued
pursuant thereto. The contractor shall take such action with respect to any subcontract or procurement as the Department
of Transportation or the Federal Highway Administration may direct as a means of enforcing such provisions including
sanctions for noncompliance: Provided, however, that, in the event a contractor becomes involved in, or is threatened with,
litigation with a subcontractor or supplier as a result of such direction, the contractor may request the Department of
Transportation to enter into such litigation to protect the interests of the State, and, in addition, the contractor may request
the United States to enter into such litigation to protect the interests of the United States.
RAN (161) : Party of the Second Part certifies that this agreement is true and accurate copy of the form
RNV (161) incorporating all revisions to date.
IN WITNESS WHEREOF, egphaf,J¢e parties to this agreement has caused the same to be executed the day and
year first above written. ,.���R & SEH,F
���y�?'•'' q9G DEPARTMENT OF TRANSPORTATION
Ste:' ';A, D—Sis„ed by
SEALBY. �h" f " ` for Karen E. Collette P.E.
ATTEST OR WITNESS: ' �•'.
�I k%Q94&WW9I,N/EoER
i•� /✓ ✓�' rt�t�
David M. Mohr, PE Engineering Director
or.fsLp„p wn�t�fsdi_-'n—S. 6PF7f3'r1TpTL7 v�
228 Georgetown Road, Jacksonville, NC 28540
INSTRUCTIONS
Second Party
When the applicant is a corporation or a municipality, this agreement must have the corporate seal and be attested by the corporation
secretary or by the empowered city official, unless a waiver of corporate seal and attestation by the secretary or by the empowered City
official is on file In the Raleigh office of the Manager of Right of Way. In the space provided in this agreement for execution, the name of
the corporation or municipality shall be typed above the name, and title of all persons signing the agreement should be typed directly
below their signature.
When the applicant is not a corporation, then his signature must be witnessed by one person. The address should be included in this
agreement and the names of all persons signing the agreement should be typed directly below their signature.
This agreement must be accompanied, in the form of an allachment, by plans or drawings showing the following applicable information:
1. All roadways and ramps.
2. Right of way lines and where applicable, the control of access lines.
3. Location of the existing and/or proposed encroachment.
4. Length, size and type of encroachment.
5. Method of installation.
6. Dimensions showing the distance from the encroachment to edge of pavement, shoulders, etc.
7. Location by highway survey station number. If station number cannot be obtained, location should be shown by
distance from some identifiable point, such as a bridge, road, intersection, etc. (To assist in preparation of the
encroachment plan, the Department's roadway plans may be seen at the various Highway Division Offices, or at the
Raleigh office.)
8. Drainage structures or bridges if affected by encroachment (Show vertical and horizontal dimensionsfrom
encroachment to nearest part of structure).
9. Method of attachment to drainage structures or bridges.
10. Manhole design.
11. On underground utilities, the depth of bury under all traveled lanes, shoulders, ditches, sidewalks, etc.
12. Length, size and type of encasement where required.
13. On underground crossings, notation as to method of crossing - boring and lacking, open cut, etc.
14. Location of vents.
Any attachment to a bridge or other drainage structure must be approved by the Head of Structure Design in Raleigh
prior to submission of encroachment agreement to the Division Engineer.
All crossings should be as near as possible normal to the centerline of the highway.
Minimum vertical clearances of overhead wires and cables above all roadways must conform to clearances set out in
the National Electric Safely Code.
Encasements shall extend from ditch line to ditch line in cut sections and 5' beyond toe of slopes In fill sections.
All vents should be extended to the right of way line or as otherwise required by the Department.
All pipe encasements as to material and strength shall meet the Standards and specifications of the Department.
Any special provisions or specifications as to the performance of the work or the method of construction that may be
required by the Department must be shown on a separate sheet attached to encroachment agreement provided that
such information cannot be shown on plans or drawings.
The Department's Division Engineer should be given notice by the applicant prior to actual starting of installation
included in this agreement.

Encroachment Agreement Standard ConditionS RECEIVED
District Office Contact Information:
295 Wilmington Hwy NOV 19 2019
Jacksonville, NC28540
[phone] DCM-MHD CITY
The Standard Conditions in this document apply to this and all encroachment agreements issued by District 1.
SC1 A Pre -Construction Meeting is required prior to beginning work. Contact the District Office to schedule.
SC2 An Initial Construction Inspection is required after the completion of the work. An Initial Inspection Report will
be issued upon satisfactory completion of the work and begins the one-year warranty period. Contact the District
Office
to schedule.
SC3 A Final Inspection is required for release of the bond after the one-year warranty period. Contact the District
Office to schedule this final inspection. Once the final inspection has been deemed satisfactory by NCDOT, the bond
will be
released.
SC4 All bonds will be held for a minimum of one year from the time of the Initial Construction /nspectionAcceptance.
SC5 All traffic control, asphalt mixes, structures, construction, workmanship and construction methods, and materials
shall be in compliance with the most -recent versions of the following resources: Manual on Uniform Traffic Control
Devices, Policies and Procedures for Accommodating Utilities on Highway Rights of Way, NCDOT Standard
Specifications for Roads and Structures, NCDOT Roadway Standard Drawings, NCDOT Asphalt Quality Management
System manual, and the approved plans.
SC6 Prior to beginning work, it is the requirement of the Encroaching Party to contact the appropriate Utility Companies
involved and make arrangements to adjust or relocate any utilities that conflict with the proposedwork.
SC7 If the work is located within'/z mile of a signalized intersection, the Encroaching Party shall contact NCDOT Traffic at
[phone] no less than one week prior to beginning work, for the location of all traffic signal and detection
cables. Location is required prior to excavation. Cost to replace or repair NCDOT signs, signals or associated
equipment shall be the responsibility of the Encroaching Party.
SC8 Prior to beginning work, if the area of work is within a municipality limit, it is the responsibility of the Encroaching
Parry to notify the municipal authorities.
SC9 The approval of this agreement does not preclude the Encroaching Party from complying with any and all statutes,
rules, regulations, and ordinances that may be imposed by other governmental agencies (local, state, and federal)
which have jurisdiction, including but not limited to, those related to sediment control, stormwater,wetlands,
streams, endangered species, and historical sites.
SC10 All wiring and related work shall conform to the latest edition of the National Electrical Safety Code.
SC1 1 No alteration of the approved plan will be allowed without written approval by NCDOT.
SC12 The Encroaching Party shall follow any and all revisions shown in RED on attached plan(s).
SC13 A readable, executed copy of this Encroachment Agreement shall be present at the work site at all times while
performing work. NCDOT reserves the right to stop all work unless evidence of approval can be shown. Additionally,
NCDOT reserves the right to further limit, restrict, or suspend operations within the right-of-way.
SC14 All flagging operations within NCDOT right-of-way require qualified and trained Work Zone Flaggers. Qualified and
trained Work Zone Traffic Control Supervisors will be required on significant projects. Training for this certification is
provided by NCDOT approved training sources and by private entities that have been pre -approved. For more
information, visit https://connect.ncdot.gov/projects/WZTC/Pages/Training.aspx or contact Steve Kite, PE with the
NCDOT Work Zone Traffic Control Unit at [phone], or [e-mail].
SC1 5 No lane closures shall be allowed on State Holidays (day of, day before, and day after) or during Localevents.
SC16 No lane closures or impediment to traffic shall be allowed on weekends without prior written approval from the
District Engineer.
SC1 7 One lane must be open to traffic only one lane closure in each direction. Ingress and egress shall be maintained to
all businesses and dwellings affected by the project. Special attention shall be paid to Police and Fire Stations, fire
hydrants and Hospitals.
Division 3, District 1 Updated 02/08/2019

SCl 8 All roadway signs removed during project work, shall be reinstalled immediately after completion of work. All
equipment and materials shall be removed from the NCDOT right-of-way when not in use.
SC19 Any work requiring personnel or equipment within S' of the travel lanes on an undivided roadway, or 10' of the
travel lane, on a divided roadway shall require a lane closure per the latest edition of the MUTCD and the NCDOT
Standard Specifications. The more stringent standards shall apply.
SC20 Material shall NOT be unloaded or stockpiled on the roadway at any time without proper lane closure duringthe
project. Work is not permitted when the shoulder material is wet or during adverse weatherconditions.
SC21 All erosion control devices shall be placed as needed prior to disturbance and maintained throughout the project.
All areas disturbed (shoulders, ditches, removed accesses, etc.) shall be graded and seeded within 15 calendardays
with an approved NCDOT seed mixture (all lawn type areas shall be maintained and reseeded as such).
SC22 The placement of curb and gutter is not allowed within shoulder sections ofroadway.
SC23 It shall be unlawful to place any highway obstruction, including a driveway headwall, fence, rural mailbox, newspaper
delivery box, or other roadside obstruction, so as to interfere with the traffic or maintenance of the roads and
highways of the state highway system. See North Carolina Administrative Code 19A NCAC2E.0404.
SC24 Fire Hydrant(s) shall be placed a maximum of 1 foot from the right-of-way line. (STD. 1515.02 in the NCDOT
Roadway Standard Drawings).
SC25 Directional drilling methods have not been given statewide approval for use on NCDOT right-of-way. Under no
condition shalljetting alone or wet boring with water be used for the installation of utility pipelines.
• Directional boring is not allowed in embankment material. Directional boring is allowed beneath embankment
material in naturally occurring soil.
• Any changes shall be submitted to the District Engineer for approval prior to construction.
• Directional bores are not allowed beneath bridge footings, culvert wingwall footings or retaining walls.
• HDPE pipe installed by directional boring shall not be connected to existing pipe or fittings for one (1) week
from the time of installation to allow tensional stresses to relax.
• Directional boring using jetting with a Bentonite (or equivalent material) slurry is approved with the following
conditions:
o Minimum depth of ten (10') feet below the pavement surface of roads with no control of access or
fifteen (1 5') feet below the surface of roads with partial or full control ofaccess.
o Minimum depth of five (5') feet below any ditch line and/or creekbed.
o Minimum depth of (4') for parallel installations. Must be outside the theoretical 1:1 slope fromthe
existing edge of pavement except where the parallel installation crosses a paved roadway.
o Minimum horizontal distance of ten (10')feet from the nearest part of any structure, including but not
limited to bridges, footings, pipe culverts, and box culverts.
o Minimum vertical distance of ten (10') feet from the nearest part of pipe culverts or boxculverts.
o Tip of the drill string shall have a cutter head and detection wire installed with non-ferrous material.
o All directional drilled piping for sewer force mains and waterlines shall be a minimum ofSDR-9.
o Minimum horizontal separation of five (5') feet between each conduit which is part of a multiple
conduit installation (including perpendicular and parallel installations). Alternatively, install
multiple
conduits within a single duct.
o Overbores shall not be more than two (2") inches greater than the diameter of the pipe or encasement.
o An overbore exceeding two (2") inches greater than the diameter of the pipe or encasement will be
considered if the encroachment agreement includes a statement signed and sealed by a North Carolina
Registered Professional Engineer indicating that an overbore in excess of two (2") inches of the diameter
of the pipe or encasement will arch and no damage will be done to the pavement orsub-grade.
SC26 All excavations inside the theoretical 1:1 slope from the existing edge of pavement to the bottom of the nearest
trench wall shall be done in accordance with the following conditions:
• Any excavation encroaching upon the theoretical 1:1 slope from the edge of pavement of any NCDOT
maintained road shall require temporary active shoring that must be reviewed and approved by
NCDOT prior to work.
Division 3, District 1 Updated 02/08/2019

• All trench excavation inside the limits of the theoretical 1:1 slope, as defined by the policy, shall be
completely backfilled and compacted at the end of each construction day. No portion of the trench shall be
left open overnight.
• The length of parallel excavation shall be limited to the length necessary to install and backfill one (1) joint of
pipe at a time.
• Traffic shall be moved to a travel lane outside the limits of a theoretical 1:1 slope from the bottom of the
nearest trench wall to the pavement surface.
• Installation of trench shoring shall be accomplished with minimal over -excavation. Trench boxes shall not
be used as shoring.
• An NCDOT Inspector, the cost of which is to be borne by the Encroaching Party, shall be assigned to this
project if deemed necessary by the Division Engineer.
• The trench backfill material shall meet the Statewide Borrow Criteria. The trench shall be backfilled, in
accordance with Section 540-6 of the latest NCDOT Standard Specifications for Roads and Structures, which
requires the backfill material to be placed in thicknesses between 4" and 8" loose and compacted to at least
97% of the maximum density obtained by compacting a sample in accordance with AASHTO T 180, as
modified by the Department.
• At the first sign of trench failure, a trench shall be immediately backfilled with materials consisting of A-1, A-
3, A-2-4 soils or A-4 soils having a maximum of 45% passing a No. 200 sieve and a maximum P.I. of 6. All
work shall cease and the Division Engineer shall be contacted. The Encroaching Party shall be required to
repair any damage to the pavement caused by the excavation.
• No part of any pit shall be within three (3) feet of edge of pavement or back of curb.
• Detection tape shall be buried in the trench approximately one foot above the utility or fiber optic cable,
whenever conduit is installed in right-of-way and is not of ferrous material.
SC27 The Encroaching Party shall comply with all OSHA requirements and provide a competent person on site to
supervise excavation at all times.
SC28 Approval is only for work within NCDOT right-of-way and excludes area(s) within Railroad right-of-way.Approval is
with the understanding that NCDOT does not guarantee the right-of-way on any road.
SC29 The proposed manholes, handholes, valves or other appurtenances shall not be located in the existing ditch line,
front slope of a ditch, or in a manner that would restrict the maintenance or flow of the existing ditch line.
SC30 The Encroaching Party is responsible for any and all damages caused from project work within the right-of-way,
including damage to drainage structures, pavement, vegetation, etc.
SC31 Any plant or vegetation in the NCDOT planted sites that is destroyed or damaged as a result of this encroachment
shall be replaced with plants of like kind or similar shape. Contact the Division Roadside Environmental Engineer at
910-259-4919.
SC32 Any pavement damaged because of settlement of the pavement or damaged by equipment used to perform
encroachment work, shall be re -surfaced to the satisfaction of the District Engineer. This may include the removal of
pavement and a 50' mechanical overlay. All temporary and final pavement markings are the responsibility of the
Encroaching Party.
SC33 Any open cutting of pavement shall be repaired using the following method:
• Pavements shall be cut full depth and removed.
• After trench work is complete, the edges of the existing pavement along the trench shall be recut a
minimum of 1' wider on each side of the trench. If the pavement is undermined, the edges of the existing
pavement along the trench shall be recut to 1' beyond the undermined portion and the pavement removed.
The design section stated below is to be placed in those areas.
�• The pavement repair shall be performed using the following method and pavement designsection:
{o M 0 11.0" B25.00 or B25.OB Asphalt Concrete Base Course (accomplished in 2 lifts minimum) according to
1—, m NCDOT Standard 654.01.
ca o Mill the entire area a depth of 2.0", starting from 15' in front of the edge of the final pavement cut.
o Overlay entire area (a minimum 50' length mechanical overlay) with 2.0" S9.SC or S9.5B Asphalt Concrete
`8 Surface Course for a total asphalt depth of 13". Butt joints are required with no feathering ofjoints.
• All open cuts shall be backfilled, paved and traversable prior to removing lane closure.
Division 3, District 1
Updated 02/08/2019

SC34 Bore pits and open trenches should remain at least four (4) diameters away from the signal equipment
foundations. A bore should be at least Three (3) feet from the signal equipment foundation. If this item cannot
be satisfied, please contact the NCDOT Geotechnicial unit to discuss alternatives for the location of concern.
Division 3, District 1 Updated 02/08/2019

VERIFICATION OF COMPLIANCE WITH
ENVIRONMENTAL REGULATIONS
(Check Appropriate Box)
❑ Permits from the N.C. Department of Environment and Natural Resources and the
U.S. Army Corp of Engineers are not required for this project. However, all applicable
federal and state regulations have been followed.
The required permits from the N.C. Department of Environment and Natural Resources
and the U.S. Army Corp of Engineers have been obtained for this project. Copies of
permits and Completion Certificates are attached.
All applications for required permits have been submitted at the same
time as encroachment agreement.
All applicable NPDES Stormwater Permit requirements have been met for this project.
(The applicant should contact the N.C. Division of Water Quality in Raleigh to determine
if a stormwater pen -nit is required.)
The project is in compliance with all applicable sedimentation and erosion control laws
and regulations.
Project Name:
Township:
Project Engineer:
Project Contact:
HDD Interconnect Phase II
SR1324 is in Jacksonville Township
US17 and SR1327 are in White Oak Township County:
Onslow
Highfill Infrastructure Engineering P.C. Phone No.: 919-313-1516
Paul R. Shivers P.E.
Applicant's Name: Onslow Water and Sewer Authority
Date Submitted: 9/20/19
Foirm VCER-I
June 1. 2006
RECEIVED
NOV 19 2019
DCM-MHD CITY
P.E. SEAL

xouwrn:snm uod a�s3iaa iox � xvrem iwm
00t91 G10Ct01 V15 Otl f3 KViI %m o
Q S v E li 3srHd SiJ36h0JL31N= t IJl.�1VM a o
z§�
t9
i � FY3n u a
a. §
i yg
TL-�
koEva 5 J
n
-
�n if
r ryn
y
vx re a z1x i1 �8
- e zc+o1 ru 8p
I�j�5
3 CA
iIIilq glib pill_ RECEIVE
�115641911!1 NOV 19 2019
!)CM-M
HD CITY

1� j

xou�uamwtlm
43aY313tl xan
'wamr inua
_Ts%tt = 7
3 x
0
d
091tt of 00 Ot V 5 -08 d001 Anm3N—
S eNM 3ie1 O H
35NHd >193Nt`Ope3lrvl OOH 3kIlb31NM11
o.
F
9
R R
tl
Y s $ Eli
a
8
_d
v
om
o
e
vi
a'�
o�
o_o
00
3p
F
i
p
z[ t
n a
4a
I
a
MP
w
n,
5p
fie.•
1 g[gg €€
$Ni
RECEIVED
gill olo
4.x a r z
Nov 19 2019

�
is �
p 't`
J•°
Jam•
R
[i
(
OSi9l 01 OO'.Ol tl15 AMH NM38 M3N
=P
x=w
?
3SVFd s102KNOJa31N10aH 3N11831VIA

1.a,.
P
k i3

r'
fu
Domestic
rU
O
a' t'
L. U
S
m
rs
rq
CerefiedMailFee $3.50.
0406
M
Er
$
02
M3 SMIo Feea(ehaekbm etltlha.5gppreNeleJ
�
❑eeWm NemIPtO��P)7 d��iAVV—RVVitt�T
❑PeMn eecdPt (elechcnic) d aV•VV
P.1l k
O
❑Canine MwlHwvlcteao 11 S sn.an
Here
p/duasgnewre n«wlrea E $0 tin
pnaanageawa nesulctas Dellrery s
p
Postage E1.30
Ir
11/13/2019
Poatageand 1b7:64
r3Total
$
�0
O
Sent To [pal IQ
S(ieeFeitdhpt. .; iu gpjt�(1fp,-_.........................
M1
lac_
m
ru
a Certified Mail Fee E3.50
m S
Cr
6ctra Services SFeas (tl lrbaG e00.leeaswwMate)
❑$atom HemIV10'a�rimPN E
O ❑neMn Re pt (Necaanlc) S
O ❑DxefiatlimilPwtrktetl DdM E In-nfl
o ❑naaksleea Paw $ 49 go
DMAShralure Peeotama DWNxy E
o Pmtage Er E1.30
ll
M Total Postage end W 60
m iII
s
a9entTu Pn rdt Ske ....
� SireeieitdApi7Po.; orpD ffo-- ;-----
-wl
Postmark
Here
11/13/2019
RECEIVED
NOV 19 ZO19
OCM_MHD CITY

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mill
or on the front If apace permits.
i. Article Addressed to:
WO-)
S,OOA gym, oc 2gt14
111111111111111111111111IIIIII111111IIIIIII III
9590 9402 5045 9092 9205 20
7018 3090 0001 9313 0234
PS Form 3811, July 2015 PEN 7530.02-000-9053
■ Complete Items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front If space permits.
1. Article Addressed to:
�ItS �+ 3ev�rl� �,jyt
7F�ks�,�;llr•, Nil �85�
111111111111111111111111111111111111111111111111111111111
9590 9402 5045 9092 9205 37
018 3090 0001 9313 0227
A. Signature
X /21 ❑ Agent
13 .gent
D. Is delivery etickBe3 different from Rem 17 w Yes
If YES, enter delivery address below: ❑ No
3. Serl Type
❑Priority Med Express®
❑Adult Signature
❑Registered Mail'e
❑ Adult Signature Restdcled Delivery
❑ Registered Mgll Restricted
OCorllged Mad®
Delivery
D cart:Gad Mad Restricted Delivery
❑ Retum Receipt for
❑ Collect on Delivery
Momhpndlsa
❑ COW on Delivery Reabicted Dalivery
❑ Sgneluro Congm,aticure
3 Insured Mail
❑ 3gnstul Conikrtatica
3 Insured Mail Restricted Delivery
Restricted Delivery
lover S500)
Domestic Return Receipt
X VY 1 ) RA9Ant
D. Is delivery address diflWiWfrom Item 17 U Yes
If YES, enter delivery address below: ❑ No
3. Service type
❑ Prlodty Mall Express®
❑ Adult signature
❑ Registered Mail"
❑ Adult signature Reslrklad Delivery
g Cerllllod MailO
❑ Rilstered Mall Restricted
pagvory
D Certified Mail Rustrktod Delhrery
❑ Return Ocelpt for
❑ Collect on Delivery
Merchandise
[3 Collect en Delivery Restricted Dallvery
11 signature Conl4mation'"
❑ Insured Me,
❑ signature Conllrmetion
❑ Insured Mall Restricted Delivery
Restricted Delivery
tover M)
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt

I
lei .
r+
or.-- '�

IN Complete Items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
14S'6 �cll"' T' i, P-� .
1 rtc'S6r "Jmr- , 4-)(- n-)t 6
IIIIII�II IIII III I II (IIII IIIIII III Ili IIII III III
9590 9402 5045 9092 9203 91
18 3090 0001 9313 ,pj 9
❑ Agent
❑ Addre
C. Date of Del
D. Is deliveryaddress c i ferent from item 17 U Yea
If Yp. enter delivery address below: ❑ No
3. Service Type
❑ Priority Moll ExproesW
❑ Adult Slgnalwo
❑ Registered Mall"
❑Adair Signoluro Restricted Delivery
@Cedlged MNle
❑R jlslero�hall Seance
De very
❑ Carolled Mall Restricted Dellvgry
❑ Return Receipt for
D Colkot on gellvery -'.
Merchandise
D Collect an Dewery ResWoled Delivery
D SIgnalum Conflrtnatbn"
a
❑ Insured Moll
❑ Siynalure Confirmation
.• -
❑ Insured Mail Restricted Delivery
Restricted Delivery
'
over55001
: PS Form 3811. July 2015 PSN 7530-02-000.9053 Domestic Return Receipt
■ Complete Items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallplece,
or on the front if space permits.
1. Artlole Addressed to:
�i'✓i,l .�OSt�h jSa «dt��.
II
.� 4CkLibAdr. IC
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIII
9590 9402 5045 9092 9204 07
�118 3090 0001 9313 0166
PS Form 3811, July 2015 PEN 7530-02-000-9053
A. Signature /� ,,,//
x ��Lie//�/.! ❑ Agent
i ❑ Addresses
B. IveQrecl� by (Printed e)/ 10. Date of Delivery
yvyu
D. Is4elfiVery address different from Item 17 0 Ye:
If YES, enter delivery address below: ❑ No
3. Service Type
❑ priority Mel' Express®
❑AMit SlgneNre
❑ Raghtared MalPe
❑ Adult Signature Restricted Delivery
❑ Regsteed Mell RasWcled
VG,Otiled Mails
DoYvery
❑ Certified Mall Restrictetl Delivery
❑ ReWm Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
❑ Signature Contlrmallon'"'
13 Insured Mail
❑ Signature Congenetlon
❑ Insured Mall Restricted Delivery
Real Delivery
Domestic Return Receipt

1
i
_ ,l
�•
F'.
I`!
1• I
+
9
� L I
1
I I
I
I
I.
��.fe. ti lI I Ir.ti, I
: �� � �iil�.l. � I '� •� �I "fit'- ' rt '..
"S.��k.��'1� I ��°�'�.y_�r ,� �yF
,��.
,
I '
0

m
m
U
M G
O
N
d C
d �C)
rn >
Q
z <
N
l
II Ir h1l% �
J e�
Q ry O
F
W
] Z N
WN
C N
O
Q
� O10
EO)
F
N
Iz
M�
19 2019
CITY 7