89227A - NC Electric Membership Corp

(IS)
K,CAMA 4 DREDGE & FILL
GENERAL PERMIT
P pVew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
N9 89227 0 B C D
Previous permit
Date previous permit issued
As authorized bb�y7the
j,StattIe�'of North Carolina, Department of ErMronnxntal Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC '�=).. ❑Rules attached. rfT.�neral Perrot R.I. avahi at the following link: www.dcen.¢oy1CAMArules
Applicant Name WC- 4 +-I c.. tL^ r<rSgit # Autorzed Agent �
Address a O 5 L.mn a.(" ✓ tL�ii^- FF`V) Proiat Location (County):
City R0, Q'I 1, ..._state /JC ZIP .I-_!7. Ca1(e Street AddressiStagazdsLot M(s)
Phiom M �) 8 9 Z t' FIR T> n Ot' � a S�"�o,}l-L.
EmaR .E'w Q.,A,a./�ls sa.r@n c QrNCs,.sil.,a._.. _._..�. AeI R)►-iu'y-s r L�7 r
city zaP2'7
Affected ❑CW RW [PTA f�iS ®PTS Adl Wit Body or,.. tbL n/CaA0.( �(mQnk)
AEC(s): ❑OEA ❑INA ❑UW E]SPIMA ❑PWS Closest Mal W, Body Pc CMJ.2s.A. 'S o..�.d
ORW: yeND PNA: yeF Fro
Type of Project/ Activity _,;,Z _A STa/( / 0or 'F%6er- Ooff 74c �
ul A.)& <-ArnA AEi's 4,_.Faf -t-ib crssi..q 6n%JOWr A -A
Shoreline length : N o
Access Length
Pier (dock) lengths _
Fixed Pladorm(s)
Floating Plallorm(s)
Finger piers)
p C. /N L.)Y /"Z-
Total Platform area ---
Groin length/T
Bu khead/ Rlprap length
Avg distance offshore
Breakwater/Sill
Maxdntance/length
Basin, channel
_..
Cubic yards
Boat ramp
Boathouse/ Boatlih
Beach Bulldozing
Other,�T[ys- n'f
* tjaof!}5!r.aA
d.aex*r
$AV observed:
yes ro
Moratorium n/a
yes
Site Photos:
yes n
Riparian Waiver Attached:
es 4o
PSl4f e.Aaer
cnm#4A-rrFaAS
170t96E�
PT
Aeprr
/Jcuwy /a
� S rLt.'t 4 A 0, ( A
;y w�d] (scale:
9$a05* n)->
OQ 6
l ?pCe Ls
CA0%P
`^ HATrO*RAS
rnE]
X4S0e1 F X1 Slty
A building permit/zoning permit maybe required by
� ❑ TAR/PAM/NEUSEBUffER (tick one)
Permit Conddons
__. ❑ See note on back regarding River Basin rules
.— - - -- ❑ See additional rotes/cond-tiara on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROTECT AND REVIEWED COMPLIANCE STATEMENT. (Please lnibal)
AAgent or r k nt PRINT D Naini Pe nit Officer's PRINTED Name
�._.
Sig�tp re Please read compliance statement on back of perms^ s ure
`i o 6 e6 8 9 9/a-512 y 9/ys/S
Application Feels) Check P/Money Order Issuing Date Expiration Date

DREDGE & FILL N9 89227 B C D
Previous permit
GENERAL PERMIT Date previous permit issued
ew ❑Modification [-]Complete Reissue ❑ Partial Reissue
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 ` A / (P 0 -'R ❑ Rules attached. R?J-15"e-neral Permit Rules available at the following link: www.deq.nc gov/CAMArules
Applicant Name i&)C_
3'
�
EL4-Gf aC. /�. Q/IM�JQf'c�i
C'/a�•t'P
n''
�
Authorized Agent
I'kg-n
11 ( \
�P.+lJ
Address '7
5 v-n+n a r BI✓cL
et'W I r"t
Project Location (County): 2) 0.f'�—
City RCO >L.Z sk
State N -_-'
ZIP 2�7Cv/ (e
Street Address/State Road/Lot #(s')
C / 2 '
Phone#�) �'Il2-�
�TiZ)a
ll
Aoi+k o� Sov.;t'Lt_`
i1.6 L'9-�ry a- /LOr,nF
Email �QA c�tP.-�@A
c o-AtCS. CA ...
P �1M n )'�i�('br°'S
i 2-`'`7 9 9' J`)G M /�'d r
/�
City Ae, Ci0.,14,,
ZIP 27 ! S'Z-
Affected ❑ CW
�EW ®-PTA
�ES SPTS
Adj. Wtr. Body /� o C"n m C0.i n /Co-r�Gl (na an/ nk)
AEC(s): ❑ OEA
❑ IHA ❑ UW
❑ SPIMA ❑ PWS
Closest Maj. Wtr. Body r 3LM �
l cm S C .-en C{
ORW: ye�
PNA: yes ,�i
Type oI, f Project/ Activity 7: A S Ta
� ( -F ! `� ar -F/ L e r- p � f Z c CC__ k
{� / � 5 Oz-'Z7 .a n a ( Bore
Lz i Ty'r, C.A R1,4 46E s
%kF�r -t",
6--Ai -fr di d
7M/2y "+wd,0(Scale:YTS )
Shoreline Length K O
-
�r L�i lA2T
N'j(c/rrM OA4tf�
E v-'rC �/ (��
Access Length
-rRvs
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) _
Sop e-
BaRG�
1pr
Finger pier(s) =
NG
Total Platform area
length/#
Groin
Bulkhead/Riprap length
Avg distance offshore -.
Breakwater/Sill
_
h m P
""
✓
�'� "' P
Max distance/length
-.
%<Qcc
J
V
'���.`` (. 1177-drA115
`t
Basin, channel
Cubic yards
Boat ramp -
-'4E
Boathouse/ Boatlift
00
on
Beach Bulldozing
Other
'f" �iool J 5 Jp ax daN
SAV observed: yes no - --
Moratorium: n/a yes o
Site Photos: yes n
Riparian Waiver Attached: es
A building permit/zoning permit may be required by:
Permit Conditions
XiS11
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) W
Argent or Applicant PRINTED Name Pe it Officer's PRINTED Name
S g r40 Please read compliance statement on back of peS ^ f'Z7 Sig °,*„ -5 41
Application Fee(s) Check tf/Money Order Issuing Date Expiration Date !/

a1+ °"'" ❑LAMA _,❑ DREDGE &,FILL NP 89227 A e c D
Previous permit
€ GENERAL PERMIT Date previous permit issued
New ❑ Modification []Complete Reissue ❑ Partial Reissue
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 ❑ Rules attached. Q General Permit Rules available at the following link: wwwdeq.nc goy/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City ! State ZIP Street Address/State Road/Lot #(s)
Phone#O '(
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ pTS Adj. Wtr. Body - (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity / �` ` ° �' 6-
,.l, .1 •.4 .- d 71317'/ (Scale:lt�
=
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a
im
0
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mom
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mmllii®llnml
inn■■■
an
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:
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Boathouse/ Boatlift
Beach Bulldozing
■®■■■■■■■
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■■■■■■■■■■■■■■■■
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No
SAV observed: no
Site
:..,. - _t..
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.■.■.■.■i-.■.■■LME■
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A building permit/zoning permit maybe required by:
r
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
V ..
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
p
us
Application Feels) Check p/Money Order
Signature
c,
Issuing Date Expiration Date

e,r
AN i ti,e
�t6 ROJnnu...
NORTH DRAIN
CROSSING
VICINITY MAP
SCALE: 1 "=5000'
RODANTHE, DARE COUNTY, NC
LEGEND
•...................••• PROPOSED FIBER OPTIC CONDUIT
— — — PROPERTY LINE
-- EDGE OF PAVEMENT
EXISTING DRIVEWAY
—w— UNDERGROUND WATER MAIN
STREAM (DELINEATED BY CZR, INC.)
WETLANDS (DELINEATED BY CZR, INC
6'x6'x4' BORE PIT WITH 25'X25'
DISTURBANCE LIMIT AND COMPOST
SOCK (TYPICAL BUT MAY DIFFER)
DRAWING No. EX 1B — NORTH DRAIN CROSSING
SEE BORE PROFILE BELOW \\
t WETLANDS AS DELINEATED 1
BY CZR, INC.
EXISTING SIDEWALK \ A
y(. a uunulp_nuunpllllllumnnumw a al uunnnnuunnm
INC HIGHWAY 12
ICOMPOST SOCK
NOTES:
I ( ; "
)
1.
NO EXCAVATION WITHIN THE CLEAR RECOVERY ZONE SHALL NOTES:
BE LEFT OPEN OVERNIGHT.
10.
SHEET 1A DEPICTS THE PREVIOUSLY PERMITTED
2.
PORTIONS OF EASEMENT DATA GATHERED BY BOOTH &
CAPE CREEK CROSSING AND IS NOT INCLUDED
ASSOCIATES.
WITH THIS SUBMITTAL.
3.
PARCEL, UNDERGROUND WATER LINES, AND CONTOUR DATA
OBTAINED FROM NC AND DARE COUNTY GEOGRAPHIC
INFORMATION SYSTEMS (GIs). LINE
SPECIFICATIONS:
4.
CONTRACTOR SHALL CALL 811 FOR UNDERGROUND UTILITY
ARMORED CABLE TO BE USED (96 OR 144
LOCATION PRIOR TO BEGINNING CONSTRUCTION.
COUNT TO BE DECIDED, BUT CONSISTENT
5.
EXISTING WATER UTILITIES BURIED APPROXIMATELY 3 FEET.
THROUGHOUT PROJECT).
VERIFICATION OF DEPTH IS NECESSARY. 0
BORE PIT APPROXIMATELY EVERY 250' OR AS
6.
PROPOSED FIBER OPTIC CONDUIT TO BE OFFSET A MINIMUM
SHOWN IN THE DRAWINGS. THESE WILL
OF FIVE FEET (5') FROM THE EDGE OF NCDOT PAVEMENT.
REQUIRED COMPOST SOCK FACING
DOWNSTREAM AS SHOWN IN THE DRAWINGS.
7.
CONTRACTOR SHALL MAINTAIN A TEN -FOOT (10') SEPARATION.
BORE DEPTH:
FROM CULVERTS AND BRIDGES.
5'-10' IN TO AVOID EXISTING
8.
TIMBER MATTING SHALL BE USED FOR ALL EQUIPMENT
UTILITIES/INFRASTRUCTURE/WATER FEATURES
OPERATING ON WETLANDS.
5'-6' EVERYWHERE ELSE.
9.
WETLAND DATA WAS DERIVED FROM A WETLAND DELINEATION •
CABLE TO BE INSTALLED VIA HORIZONTAL
REPORT PREPARED BY CZR ENVIRONMENTAL CONSULTANTS
DIRECTIONAL DRILLING EXCEPT WHERE 01
j
WITH A DATE OF JANUARY 05, 2024. THE REPORT AND
OTHERWISE STATED ON THE DRAWINGS; E.G.,
i
WETLAND DELINEATION WAS COMPLETED ONLY FOR THE FIBER
BRIDGE LOCATIONS.
INSTALLATION CORRIDOR ON THE SOUND SIDE OF NC-12, AND
ANY WETLANDS THAT MAY EXIST OUTSIDE OF THIS CORRIDOR •
MAXIMUM BORE DIAMETER SHALL BE 5
ARE NOT SHOWN
INCHES.
02/30/2024
11111111�111
1111111111111111111111111111111111111
EP
100'
NCDOT
32'
R/W
WIDTH
EP
NORTH DRAIN SECTION AS
DELINEATED BY CZR, INC.
-5'
FROM
EDGE OF
PAVEMENT
R�hsl
FLOOD ZONE AE
PER FEMA
a
UNDERGROUND CABLE COMPOST SOCK
�— EQUIPMENT ONLY
DISTURBING BORE PIT AREA .K«,.,
N, -
-
IME: EVANS, CHARLES 0 40 20 10 4D
ME'!N. 065809057132
PIN: 065813043939
PC Q449
I 1,.= 40'
DIRECTIONAL BORING UNDER NORTH DRAIN (NOT TO SCALE)
EDGE OF EDGE OF
a.
-76' CREEK 86, CREEK N 16'
A
w
m
o
v_
OD
w X w
wA I
w w
a
o
a
10 W
—
8' WATER MAIN o ? a
a
—
� �
10' 16'
(MAX.) ti 78, (MAX.
4DNCElectric
OUTER BANKS FIBER
Cooperatives OPTIC EXPANSION
NORTH DRAIN CROSSING
056748 J 2*1 REV. I DESCRIPTION I APR.
1
A — PHASE 1
DRAWING PREPARED BY:
BOOTH & ASSOCIATES LLC
2300 REXWOODS DRIVE, SUITE 300
RALEIGH NC 27607
APR: LRH I FILE N
;ING EXHIBITS
AS SHOWN

AR ena
SOUTH RODANTHE
CROSSING
V� i spa,
v.,�: 1 1-
VICINITY MAP
SCALE: 1 `5000'
i
RODANTHE, DARE COUNTY, NC
LEGEND
..................••••• PROPOSED FIBER OPTIC CONDUIT
— — —
PROPERTY LINE
EDGE OF PAVEMENT
EXISTING DRIVEWAY
•,, , ,,, ,
—w—
UNDERGROUND WATER MAIN
STREAM (DELINEATED BY CZR, INC.)
WETLANDS (DELINEATED BY CZR, INC.)
,L ■ 1
�4•��
6'x6'x4' BORE PIT WITH 25'X25
DISTURBANCE LIMIT AND COMPOST
SOCK (TYPICAL BUT MAY DIFFER)
MOM
N.WPYS MI "I
NOTES:
6EFURE YU°10
1. NO EXCAVATION WITHIN THE CLEAR RECOVERY ZONE
SHALL BE LEFT OPEN OVERNIGHT.
2. PORTIONS OF EASEMENT DATA GATHERED BY BOOTH &
ASSOCIATES.
3. PARCEL, UNDERGROUND WATER LINES, AND CONTOUR
DATA OBTAINED FROM NC AND DARE COUNTY
GEOGRAPHIC INFORMATION SYSTEMS (GIS).
4. CONTRACTOR SHALL CALL 811 FOR UNDERGROUND
UTILITY LOCATION PRIOR TO BEGINNING CONSTRUCTION.
5. EXISTING WATER UTILITIES BURIED APPROXIMATELY 3
FEET. VERIFICATION OF DEPTH IS NECESSARY.
6. PROPOSED FIBER OPTIC CONDUIT TO BE OFFSET A
MINIMUM OF FIVE FEET (5') FROM THE EDGE OF NCDOT
PAVEMENT.
7. CONTRACTOR SHALL MAINTAIN A TEN -FOOT (10')
SEPARATION FROM CULVERTS AND BRIDGES.
B. TIMBER MATTING SHALL BE USED FOR ALL EQUIPMENT
OPERATING ON WETLANDS.
9. WETLAND DATA WAS DERIVED FROM A WETLAND
DELINEATION REPORT PREPARED BY CZR ENVIRONMENTAL
CONSULTANTS WITH A DATE OF JANUARY 05, 2024. THE
REPORT AND WETLAND DELINEATION WAS COMPLETED
ONLY FOR THE FIBER INSTALLATION CORRIDOR ON THE
SOUND SIDE OF NC-12, AND ANY WETLANDS THAT MAY
EXIST OUTSIDE OF THIS CORRIDOR ARE NOT SHOWN.
DRAWING No. EX 1C — SOUTH RODANTHE CROSSING 1 1 , - «:
FLOOD ZONE AE /
PER FEMA I .4
' SEE BORE PROFILE BELOW \
r
CZR, INC DELINEATED 1
WATERS -5' FROM EDGE
j - EXISTING SIDEWALK OF PAVEMENT
s �..#CZR, INC DELINEATED
COMPOST SOCK 4
-� ,�.WETLANDS
I .fi.
I'>h. ,
EXISTING CULVERT
ull nnnnnnuuummmmuumu� nnuumnnmuw7uniuun nuu�nnmrnmumm�unun mnmrnnnu�n .. ....:u.:nnnnmumm�nnunru n,nuiruuuoruueunuurrurouuunmrumu�nuuunu �4nuunmrumm .ae' ur u,
.6 EP
100' 1 1
NCDOT
NC HIGHWAY 12 R/W 32'
WIDTH
EP
'P'y.+s.. �.,,.,-......, ... ..�..a'r, x•N.ri.. _., vw4.4,e -,rm,.
* UNDERGROUND CABLE"
EQUIPMENT ONLY
DISTURBING BORE PIT AREA
NOTES:
10. SHEET 1A DEPICTS THE PREVIOUSLY PERMITTED
CAPE CREEK CROSSING AND IS NOT INCLUDED
WITH THIS SUBMITTAL.
LINE SPECIFICATIONS:
• ARMORED CABLE TO BE USED (96 OR 144
COUNT TO BE DECIDED, BUT CONSISTENT
THROUGHOUT PROJECT).
• BORE PIT APPROXIMATELY EVERY 250' OR AS
SHOWN IN THE DRAWINGS. THESE WILL
REQUIRED COMPOST SOCK FACING
DOWNSTREAM AS SHOWN IN THE DRAWINGS.
• BORE DEPTH:
5'-10' IN TO AVOID EXISTING
UTILITIES/INFRASTRUCTURE/WATER FEATURES.
5'-6' EVERYWHERE ELSE.
• CABLE TO BE INSTALLED VIA HORIZONTAL
DIRECTIONAL DRILLING EXCEPT WHERE
OTHERWISE STATED ON THE DRAWINGS; E. J
BRIDGE LOCATIONS. e
• MAXIMUM BORE DIAMETER SHALL BE 5 z
INCHES.
08/30/2024
i.A.d6;_..w ,w,. .
COMPOST SOCK
40
20
10
0 40
r1= 40'
DIRECTIONAL BORING IN SOUTH RODANTHE (NOT TO SCALE
EDGE OF
EDGE OF
a
�230' WATERS
176' WATERS
6'
ED
A
w
rn
o
T
DO
w us
w w w-
X
w
w
w
w
O
v
'0
WATER MAIN o ?
d
a
—
0'
L(M
16'AX.)
62'
(MAX.
CA
S/0
OUTER BANKS FIBER
DRAWING PREPARED BY:
BOOTH & ASSOCIATES LLC
pF ,L�yGNCEE'oeoperaCtrlCtIVes
OPTIC EXPANSION
2300 RRALEOGHS DRIVE,
I300
SOUTH RODANTHE CROSSING
60SUITE
056748
REV.
DESCRIPTION
APR.
DATE
I DRW:
WTD/JEH/REA
DATE: 07/31/2024
� +G may.`
E� �
0
ISSUED FOR PERMIT
LRH
08/30/24
CHK:
QNM
SCALE: AS SHOWN
I N �•`
' PQ �
APR:
LRH
FILE NAME:1832719ESCP
��op,R;,n"���
CAMA — PHASE 1 CROSSING
EXHIBITS

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OUTER BANKS FIBER
DRAWING PREPARED BY:
BOOTH & ASSOCIATES LLC
pF 2%s
OPTIC
EXPANSION
2300 REXWOODS DRIVE, SUITE 300
DETAILS
RALEIGH NC 27607
056748 =
REV.
DESCRIPTION
APR.
I DATE
DRW:
WTD/JEH/REA
DATE: 07/31/2024
i�G1NEf0��`y
0
ISSUED FOR PERMIT
LRH
08/30/24
CHK:
QNM
SCALE: N.T.S.
q R
APR:
LRH
FILE NAME:1832719ESCP
10011111 1
CAMA — PHASE 1 CROSSING
EXHIBITS

DRAWING No. EX 3 — DETAILS
EXISTING GROUND 36° MIN.
L
U TI LI
PROPOSED FIBER
OPTIC
FIBER OPTIC INSTALLATION IN REFERENCE
TO EXISTING UNDERGROUND UTILITIES
SCALE: N.T.S.
TEMPORARY TIMBER MATTING
(EXAMPLE) TO BE USED IN
WETLAND AREAS
SCALE: N.T.S.
OAS /30 /2024
WIDTH WIDTH 5' NC HWY 12
VARIES VARIES MIN. (WIDTH VARIES)
O
H
H
U
w
(AU
x
F
IL
W
W
oa
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vL
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BORE DEPTH - VARIES
(DEPTH SHOULD BE
EQUAL TO OR LESS -
THAN DISTANCE FROM
EDGE OF PAVEMENT)
Y.
dr
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a
61
1
<
PLAN VIEW
WIDTH WIDTH 5' NC HWY 12
VARIES VARIES MIN. (WIDTH VARIES)
PROPOSED
FIBER OPTIC
(BORED)
I
w w
7THEORETICAL
EDGE
/ NT
1:1
EXISTING
DOT EDGE OF
PAVEMENT
PROFILE VIEW
NOTE:
LOCATION OF FIBER OPTIC RELATIVE RELATIVE TO EXISTING DITCHES AND SIDEWALK VARIES THROUGHOUT
VILLAGES. (FOR EXAMPLE, THE SIDEWALK MAY AT TIMES BE IN-BETWEEN THE FIBER AND NC HIGHWAY 12,
ETC.) THIS DETAIL IS MEANT TO REPRESENT A "TYPICAL" SECTION.
LONGITUDINAL FIBER OPTIC
INSTALLATION DETAIL (TYPICAL)
SCALE: N.T.S.

Booth & Associates
August 30, 2024
VIA EMAIL & UPS/GROUND
Ms. Yvonne Carver
North Carolina Department of Environmental Quality
Division of Coastal Management
401 S. Griffin St., Suite 300
Elizabeth City, NC 27909
yvonne.carver(c deq.nc.gov
Subject: Outer Banks Fiber Optic Expansion Phase 1
Physical Submittal for Two Crossings Near Rodanthe, NC
CAMA General Permit for Subaqueous Utility Lines
NC Dredge & Fill Permit
Dear Ms. Carver:
On behalf of North Carolina Electric Membership Corporation ("NCEMC"), Booth & Associates ("Booth") is
submitting physical copies of the Outer Banks Fiber Optic Expansion Phase 1 plans and documents for two
crossings of proposed bored fiber optic underneath existing canals near Rodanthe, NC.
The permits being sought are:
1. CAMA General Permit for the Installation of Aerial and Subaqueous Utility Lines with Attendant
Structures in Coastal Wetlands, Estuarine Waters, Public Trust Waters and Estuarine Shorelines
2. North Carolina Dredge & Fill Permit
The attachments are as follows:
1. Permit Fee Check for $400.00 (in binder pocket)
2. North Drain and South Rodanthe Crossing Exhibit Plans
• 1 Copy: 11'x17" (To Scale)
Revision 0, dated 08/30/2024
3. Property Owner Notifications and Responses
A. Response from William G Alexander
• USPS Domestic Return Receipt (Green Card)
• Adjacent Riparian Property Owner Notice/Waiver Form (Signed)
B. Original Package Sent to William G Alexander Ttee; Charles D Evans Ttee
• Cover Letter
• Adjacent Riparian Property Owner Notice/Waiver Form
• North Drain Crossing Exhibit plan (dated 712412024)
o Included as a separate attachment in this package to avoid repeated copies (See
Attachment O below)
o Please note that this version of the drawings is old and is only included to reflect
what was sent to Mr. Alexander.
C. Response from Camp Hatteras, LLC
• USPS Domestic Return Receipt (Green Card)
• Adjacent Riparian Property Owner Notice/Waiver Form (Signed)
D. Original Package Sent to Camp Hatteras LLC
• Cover Letter
• Adjacent Riparian Property Owner Notice/Waiver Form
• South Rodanthe Crossing Exhibit plan (dated 712412024)
o Included as a separate attachment in this package to avoid repeated copies (See
Attachment O below)
2300 Rexwoods Drive, Ste. 300 919.851.8770 office
Raleigh, NC 27607 919.859.5918 facsimile
www.booth-assoc.com

Ms. Yvonne Carver
August 30, 2024
Page 2
o Please note that this version of the drawings is old and is only included to reflect
what was sent to Camp Hatteras LLC.
E. Response from Equity Trust Custodians, the Bishops
• USPS Domestic Return Receipt (Green Card)
F. Original Package sent to Equity Trust Company Custodian, FBO Kristy and Evan Bishop
• Cover Letter
• Adjacent Riparian Property Owner Notice/Waiver Form
• North Drain Crossing Exhibit plan (dated 712412024)
o Included as a separate attachment in this package to avoid repeated copies (See
Attachment O below)
o Please note that this version of the drawings is old and is only included to reflect
what was sent to Ms. Bishop.
G. Response from Alyson C Jacobs
• USPS Domestic Return Receipt (Green Card)
H. Original Package sent to Alyson C Jacobs
• Cover Letter
• Adjacent Riparian Property Owner Notice/Waiver Form
• North Drain Crossing Exhibit plan (dated 712412024)
o Included as a separate attachment in this package to avoid repeated copies (See
Attachment O below)
o Please note that this version of the drawings is old and is only included to reflect
what was sent to Ms. Jacobs.
I. Response from Tina M Insley
• USPS Domestic Return Receipt (Green Card)
J. Original Package sent to Tina M Insley
• Cover Letter
• Adjacent Riparian Property Owner Notice/Waiver Form
• South Rodanthe Crossing Exhibit plan (dated 712412024)
o Included as a separate attachment in this package to avoid repeated copies (See
Attachment O below)
o Please note that this version of the drawings is old and is only included to reflect
what was sent to Ms. Insley.
K. Response from Equity Trust Custodians, Mr. Molloy
• USPS Domestic Return Receipt (Green Card)
L. Original Package sent to Equity Trust Company Custodian, FBO Christopher Molloy
• Cover Letter
• Adjacent Riparian Property Owner Notice/Waiver Form
• North Drain Crossing Exhibit plan (dated 712412024)
o Included as a separate attachment in this package to avoid repeated copies (See
Attachment O below)
o Please note that this version of the drawings is old and is only included to reflect
what was sent to Mr. Molloy.
M. Response from South Shore HOA
• USPS Domestic Return Receipt (Green Card)
N. Original Package sent to South Shore Homeowners Association (HOA)
• Cover Letter
• Adjacent Riparian Property Owner Notice/Waiver Form
• North Drain Crossing Exhibit plan (dated 712412024)
o Included as a separate attachment in this package to avoid repeated copies (See
Attachment O below)
o Please note that this version of the drawings is old and is only included to reflect
what was sent to South Shore HOA.
* Booth & Associates

Ms. Yvonne Carver
August 30, 2024
Page 3
O. South Rodanthe and North Drain Crossing Exhibit Plans
• 1 Copy of each: 11 x17" (To Scale)
o Revision A, dated 07/24/2024
o Please note that this version of the drawings is old and is only included to reflect
what was sent to the property owners with the Adjacent Riparian Property Owner
Notifications.
NCDOT Approval Package for Permit #E011-028-23-00453
• Cover Letter
• Encroachment General Provisions
• Right of Way Encroachment Agreement - Primary and Secondary Highways
• Outer Banks Fiber Optics Expansion Phase 1 Drawings (Revision 0, dated 1210412023)
• NCDOT Required Information for Encroachments Using Horizontal Directional Drilling (HOD)
• TRU-BORE@ Product Information
• Ditch Witch@ JT24 Horizontal Directional Drill Product Information
• Verification of Compliance with Environmental Regulations
An Agent Authorization Form has not been included in this submission since the applicant themselves,
NCEMC, will be signing the permit.
Please contact Laura Harris of Booth & Associates with any questions, comments, or concerns: by phone
at 919-851-8770 x 179 or by email at Laura. Harris(o)Booth-Assoc.com.
LRH/meb
cc
Sincerely,
BOOTH & ASSOCIATES, LLC
-�C� t Weu�
Laura R. Harris, P.E.
Project Engineer III - Team Lead
• NCDEQ: Ron Renaldi
• NCEMC: Ken Melcher, Cooper Cash, Jim Brookover, Jason Klinger
• Electricom: Tony Pasquarello, Jr.
• Booth: Q Mohamed, Rafael Arellano
Attachment(s): Listed above
P.0612719.E.00.9005 / 183
<BA>Booth
& Associates

Booth & Associates
July 31, 2024
VIA USPS
William G Alexander Ttee; Charles D Evans Ttee
3717 Benson Dr
Raleigh, NC 27609
Subject: Adjacent Riparian Property Owner Notification/Waiver Form
To Whom It May Concern:
This letter is to inform you of a proposed project that will pass underneath the North Drain canal adjacent
to your property on NC Highway 12 in Rodanthe, NC (Parcel Number 014226000). The project in question
is an underground fiber optic line to be installed by North Carolina Electric Membership Corporation
(NCEMC). The company I represent, Booth & Associates, is providing permitting services for this project to
NCEMC. The fiber optic line near your properties is proposed to be entirely in North Carolina Department
of Transportation (NCDOT) right-of-way and on the west side of NC Highway 12.
The purpose of this project is to improve the telecommunications fiber optic cable network throughout the
coast, which includes Rodanthe and neighboring communities along NC Highway 12. The proposed work
will not have adverse effects to your property and will be bored under existing driveways as to not affect
vehicle traffic into and out of nearby properties.
Please review and sign the attached waiver and return to the following address within ten (10) days of
receipt:
Booth & Associates
Attn: Laura Harris
2300 Rexwoods Drive, Suite 300
Raleigh, NC 27607
No response within ten (10) days will result in the assumption that you have no objection to the project
per law 15A NCAC 07H .1602(b)(2). If you have any questions, comments, or concerns, please do not
hesitate to contact me. I am available by phone at 919-851-8770 and by email at Laura.Harrisaa booth -
a ssoc. com .
Sincerely,
BOOTH & ASSOCIATES, LLC
- � ik W"�U�
Laura R. Harris, P.E.
Project Engineer III - Team Lead
LRH/wtd
cc:
Attachments: Phase 1 Rodanthe Crossing Exhibit, Notification/Waiver Form
P.0612719.E.00.9005
2300 Rexwoods Drive, Ste. 300 919.851.8770 office
Raleigh, NC 27607 919.859.5918 facsimile
www.booth-assoc.com

■ Complete items 1, 2, and S.
A.
■ 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.
X
R•
C
1. Article Addressed to: -
D,
pp3717 ^�ijrn
IIIIIIIII IIII IIIIIIIII IIIIIIIIIII IIIII IIII IIII11
Ad
Agent
by (Printed Name)— 10.
cellveryaddress different from item 1? U Ye:
YES, enter delivery address below: ❑ No
❑ Priority Mail Express®
❑ Registered Mail*'"
Restricted Delivery ❑ Registered Mail Restricted
Delivery
9590 9402 8837 4005 2488 70
D Codified Mail Restricted Delivery❑ Signature Confirmation*M
❑ Collect on Delivery ❑ Signature Confirmation
2. Article Number i7ransfar from service label) 10
Collect on Delivery Restricted Delivery Restricted Delivery
7004 1350 0004 H11 2021 it Restricted Delivery
PS Form 3811, July 2020 PSN 7530-02-000-9053 Domestic Return Receipt
,

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
William G Alexander, Ttee; Charles D Evans, Ttee
Address of Property: 0 NC 12 Hwy, Rodanthe, NC 27968 (Parcel ID 014226000)
Mailing Address of Owner: 3717 Benson Dr, Raleigh, NC 27609
Owner's email:
Agent's Name:
Laura R, Harris
Owner's Phone#:
Agent's Email: Laura. [e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Propedy Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing with dimensions must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.G. Diviston of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
M43 lipe-
Typed/Printed name of ARPO: ) IL, (F%M C. /ton"& rw( rr7- 5 n
Mailing Address of ARPO: 3 J1 2 ?Zea /S,V& Le I tp& �l�L�t7bfrrf N'c ggkD f
ARPO's email: 0 A,
%/w3A a �ur, CoMARPO's Phone#: rl b-) 0
Date: - p zDZ4� *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

Booth & Associates
July 31, 2024
VIA LISPS
Equity Trust Company Custodian - FBO Kristy L. Bishop IRA
Equity Trust Company Custodian - FBO Evan E. Bishop IRA
1 Equity Way
Westlake, OH 44145
Subject: Adjacent Riparian Property Owner Notification/Waiver Form
To Whom It May Concern:
This letter is to inform you of a proposed project that will pass underneath the North Drain canal adjacent
to your property at 24732 NC Highway 12 in Rodanthe, NC (Parcel Number 014233000). The project in
question is an underground fiber optic line to be installed by North Carolina Electric Membership
Corporation (NCEMC). The company I represent, Booth & Associates, is providing permitting services for
this project to NCEMC. The fiber optic line near your property is proposed to be entirely in North Carolina
Department of Transportation (NCDOT) right-of-way.
The purpose of this project is to improve telecommunications fiber optic cable network throughout the
coast, which includes Rodanthe and neighboring communities along NC Highway 12. The proposed work
will not have adverse effects to your property and will be bored under existing driveways as to not affect
vehicle traffic into and out of your property.
Please review and sign the attached waiver and return to the following address within ten (10) days of
receipt:
Booth & Associates
Attn: Laura Harris
2300 Rexwoods Drive, Suite 300
Raleigh, NC 27607
No response within ten (10) days will result in the assumption that you have no objection to the project
per law 15A NCAC 07H .1602(b)(2). If you have any questions, comments, or concerns, please do not
hesitate to contact me. I am available by phone at 919-851-8770 and by email at Laura.HarrlS(ftooth-
assoc.com.
Sincerely,
BOOTH & ASSOCIATES, LLC
Laura R. Harris, P.E.
Project Engineer III - Team Lead
LRH/wtd
cc:
Attachments: Phase 1 Rodanthe Crossing Exhibit, Notification/Waiver Form
P.0612719. E.00.9005
2300 Rexwoods Drive, Ste. 300 919.851.8770 office
Raleigh, NC 27607 919.859.5918 facsimile
www.booth-assoc.com

s
■ Complete Items l,.4s MUU-a
■ Print your name,allo'address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailPlece, .
1 ao ii/f,s�.y `. C3t 6l�orA A
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❑ collect
7004 1350 0004 8911 2038
PS Form 3811, July 2020 PSN 7530-02-000.9053 _v
Domestic Return Receipt
pe ❑
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Restftted Delivery ❑O
;livery
alivery Restricted Delivery
Resldcled Delivery

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Equity Trust Company Custodian - FBO Kristy Bishop IRA (Primary Owner)
Name of Property Owner: FBO Evan E. Bishop IRA (Secondary Owner)
Address of Property:
Mailing Address of Owner:
Owner's email:
24732 INC 12 Hwy, Rodanthe, NC 27968 (Parcel ID 014233000)
1 Equity Way, Westlake, OH 44145
Agent's Name: Laura R.Harris
Owner's Phone#:
Agent's Email: Laura. [e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing with dimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
M
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

Booth & Associates
July 31, 2024
VIA USPS
Alyson C Jacobs
P. O. Box 662
Rodanthe, NC 27968
Subject: Adjacent Riparian Property Owner Notification/Waiver Form
To Whom It May Concern:
This letter is to inform you of a proposed project that will pass underneath the North Drain canal adjacent
to your property on Seabreeze Or in Rodanthe, NC (Parcel Number 014224000). The project in question is
an underground fiber optic line to be installed by North Carolina Electric Membership Corporation
(NCEMC). The company I represent, Booth & Associates, is providing permitting services for this project to
NCEMC. The fiber optic line near your properties is proposed to be entirely in North Carolina Department
of Transportation (NCDOT) right-of-way and on the west side of NC Highway 12.
The purpose of this project is to improve the telecommunications fiber optic cable network throughout the
coast, which includes Rodanthe and neighboring communities along NC Highway 12. The proposed work
will not have adverse effects to your property and will be bored under existing driveways as to not affect
vehicle traffic into and out of nearby properties.
Please review and sign the attached waiver and return to the following address within ten (10) days of
receipt:
Booth & Associates
Attn: Laura Harris
2300 Rexwoods Drive, Suite 300
Raleigh, NC 27607
No response within ten (10) days will result in the assumption that you have no objection to the project
per law 15A NCAC 07H .1602(b)(2). If you have any questions, comments, or concerns, please do not
hesitate to contact me. I am available by phone at 919-851-8770 and by email at Laura.Harris0booth-
assoc.com.
Sincerely,
BOOTH & ASSOCIATTEES,,, LLC
Laura R. Harris, P.E.
Project Engineer III
- Team Lead
LRH/wtd
cc:
Attachments: Phase 1 Rodanthe Crossing Exhibit, Notification/Waiver Form
P.0612719.E.00.9005
2300 Rexwoods Drive, Ste. 300 919.851.8770 office
Raleigh, NC 27607 919.859.5918 facsimile
www.booth-assoc.com

• 11 WIr
■ Complete Items 1, 2, and 3.
A. dig t' e
■ Print your name and address on the reverse
/
.i) Agent
so that we can return the card to you. -
(% 11 Addressee
43. R ived by (Panted lJ e)
C. Dat of D Ilve
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Articlq,(6ddressed to
D. Is delivery address different from Item 17 Ye
son �,
If YES, enter delivery address below: ❑ No
t�uco�s
Ae o�-� e. 1W �7-169
3. Service Type
❑iMan l
IIII IIIII'III IIIII IIIIII'III III III III
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❑ Registered Maillm
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❑ ult Signature Restricted Delivery
El Registered Mail Restricted
Delivery
9590 9402 8837 4005 2488 56
Certified Mall®
❑ Certified Mall Restricted Delivery
❑ Signature Confirmationem
❑ Collect on Delivery
D Collect on Delivery Restricted Delivery
... il
❑ Signature Confirmation
Restricted Delivery
2. Article Number (transfer from service label)
7004 1350 0004 8911 1970
.It Restricted Delivery
PS Form 3811, July 2020 PSN 7530-02-000-9053 Domestic Return Receipt I

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Alyson C Jacobs
Address of Property: 0 Seabreeze Dr, Rodanthe, NC 27968 (Parcel ID 014224000)
Mailing Address of Owner: P. O. Box 662, Rodanthe, NC 27968
Owner's email:
Agent's Name: Laura R Harris
Owner's Phone#:
Agent's Email: Laura.Harris@_booth-assoc.com
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing, with dimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
Corr
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

Booth & Associates
July 31, 2024
VIA USPS
South Shore-Rodanthe Homeowners Assoc
Suite 135 Park Center
324 West Wendover Ave
Greensboro, NC 27408
Subject: Adjacent Riparian Property Owner Notification/Waiver Form
To Whom It May Concern:
This letter is to inform you of a proposed project that will pass underneath the North Drain canal adjacent
to your property on NC Highway 12 in Rodanthe, NC (Parcel Number 014227025). The project in question
is an underground fiber optic line to be installed by North Carolina Electric Membership Corporation
(NCEMC). The company I represent, Booth & Associates, is providing permitting services for this project to
NCEMC. The fiber optic line near your properties is proposed to be entirely in North Carolina Department
of Transportation (NCDOT) right-of-way and on the west side of NC Highway 12.
The purpose of this project is to improve the telecommunications fiber optic cable network throughout the
coast, which includes Rodanthe and neighboring communities along NC Highway 12. The proposed work
will not have adverse effects to your property and will be bored under existing driveways as to not affect
vehicle traffic into and out of nearby properties.
Please review and sign the attached waiver and return to the following address within ten (10) days of
receipt:
Booth & Associates
Attn: Laura Harris
2300 Rexwoods Drive, Suite 300
Raleigh, NC 27607
No response within ten (10) days will result in the assumption that you have no objection to the project
per law 15A NCAC 07H .1602(b)(2). If you have any questions, comments, or concerns, please do not
hesitate to contact me. I am available by phone at 919-851-8770 and by email at Laura.Harrisftooth-
assoc.com.
Sincerely,
BOOTH & ASSOCIATES, LLC
Laura R. Harris, P.E.
Project Engineer III - Team Lead
LRH/wtd
cc:
Attachments: Phase 1 Rodanthe Crossing Exhibit, Notification/Waiver Form
P.0612719. E.00.9005
2300 Rexwoods Drive, Ste. 300 919.851,8770 office
Raleigh, NC 27607 919.859.5918 facsimile
www.booth-assoc.com

■ complete Items r. -"- -
III print your name and address on the reverse
so that we can return the card to you.
to ihe�b�aecmof lt . maflplece,
■ Attach this card
�k SYj�6c-- 1'lOad••„
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7004 1350 0004 8911 1963 0
N 7530.02.000.9053
PS Form 3811. July 2020.PS

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: SOUTH SHORE-RODANTHE HOMEOWNERS ASSOC
Address of Property: 0 NC 12 Hwy, Rodanthe, NC 27968 (Parcel ID 014227025)
Mailing Address of Owner: Suite 135 Park Center, 324 West Wendover Ave, Greensboro, NC 27408
Owner's email: Owner's Phone#:
Agent's Name:
Laura R Harris
Agent's Email: Laura. [e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own properly adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing, with dimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
Sala
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

Booth & Associates
July 31, 2024
VIA USPS
Equity Trust Company Custodian - FBO Christopher Molloy IRA
Equity Trust Company Custodian - FBO C. Molloy Bene IRA of Joseph K. Molloy DC
2504 South Compass Lane
Nags Head, NC 27959
Subject: Adjacent Riparian Property Owner Notification/Waiver Form
To Whom It May Concern:
This letter is to inform you of a proposed project that will pass underneath the North Drain canal adjacent
to your property at 24702 NC Highway 12 in Rodanthe, NC (Parcel Number 014231000). The project in
question is an underground fiber optic line to be installed by North Carolina Electric Membership
Corporation (NCEMC). The company I represent, Booth & Associates, is providing permitting services for
this project to NCEMC. The fiber optic line near your properties is proposed to be entirely in North
Carolina Department of Transportation (NCDOT) right-of-way.
The purpose of this project is to improve the telecommunications fiber optic cable network throughout the
coast, which includes Rodanthe and neighboring communities along NC Highway 12. The proposed work
will not have adverse effects to your property and will be bored under existing driveways as to not affect
vehicle traffic into and out of your property.
Please review and sign the attached waiver and return to the following address within ten (10) days of
receipt:
Booth & Associates
Attn: Laura Harris
2300 Rexwoods Drive, Suite 300
Raleigh, NC 27607
No response within ten (10) days will result in the assumption that you have no objection to the project
per law 15A NCAC 07H .1602(b)(2). If you have any questions, comments, or concerns, please do not
hesitate to contact me. I am available by phone at 919-851-8770 and by email at Laura. Harrls(shbooth-
assoc.com.
Sincerely,
BOOTH & ASSOCIATES,LLC
-� t .
Laura R. Harris, P.E.
Project Engineer III - Team Lead
LRH/rea
cc:
Attachments: Phase 1 Rodanthe Crossing Exhibit, Notification/Waiver Form
P.0612719. E. 00.9005
2300 Rexwoods Drive, Ste. 300 919.851.8770 office
Raleigh, NC 27607 919.859.5918 facsimile
www.booth-assoc.com

■ 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.
�69 C1,r:a��itGG'/"�l�°y KKR
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1�1111111�11111111ill III III IIIIIIIIII 11111111 I0 Adult Signature
�Certfietlmail® Restricted Delivery
9590 9402 8837 4005 2488 63 I 0 Certified Mall Restricted Delivery
JI ❑ Collect on Delivery
❑ Collect on Delivery Restricted Delivery
all
2 0 0 7 ail Restricted Delivery
4
B.
D. Is delivery address dif
If YES, enter delivery
❑ Agent
from item 17 u reE
as below: ❑ No
7004 1350 0004 8911
❑ Priority Mail Express®
❑ Registered Mail"'
❑ Registered Mail Restricted
Delivery
❑ Signature ConfirmationL°
❑ Signature Confirmation
Restricted Delivery
PS Form 3811, July 2020 PSN 7530-02-000-9053 Domestic Return Receipt
i

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Equity Trust Company Custodian - FBO Christopher Molloy IRA (Primary Owner)
Name of Property Owner: Equity Trust Company Custodian - FBO Bone IRA of Joseph K. Molly DC (Secondary Owner)
Address of Property: 24702 NC 12 Hwy, Rodanthe, NC 27968 (Parcel ID 014231000)
Mailing Address of Owner: 2504 S Compass Ln, Nags Head, NC 27959
Owner's email:
Agent's Name: Laura R.Harris
Owner's Phone#:
Agent's Email: Laura. [e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing, with dimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
it you nave opfecnons to wnat is vemg proposes, you must noury the N.c. utvision or coastat
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

Booth & Associates
July 31, 2024
VIA USPS
Camp Hatteras, LLC
P.O. Box 10
Rodanthe, NC 27968
Subject: Adjacent Riparian Property Owner Notification/Waiver Form
To Whom It May Concern:
This letter is to inform you of a proposed project that will pass underneath the unnamed creek adjacent to
your property (which empties to the west into Pamlico Sound) at 24798 NC Highway 12 in Waves, NC
(Parcel Number 014239000). The project in question is an underground fiber optic line to be installed by
North Carolina Electric Membership Corporation (NCEMC). The company I represent, Booth & Associates,
is providing permitting services for this project to NCEMC. The fiber optic line near your property is
proposed to be entirely in North Carolina Department of Transportation (NCDOT) right-of-way.
The purpose of this project is to improve the telecommunications fiber optic cable network throughout the
coast, which includes Waves and neighboring communities along NC Highway 12. The proposed work will
not have adverse effects to your property and will be bored under existing driveways as to not affect
vehicle traffic into and out of your property.
Please review and sign the attached waiver and return to the following address within ten (10) days of
receipt:
Booth & Associates
Attn: Laura Harris
2300 Rexwoods Drive, Suite 300
Raleigh, NC 27607
No response within ten (10) days will result in the assumption that you have no objection to the project
per law 15A NCAC 07H .1602(b)(2). If you have any questions, comments, or concerns, please do not
hesitate to contact me. I am available by phone at 919-851-8770 and by email at Laura.Harris(abbooth-
assoc.com.
Sincerely,
BOOTH & ASSOCIATES,LLC
i&1�.1/fil� t
.
Laura R. Harris, P.E.
Project Engineer III
- Team Lead
LRH/wtd
cc:
Attachments: Phase 1 Rodanthe Crossing Exhibit, Notification/Waiver Form
P.0612719. E.00.9005
2300 Rexwoods Drive, Ste. 300 919.851.8770 office
Raleigh, NC 27607 919.859.5918 facsimile
www.booth-assoc.com

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Camp Hatteras, LLC
Address of Property: 24798 NC 12 Hwy, Waves, NC 27982 (Parcel ID 014239000)
Mailing Address of Owner: PO Box 10, Rodanthe, NC 27968
Owner's email: �tt� rrP`eeaAOI6,1SVQwner's Phone#:
Agent's Name: Laura R Harris
Agent's Email: Laura. [e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
7 74f
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
1 DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
am
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's
Date: .
aARPO's Phone#:
/Vk' ier 10,0vefre —
Z 7 ib"k-
7 7
'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

■ Complete items 1, z, ana o.
■ Print your name and address on the reverse
su that we can return the card to you.
■ ,attach this card to the back of the mailpiece,
...,.n +ha front if space permits.
P ?fin-H-e (as, �z
c
C � '
enter aenvmy --_ __-
Vl� U 3. Service Type ❑ Priority Mail Express®
❑ Adult $ignature ❑ Registered Maf'M
IIIIIIIII IIII IIIII'lII IIIIIIIIIII'lll l'IIIIIII ❑,Adult Signature Restricted Delivery ❑ Qeli seryBd Mail Restdded
fL Certified Mall® ❑ Signature Confirmation
❑ Carried Mail Restncted Delivery ❑ Signature Confirmation
9590 9402 8837 4005 2488 94 ❑ Collect on Delivery Restricted Delivery
D live Restricted Delivery
PS Form
❑Collect on le ry
Imber (j'lall5 n c r service o label) I Restricted Delivery
1350 ��n4 8911 2045 oomesticReturn Receaa ;
811, July 2020 PSN 7530-02-000-uu'

Booth & Associates
July 31, 2024
VIA LISPS
Tina Marie Insley
P.O. Box 209
Rodanthe, NC 27968
Subject: Adjacent Riparian Property Owner Notification/Waiver Form
To Whom It May Concern:
This letter is to inform you of a proposed project that will pass underneath the unnamed creek adjacent to
your property (which empties to the west into Pamlico Sound) at 24753 NC Highway 12 in Rodanthe, NC
(Parcel Number 014234002). The project in question is an underground fiber optic line to be installed by
North Carolina Electric Membership Corporation (NCEMC). The company I represent, Booth & Associates,
is providing permitting services for this project to NCEMC. The fiber optic line near your property is
proposed to be entirely in North Carolina Department of Transportation (NCDOT) right-of-way and will be
located on the west side of NC Highway 12.
The purpose of this project is to improve the telecommunications fiber optic cable network throughout the
coast, which includes Rodanthe and neighboring communities along NC Highway 12. The proposed work
will not have adverse effects to your property and will be bored under existing driveways as to not affect
vehicle traffic into and out of nearby property.
Please review and sign the attached waiver and return to the following address within ten (10) days of
receipt:
Booth & Associates
Attn: Laura Harris
2300 Rexwoods Drive, Suite 300
Raleigh, NC 27607
No response within ten (10) days will result in the assumption that you have no objection to the project
per law 15A NCAC 07H .1602(b)(2). If you have any questions, comments, or concerns, please do not
hesitate to contact me. I am available by phone at 919-851-8770 and by email at Laura. Harris(o)booth-
assoc.com.
Sincerely,
BOOTH & ASSOCIATES, LLC
_�" k
W6/�-cL�
Laura R. Harris, P.E.
Project Engineer III
- Team Lead
LRH/wtd
cc:
Attachments: Phase 1 Rodanthe Crossing Exhibit, Notification/Waiver Form
P.0612719. E.00.9005
2300 Rexwoods Drive, Ste. 300 919.851.8770 office
Raleigh, NC 27607 919.859.5918 facsimile
www.booth-assoc.com

■ Complete Items 1, 2, anc s.
■ 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. _
3. Service TYPe ❑
❑p�ppMduit SlgnaWre ❑
III�IIIII I'II I�IIIIIII II I II I IIIIIII'IIIIIII III [jCe t'fed Mall® Restricted Delivery ❑
9590 9402 8837 4005 2489 00 ❑ Certified Mail Reslrtcted Delivery o
❑ Collect on Delivery
Delivery Restricted Delivery
n c n n n n 4 8 911 19 87 °" p,�l,mcea Delivery
PS Form
1, July 2020 PSN 75$0.02-000-9053
Domestic Return Receipt

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Tina Marie Insley
Address of Property: 24753 NC 12 Hwy, Rodanthe, INC 27968 (Parcel ID 014234002)
Mailing Address of Owner:
Owner's email:
P O Box 209, Rodanthe, INC 27968
Owner's Phone#:
Agent's Name: Laura R Harris Agent Phone#: [phone]
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing with dimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
of Adjacent Riparian Property Owner
so
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

Roy COOPER
GOVERNOR
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
February 20, 2024
North Carolina Electric Membership Corporation
3400 Summer Blvd
Raleigh, NC 27616
County: Dare
J.R. "JOEY" HOPx1NS
SF.CRFTARY
Subject: Encroachment to allow the installation of fiber optic cable along and under NC 12
and SR1233
Dear Applicant,
Attached for your records is a copy of the approved encroachment package to allow the
installation of fiber optic cable along and under NC12 and SR1233, from Light Plant Rd to
Bridge 71. Any and all damages done to State Routes must be properly repaired. This
approval will expire on February 20, 2025, unless construction has started or been completed
prior to that date.
Please feel free to contact the District Office at [phone] if you have any questions.
Sincerely yours,
E DocuSigned
ny:
930880FAe40F4'5A...
Caitlin A. Spear, PE
District Engineer
Attachments
Cc: Division Engineer (W/Attachments) County Maintenance Engineer (W/Attachments)
1929 North Road Street, Elizabeth City, NC 27909 Phone: [phone]; Fax: [phone]

Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
Pre -Construction Notices
PCN 1 Approval may be rescinded upon failure to follow any of the provisions in this permit and may be
considered a violation of the encroachment agreement.
PCN 2 The Encroaching party or their contractor shall provide the following notices prior to construction activity
within the NCDOT Right of Way:
A) Three (3) business days advance phone call at telephone [phone] to the District Engineer's
office
B) If the construction falls within the limits of an NCDOT managed construction project, five (5)
business days advance phone call to the Resident Engineer at [phone]
Failure to provide these notifications prior to beginning construction is subject to the Division Engineer's
discretion to cease construction activity for this encroachment. NCDOT reserves the right to cease any
construction or maintenance work associated with this installation by the encroaching party until the
construction or maintenance meets the satisfaction of the Division Engineer or their representative
PCN 3 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
proposed work.
PCN 4 It shall be the responsibility of the encroaching party to determine the location of utilities within the
encroachment area. NCGS § 87-115 through § 87-130 of the Underground Utility Safety and Damage
Prevention Act requires underground utilities to be located by calling 811 prior to construction. The
encroaching party shall be responsible for notifying other utility owners and providing protection and
safeguards to prevent damage or interruption to existing facilities and maintain access to them.
PCN 7 Trenching, bore pits and/or other excavations shall not be left open or unsafe overnight.
PCN 8 Excavation within 1000 feet of a signalized intersection will require notification by the encroaching party to
the Division Traffic Engineer at telephone number [phone], no less than one week prior to
beginning work. All traffic signal or detection cables must be located prior to excavation. Cost to replace
or repair NCDOT signs, signals, pavement markings or associated equipment and facilities shall be the
responsibility of the encroaching party.
PCN 9 This agreement does not authorize installations within nor encroachment onto railroad rights of way.
Permits for installations within railroad right of way must be obtained from the railroad and are the
responsibility of the encroaching party.

Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
Legal & Right -of -Way
RW 1 This approval and associated plans and supporting documents shall not be interpreted to allow any
design change or change in the intent of the design by the Owner, Design Engineer, or any of their
representatives. Any revisions or changes to these approved plans or intent for construction must be
obtained in writing from the Division Engineer's office or their representative prior to construction or
during construction, if an issue arises during construction to warrant changes.
RW 2 NCDOT does not guarantee the right of way on this road, nor will it be responsible for any claim for
damages brought about by any property owner by reason of this installation. It is the responsibility of the
encroaching party to verify the right of way.
RW 4 Encroaching party shall be responsible for obtaining all necessary permanent and/or temporary
construction, drainage, utility and/or sight distance easements.
RW 6 No commercial advertising shall be allowed within NCDOT Right of Way.
RW 7 The encroaching party shall obtain proper approval from all affected pole owners prior to attachment to
any pole.
Work Zone Traffic Control
TC 2 WORK ZONE TRAFFIC CONTROL QUALIFICATIONS AND TRAINING PROGRAM
All personnel performing any activity inside the highway right of way are required to be familiar with the
NCDOT Maintenance / Utility Traffic Control Guidelines (MUTCG). No specific training course or test is
required for qualification in the Maintenance /Utility Traffic Control Guidelines (MUTCG).
All flagging, spotting, or operating Automated Flagger Assist Devices (AFAD) inside the highway right of
way requires qualified and trained Work Zone Flaggers. Training for this certification is provided by
NCDOT approved training resources and by private entities that have been pre -approved to train
themselves.
All personnel involved with the installation of Work Zone Traffic Control devices inside the highway right
of way are required to be qualified and trained Work Zone Installers. Training for this certification is
provided by NCDOT approved training resources and by private entities that have been pre -approved to
train themselves.
All personnel in charge of overseeing work zone Temporary Traffic Control operations and installations
inside the highway right of way are required to be qualified and trained Work Zone Supervisors. Training
for this certification is provided by NCDOT approved training resources and by private entities that have
been pre -approved to train themselves.
For questions and/or additional information regarding this training program please refer to
https://connect.ncdot.gov/projects/WZTC/Pages/Training.aspx or call the NCDOT Work Zone Traffic
Control Section [phone].

Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
TC 3 The party of the second part shall employ traffic control measures that are in accordance with the
prevailing federal, state, local, and NCDOT policies, standards, and procedures. These policies,
standards, and procedures include, but are not limited to the following:
TC B) NCDOT Maintenance / Utility Traffic Control Guidelines — This document enhances the
fundamental principles and best practices established in MUTCD Part 6, Temporary Traffic Control,
incorporating NCDOT-specific standards and details. It also covers important safety knowledge for a wide
range of work zone job responsibilities.
TC 5 Ingress and egress shall be maintained to all businesses and dwellings affected by the project. Special
attention shall be paid to police, EMS and fire stations, fire hydrants, secondary schools, and hospitals.
TC 6 Traffic shall be maintained at all times. All lanes of traffic are to be open during the hours of 7:00 A.M. to
9:00 A.M. and from 4:00 P.M. to 6:00 P.M. Monday through Friday, during any time of inclement weather,
or as directed by the District Engineer. Any violation of these hours will result in ceasing any further
construction by the Encroaching Party or their contractor.
TC A) The Contractor shall not perform any work on US158 and/or NC12 that would require a lane
closure or alter the traffic flow during the following day and time restrictions: May14th from thirty (30)
minutes before sunset to thirty (30) minutes after sunrise October 4th or any other time when traffic is
unusually heavy.
TC 7 Nighttime and weekend operations will NOT be allowed unless written approval is received from the
District Engineer. If nighttime or weekend work is allowed or required, all signs must be retro-reflective,
and a work zone lighting plan must be submitted for approval prior to construction.
TC 8 Two-way traffic shall be maintained at all times unless designated by the District Engineer. Traffic shall
not be rerouted or detoured without the prior written approval from the District Engineer. No utility work
will be allowed on state holidays from 7:00 PM the night before through 9:00 AM the day prior to, following
or during local events without prior approval from the District Engineer. If the construction is within 1000
feet of a school location or on a designated bus route, the construction shall be coordinated with the
school start and end times to avoid traffic delays.
TC 9 Work requiring lane or shoulder closures shall not be performed on both sides of the road simultaneously
within the same area.
TC 10 Any work requiring equipment or personnel within 5 feet of the edge of any travel lane of an undivided
facility and within 10 feet of the edge of any travel lane of a divided facility shall require a lane closure
with appropriate tapers per current NCDOT Roadway Standard Drawings or MANUAL ON UNIFORM
TRAFFIC CONTROL DEVICES.
TC 13 Any pavement markings that are damaged or obliterated shall be restored by the encroaching party at no
expense to NCDOT.

_ Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
TC 14 Sidewalk closures shall be installed as necessary. Pedestrian traffic shall be detoured around these
closures and shall be signed appropriately and in accordance with The American with Disabilities Act
Accessibility Guidelines. The encroaching party must adhere to the guidelines for accommodating
pedestrians in encroachment work zones as described in the NCDOT Pedestrian Work Zone
Accommodations Training found at https://www.youtube.com/watch?v=AOuYa5lW3dg&feature=youtu.be
TC 15 Parking and material storage shall not be allowed along the shoulders of any NCDOT roadways, any
NCDOT roadways along the route and adjacent to the route.
TC 16 During periods of construction inactivity, place approved traffic control drums 3' minimum from the
existing travel way.
TC 17 Any violation of the Traffic Control provisions will result in the termination of the encroachment agreement
and liquidated damages in the amount of $2,000 per hour or any portion thereof and will be assessed by
the District Engineer's office.
Environmental Regulations
EC 1 The encroaching party shall comply with all applicable Federal, State and local environmental regulations
and shall obtain all necessary Federal, State and local environmental permits, including but not limited to,
those related to sediment control, stormwater, wetland, streams, endangered species and historical sites.
Additional information can be obtained by contacting the NCDOT Roadside Environmental Engineer
regarding the North Carolina Natural Heritage Program or the United States Fish and Wildlife Services.
Contact the Division Roadside Environmental Engineer's Office at [phone]
EC 2 When surface area in excess of one acre will be disturbed, the Encroacher shall submit a Sediment and
Erosion Control Plan which has been approved by the appropriate regulatory agency or authority prior to
beginning any work on the Right of Way. Failure to provide this information shall be grounds for
suspension of operations. Proper temporary and permanent measures shall be used to control erosion
and sedimentation in accordance with the approved sediment and erosion control plan.
EC 3 The Verification of Compliance with Environmental Regulations (VCER-1) form is required for all non -
utility encroachment agreements or any utility encroachments when land disturbance within NCDOT right
of way exceeds 1 acre. The VCER-1 form must be PE sealed by a NC registered professional engineer
who has verified that all appropriate environmental permits (if applicable) have been obtained and all
applicable environmental regulations have been followed.

Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
EC 4 All erosion control devices and measures shall be constructed, installed, maintained, and removed by the
Encroacher in accordance with all applicable Federal, State, and Local laws, regulations, ordinances, and
policies. Permanent vegetation shall be established on all disturbed areas in accordance with the
recommendations of the Division Roadside Environmental Engineer. All areas disturbed (shoulders,
ditches, removed accesses, etc.) shall be graded and seeded in accordance with the latest NCDOT
Standards Specifications for Roads and Structures and within 15 calendar days with an approved
NCDOT seed mixture (all lawn type areas shall be maintained and reseeded as such). Seeding rates per
acre shall be applied according to the Division Roadside Environmental Engineer. 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.
EC 5 No trees within NCDOT shall be cut without authorization from the Division Roadside Environmental
Engineer. An inventory of trees measuring greater than 4 caliper inches (measured 6" above the ground)
is required when trees within C/A right of way will be impacted by the encroachment installation.
Mitigation is required and will be determined by the Division Roadside Environmental Engineer's Office.
EC 6 Prior to installation, the Encroaching Party shall contact the District Engineer to discuss any
environmental issues associated with the installation to address concerns related to the root system of
trees impacted by boring or non -utility construction of sidewalk, roadway widening, etc.
EC 7 The applicant is responsible for identifying project impacts to waters of the United States (wetlands,
intermittent streams, perennial streams and ponds) located within the NCDOT right-of-way. The
discharge of dredged or fill material into waters of the United States requires authorization from the
United States Army Corps of Engineers (USAGE) and certification from the North Carolina Division of
Water Quality (NCDWQ). The applicant is required to obtain pertinent permits or certification from these
regulatory agencies if construction of the project impacts waters of the United States within the NCDOT
right-of-way. The applicant is responsible for complying with any river or stream Riparian Buffer Rule as
regulated by the NCDWQ. The Rule regulates activity within a 50-foot buffer along perennial streams,
intermittent streams and ponds. Additional information can be obtained by contacting the NCDWQ or the
USACE.
EC 8 The contractor shall not begin the construction until after the traffic control and erosion control devices
have been installed to the satisfaction of the Division Engineer or their agent.
EC 10 Vegetative cover shall be established on all disturbed areas in accordance with the recommendations of
the Division Roadside Environmental Engineer.

)Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
General
G 1 An executed copy of the encroachment agreement, provisions and approved plans shall be present at the
construction site at all times. If safety or traffic conditions warrant such an action, NCDOT reserves the
right to further limit, restrict or suspend operations within the right of way.
G 2 The Encroaching Party and/or their Contractor shall comply with all OSHA requirements. If OSHA visits
the work area associated with this encroachment, the District Office shall be notified by the encroaching
party immediately if any violations are cited.
G 3 Any REVISIONS marked in RED on the attached non -PE sealed plans shall be incorporated into and
made part of the approved encroachment agreement.
G 4 All disturbed areas are to be fully restored to current NCDOT minimum roadway standards or as directed
by the Division Engineer or their representative. Disturbed areas within NCDOT Right -of -Way include,
but not limited to, any excavation areas, pavement removal, drainage or other features.
G 5 The encroaching party shall notify the Division Engineer or their representative immediately in the event
any drainage structure is blocked, disturbed or damaged. All drainage structures disturbed, damaged or
blocked shall be restored to its original condition as directed by the Division Engineer or their
representative.
G 6 A minimum of 5 feet clearance is required for utility installations beneath or near drainage pipes,
headwalls, and a minimum of 2 feet clearance below the flowline of streams. If directional drilling, a
minimum 10 feet clearance distance is required from drainage structures and a minimum of 5 feet below
flowline of streams.
G 7 At points where the utility is placed under existing storm drainage, the trench will be backfilled with
excavatable flowable fill up to the outside diameter of the existing pipe.
G S Unless specified otherwise, during non -working hours, equipment shall be located away from the job site
or parked as close to the right of way line as possible and be properly barricaded in order not to have any
equipment obstruction within the Clear Recovery Area. Also, during non -working hours, no parking or
material storage shall be allowed along the shoulders of any state -maintained roadway.
G 10 Guardrail removed or damaged during construction shall be replaced or repaired to its original condition,
meeting current NCDOT standards or as directed by the Division Engineer or their representative.
12 Right of Way monuments disturbed during construction shall be referenced by a registered Land
Surveyor and reset after construction.
G 13 All Traffic signs moved during construction shall be reinstalled as soon as possible to the satisfaction of
the Division Engineer or their representative.

Encroachment General Provisions
141717/)
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
G 14 Any utility markers, cabinets, pedestals, meter bases and services for meter reading required shall be as
close to the Right of Way line as possible. If it is not feasible to install at or near Right of Way line, then
written approval shall be obtained from NCDOT prior to installation.
G 15 Detection tape, where required by NCGS § 87-115 through § 87-130 of the Underground Utility Safety
and Damage Prevention Act, shall be buried in the trench approximately 1 foot above the installed facility.
Where conduit is installed in the right of way and is not of ferrous material, locating tape or detection wire
shall be installed with the conduit.
G 16 All driveways disturbed during construction shall be returned to a state comparable with the condition of
the driveways prior to construction.
G 19 If the approved method of construction is unsuccessful and other means are required, prior approval must
be obtained through the District Engineer before construction may continue.
G 19 Open cut of pavements SHALL NOT be allowed without prior approval from the District Engineer. Boring
shall be utilized. If allowed, appropriate traffic control, pavement protection measures, and pavement
repair techniques as stated in these provisions, NCDOT manuals, and as directed by the District Engineer
shall be utilized.
G 21 The proposed utility shall be placed at a minimum depth of 3' from finished ground for plowing or
trenching installations.
G 22 Strict compliance with the Policies and Procedures for Accommodating Utilities on Highway Rights of
Way manual shall be required.
G 23 The encroaching party may delegate the performance of certain provisions of this agreement to
contractors or other parties. However, this shall not in any way release the encroaching party from its
obligations to the terms and provisions of the encroachment.
G 24 The encroaching party shall assume all responsibility, obligation, and liability for maintenance and
operation of the installation permitted under this encroachment agreement. This condition shall be
conveyed in any future buy, lease, sell or rental agreement. In the event that the encroaching party, or
any future responsible party should fail to satisfy this condition, NCDOT reserves the right close or
remove the installation at the encroaching party's expense.
G 25 A one-year warranty shall be required on all work performed within the NCDOT right of way. It shall
commence after District review and acceptance of the completed work associated with the encroachment.

.)Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
Engineering
E 1 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: ASTM
Standards, Manual on Uniform Traffic Control Devices, NCDOT Utilities Accommodations Manual,
NCDOT Standard Specifications for Roads and Structures, NCDOT Roadway Standard Drawings,
NCDOT Asphalt Quality Management System manual, and the approved plans.
E 3 Regulator stations, metering stations, cathodic test stations, and anode beds are not permitted within
NCDOT right of way. Header wires are permitted.
E 5 All wiring and related electrical work shall conform to the latest edition of the National Electrical Safety
Code.
Location Within Right -of -Way
L 1 All utility access points, such as manholes, vaults, handholes, splice boxes and junction boxes shall be
located as close to the right of way line as possible and shall not be placed in the ditch line, side slopes of
the ditches or in the pavement. All manholes, handholes, splice boxes, junction boxes and vaults and
covers shall be flush with the ground when located within the vehicle clear zone. Slack loops for
telecommunications in industry standard housing units shall be buried a minimum of 18 inches when
buried or meet minimum NCDOT vertical and horizontal clearances when installed aerially.
L 5 Hot box (aka ASSE 1060) or Safe-T-Cover type enclosures covering utility main pipe joints, backflow
preventers, valves, vent pipes, cross connections, pumps, grinders, irrigation assemblies, transformers,
generators, and other similar large appurtenances shall be located outside sight distance triangles and off
of the NCDOT Right -of -Way.
Excavation
EX 1 Excavation material shall not be placed on pavement.
EX 2 It is the responsibility of the encroaching party or their contractor to prevent any mud/dirt from tracking
onto the roadway. Any dirt which may collect on the roadway pavement from equipment and/or truck
traffic on site shall be immediately removed to avoid any unsafe traffic conditions.

Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
EX 3 The utility shall be installed within 5 feet of the right of way line and outside the 5-foot minimum from
travel lane plus theoretical 2:1 slope from the edge of pavement to the bottom of the nearest excavation
wall for temporary shoring. If the 2:1 slope plus 5 feet requirement above is met for traffic, then
temporary shoring is typically only necessary to protect roadways from damage when a theoretical 1:1
slope from the edge of pavement intersects the nearest excavation wall. This rule of thumb should be
used with caution and does not apply to all subsurface conditions, surcharge loadings and excavation
geometries. Situations where this 1:1 slope is not recommended include groundwater depth is above
bottom of excavation or excavation is deeper than 10 feet or in Type B or C soils as defined by OSHA
Technical Manual. Temporary shoring may be avoided by locating trenches, bore pits, and other
excavations far enough away from the open travel lane, edge of pavement and any existing structure,
support, utility, property, etc. to be protected. Temporary shoring is required when a theoretical 2:1 slope
from the bottom of excavation will intersect the existing ground line less than 5 feet from the outside edge
of an open travel lane as shown in the figure below or when a theoretical 2:1 slope from the bottom of
excavation will intersect any existing structure, support, utility, property, etc. to be protected.
Ex 3 Open Travel
Lane 5 ft —Existing Ground
—� min Line
Theoretical Edge of
2:1 (H:V) �/[*• [*-.........Pavement
Bottom of
..
Slope H .Excavation
EX a Temporary shoring shall be designed and constructed in accordance with current NCDOT Standard
Temporary Shoring provisions (refer to https://connect.ncdot.gov/resources/Specifications/Pages/2018-
Specifications-and-Special-Provisions.aspx and see SP11 R002).
A) Temporary excavation shoring, such as sheet piling, shall be installed. The design of the shoring
shall include the effects of traffic loads. The shoring system shall be designed and sealed by a licensed
North Carolina Professional Engineer. Shoring plans and design calculations shall be submitted to the
Division Engineer for review and approval prior to construction. (See NCDOT Utilities Accommodations
Manual for more information on requirements for shoring plans and design calculations.) Trench boxes
shall not be accepted as temporary shoring and will not be approved for use in instances where shoring is
required to protect the highway, drainage structure, and/or supporting pavement or structure foundation.
B) All trench excavation inside the limits of the theoretical one-to-one 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. Any excavation that is not backfilled by the end of the workday must
address any safety and traveling public concerns including accommodations for bicycles, pedestrians and
persons with disabilities.

Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
EX 5 The trench backfill material shall meet the Statewide Borrow Criteria. The trench shall be backfilled in
accordance with Section 300-7 of the latest NCDOT Standard Specifications for Roads and Structures,
which basically requires the backfill material to be placed in layers not to exceed 6 inches loose and
compacted to at least 95% of the density obtained by compacting a sample in accordance with AASHTO
T99 as modified by DOT.
EX 7 All roadway sections, ditch lines and slopes, and shoulders affected by the operations under this
encroachment shall be restored to the satisfaction of the District Engineer.
Boring
1 Boring equipment will be provided of a type and size to facilitate boring in the local geologic conditions
and shall be able to facilitate the encroachment work.
2 When Horizontal Directional Drilling (HOD) is used, the following stipulations apply:
A) Use drilling fluids as appropriate for the type soils but use of water alone is prohibited. Pump
drilling fluids only while drilling or reaming. Directional boring using jetting with a Bentonite (or equivalent
material) slurry is recommended. Monitor flow rates to match the amount leaving the bore hole and do
not increase pressure or flow to free stuck drill heads, reamers or piping. Open cutting to retrieve stuck
drill heads is not allowed without prior permission from the District Engineer.
B) The minimum depth shall adhere to the table below for transverse (under non -controlled access,
partial controlled access, or limited controlled access roadway) installations and refers to maximum
diameter of hole drilled and not the dimension of the carrier or encasement pipe.
Diameter of Drilled Hole Minimum Depth of Cover
(Back ream)
2" to 6" 5 feet
>6" to 15" 12 times hole diameter (e.g. 6-inch hole means 6 feet
minimum depth)
>15" to 36" 15 feet or greater
C) Under fully controlled access roadway installations, the minimum depth for transverse crossings
shall be 15 feet under any pavement (ramps or thru lanes)

Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
D) An overbore (backream diameter) shall not be more than 1.5 times the outside diameter of the pipe
or encasement under any highway for pipes 12 inches in diameter or less. For pipes with outer diameter
larger than 12 inches, the overbore may be no larger than outer diameter of pipe plus 6 inches. An
overbore exceeding 1.5 times greater than the outside diameter of the pipe or encasement may be
considered if the encroachment agreement includes a statement signed and sealed by a licensed North
Carolina Professional Engineer indicating that an overbore in excess of 1.5 times the outside diameter of
the pipe or encasement will appropriately arch and no damage will be done to the pavement or sub -grade.
F) Any parallel installation utilizing the directional boring method shall be made at a minimum depth of
five (6) feet (cover) below the ground surface and outside the theoretical 1:1 slope from the existing edge
of pavement except where the parallel installation crosses a paved roadway.
G) All directional bores shall maintain ten (10) feet minimum (clear) distance from the nearest part of
any structure, including but not limited to bridges, footings, pipe culverts or box culverts. Directional
bores are not allowed beneath bridge footings, culvert wingwall footings, slope protection or retaining
walls.
H) The tip of the drill string shall have a cutter head.
Detection wire shall be installed with non-ferrous material.
4 All borings shall be made as perpendicular to the roadway as much as practicable. Any bore exceeding 6
inches shall be cased.
All bores shall provide the following vertical clearances unless stipulated elsewhere: 3' from pavement
subgrade, 3' from ditch line, 3' clear from culverts/conduit, otherwise 3' from finished grade.
B 6 Pavement settlement, buckling, or heaving shall be repaired as directed by the District Engineer. This
may include removal and replacement of pavement and subbase, associated overlay, pavement marking
replacement, etc. as directed by the District Engineer. Any replacements shall be done with like or better
materials as approved by the District Engineer.

Encroachment General Provisions
Our mission is to safely and efficiently manage and facilitate as much as practicable the
accommodation of utilities along NCDOT Highways while protecting our public infrastructure.
DARE COUNTY
Pavement Repair
PR 4 A) The pavement repair shall be as directed by NCDOT. Pavement shall be repaired with a minimum of 3
inches of surface course (S9.56 or S9.5C) and asphalt base course (B25.00) to the original subgrade, or
a minimum of 8 inches, whichever is greater.
B) Asphalt surface course shall be placed in lifts not to exceed 1.5 inches in depth. Asphalt base course
shall be placed in lifts not exceeding 5.5 inches and not less than 4 inches in depth.
C) Work shall be performed by cutting the existing pavement to a neat vertical joint and uniform line;
removing and disposing of pavement, base, and subgrade material as approved or directed by NCDOT;
coating the area to be repaired with a tack coat; and furnishing, placing, and compacting the asphalt plant
mix. An approved compaction
pattern shall be used to achieve proper compaction.
D) The replacement asphalt surface course and asphalt base course shall extend a minimum of 1 foot on
each side of the excavated opening. The thickness of the replacement material shall be sufficient to
provide a base and surface of equivalent
strength to the undisturbed base and surface.
E) Milling and replacement of 1.5 inches of asphalt surface course should extend at least 1 foot beyond
the edge of the pavement cut to create a benched asphalt joint. Additional milling and overlay may be
required.
PR 7 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 pavement work and pavement
markings (temporary and final) are the responsibility of the Encroaching Party.

0d.re.nk. F..r 0'. a ...... on STATE OF NORTH CAROLINA
ROUTE NC-12, SR 1233 PROJECT ca..=+ COUNTY OF Dare
DEPARTMENT OF TRANSPORTATION RIGHT OF WAY ENCROACHMENT AGREEMENT
-AND- PRIMARY AND SECONDARY HIGHWAYS
North Carolina Electric Membership Corporation
3400 Sumner Blvd
Raleigh NC 27616
THIS AGREEMENT, made and entered into this the loth day of February 20 24 by and between the Department
of Transportation, party of the first part; and North Carolina Electric Membership Corporation
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) Outer Banks Scenic Byway (NC-12), Light Plant Road SR 1233) , located from 47109 Licht Plant Road (SR 1233) to the intersection of
SR 1233 and NC-12, then along NC-12 continuously to the south end of the Rodanthe Bridge (except between Buxton and Avon and between Avon and Salvo)
with the construction and/or erection of: an underground fiber optic line.
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 UTILITIES ACCOMMODATIONS MANUAL, 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 Utilities
Manager of the parry of the first part.
That the said parry of the second part 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 the installation and existence of the facilities of the party of the second pan, and if at any time the parry of the first part
shall require the removal of or changes in the location of the said facilities, that the said parry 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 part.
That the party of the second part agrees to provide during construction and any subsequent maintenance proper signs, signal lights,
flagmen 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 parry of the first pad.
That the party of the second part hereby agrees to indemnify and save harmless the party of the first part from all damages and
daims 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
construction 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 miss 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 parry of the
first part.
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 part, 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
first part.
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 parry of the first part unless written waiver is secured by the parry of the
second part from the parry 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 pan of this contract.
It. 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 mated als
FORM RNy 16.1 (Rev. February 2021)

and leases of equipment. The contractor shall not participate either directly or indirectly In the discrimination prohibited by
Section 21.5 of the Regulations. inducting employment practices when the contract covers a program set forth in Appendix B
of the Regulations.
c. Solicitations for Subcontracts includ nit Procurements of Materials and Enulpment: In all solicitations either by competitive
bidding or negotiation made by the contractor for work to be performed under a subcontracl, 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.
of Information and Reports. The contractor shall provide all information and reports required by the Regulations. or directives
issued pursuant thereto, and shall permit access to its books, records, accounts. other sources of information, and its
facildies as may be determined by the Department of Transportation or the Federal Highway Administration to be pennant
to ascertain compliance with such Regulations of directives. Vvhere 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 candy 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 Adminislratbn
may determine to be appropriate, including, but not limited 10.
(U 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 part.
I Incorporation of Provisions: The contractor shall include the provisions of paragraphs -a- through T 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 subcontrad of procurement as the Department
of Transportation or the Federal Highway Administration may direct as a means of mfodng such provisions including
sanctions for noncompliance: Provided. however, thatin the event a contractor becomes Involved in. cur 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 Slate, and. in addhion. the contractor may request
the United Stales to enter into such litigation to protect the interests of the United Stales.
RNV (161) :Party of the Second Part certifies that this [
RW (161) incorporating all revisions to date.
IN WITNESS WHEREOF, each of the parties to this ag
year first above written. - "' ilco
30? V �PO. DJ
ATTEST OR WITNESS
Tim Dodge, Secretary
North Carolina Electric Membership Corporation
INSTRUCTIONS
is true and accurate copy of the form
has caused the same to be executed the day and
TRANSPORTATION
EY: r
swleiew twGilkik K
DISTRICT ENGINEER
/Fart �'i2¢�ciLa�t,
Kenneth Melcher, VP IT Operations
North Carolina Electric Membership Corporation
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 ism file in the Raleigh office of the State Utilities Manager. In the space provided in this agreement for execution, the name of
the corporation or municipality shall be typed above the name. and sire of all persons signing the agreement should be typed directly
below their signature.
When the applicant is not a corporation. (hen 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 attachment. 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. Lowlbn 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. mad, 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 0 affected by encroachment (show vertical and horizontal dimensions from encroachment to
nearest pan of structure).
9. Method of attachment to drainage structures or bridges.
10. Manhole design.
I I On underground utilities, the depth of bury under all traveled lanes. shoulders, etches, sidewalks. etc.
12, Length, size and type of amusement where required.
13. On underground crossings, notation as to method of crossing - boring and jacking, open cut. etc.
14. Location of vents.
GENERAL REQUIREMENTS
1. Any attachment to a bridge or other drainage structure must be approved by the Stale Utilities Manager in Raleigh prior to
submission of encroachment agreement to the Division Engineer.
2. All crossings should be as near as possible normal to the contortions of the highway.
3. Minimum vertical clearances of overhead wires and cables above all roadways must conform to clearances set out in the
National Electric Safety Code.
4. Encasements shall extend from ditch line to ditch Ina in cut sections and 5' beyond lee of slopes in fill sections.
5. All vents should be extended to the night of way line or as otherwise required by the Department.
6. All pipe encasements as to material and strength shall meet the standards and specifications of the Department
7. 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.
8. The Depa hmen('s Division Engineer should be given notice by the applicant prior to actual starting of installation Included in this
agreement.

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