WM0401303_Monitoring Well Permit Application_20210702 (2)

NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
PLEASE TYPE OR PRINT CLEARLY
In accordance with the provisions of Article 7, Chapter 87, General Statutes of North Carolina and regulations pursuant thereto,
application is hereby made for a permit to construct monitoring or recovery wells.
1. Date: 6/28/2021
2. County: Guilford
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Duke Energy Carolinas, LLC
Telephone: [phone]
Applicant's Mailing Address: 526 S Church Street #EC13K, Charlotte, NC 28202-1802
Applicant's Email Address (if available):
5. Contact Person (if different than Applicant): Chris Gilbert
Telephone: [phone]
Contact Person's Mailing Address: 526 S Church Street #EC13K, Charlotte, NC 28202-1802
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): Norfolk Southern Corp & NCDOT Telephone: NA
Property Owner's Mailing Address: Norfolk Southern: 3 Commercial PI Norfolk, VA 23510 &
NCDOT: 1501 Mail Service Center Raleigh, NC27699-1501
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 100 N Centennial St (7800357844)
City High Point County Guilford Zip Code 27260
8. Reason for Well(s): Groundwater Assessment on Norfolk Southern Right of Way and NCDOT Right of Way
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility or site for which the well(s) is(are) needed: Former Manufactured Gas Plant
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
10. Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
#NCD986188837
11. Type of contaminants being monitored or recovered: MGP Related Constituents (i.e., Naphthalene, Benzene)
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 14
Existing Monitoring or Recovery Well Construction Permit No(s).: Guilford County Permit 001-11-MW16-RWO
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 0
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s):
15. Well Contractor: Geologic Exploration, Kenneth Sargent Certification No.: A-4226
Well Contractor Address: 176 Commerce Blvd, Statesville, NC 28625
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following:
a.
b.
c.
d.
Borehole and well diameter
Estimated well depth
Screen intervals
Sand/gravel pack intervals
e. Type of casing material and thickness
f. Grout horizons
Well head completion details
g.
Continued on Reverse

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material: 18 Temp wells (11 turned permanent)
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 18
(add answers from 2 and 3)
5. How will the well(s) be secured? "Dolphin Lock"
Padlock
6. Estimated beginning construction date: July 2021
7. Estimated construction completion date: August 2021
1.
ADDITIONAL INFORMATION
As required by 15A NCAC 02C .0105(f)(5), attach a scaled map of the site showing the locations of the following:
a. All property boundaries, at least one of which is referenced to a minimum of two landmarks such as identified roads, intersections,
streams, or lakes within 500 feet of the proposed well or well system.
b. All existing wells, identified by type of use, within 500 feet of the proposed well or well system.
C. The proposed well or well system.
d. Any test borings within 500 feet of proposed well or well system.
e. All sources of known or potential groundwater contamination (such as septic tank systems, pesticide, chemical or fuel storage areas,
animal feedlots as defined in G.S. 143-215.106(5), landfills, or other waste disposal areas) within 500 feet of the proposed well or well
system.
Property owner consent agreement from Norfolk Southern and an application for a right of way encroachment agreement with the North
Carolina Department of Transportation are attached.
SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction Permit as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these rules
VP, EHS
Signature of Applicant or *Agent Title of Applicant or *Agent
James R. Wells * If signing as Agent, attach authorization agreement stating
Printed name of Applicant or *Agent that you have the authority to act as the Agent.
If the property is owned by someone other than the applicant, the property owner hereby consents to allow the applicant to construct
wells as outlined in this Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the
well(s) conform to the Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
See attached executed agreements with NC Dept. of Transportation and Norfolk Southern consenting to well installations.
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources' Regional Office:
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Phone: [phone]
Fax: [phone]
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
Phone: [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
ik&diethek
/kw= "-IVOR
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
Wil ngton
GW-22MR Rev. 3-1-2016

PROPOSED MONITORING WELL CONSTRUCTION
JOB NAME High Point Former MGP JOB NUMBER 7812-21-0626
WELL NUMBER
T-1 Deep (3 total)
LOCATION (LAT, LONG)
INSTALLATION DATE TBD
TBD
TOP OF CASING ELEVATION (FT AMSL) TBD
GRANULAR BACKFILL MATERIAL #2 Sand SLOT SIZE 0.010 in
SCREEN MATERIAL PVC SCREEN DIAMETER 2 in
RISER MATERIAL PVC RISER DIAMETER 2 in
DRILLING TECHNIQUE Rotary Sonic DRILLING CONTRACTOR Geologic Exploration
BOREHOLE DIAMETER $vi WOOD FIELD
REPRESENTATIVE TBD
LOCK BRAND "Dolphin lock" padlock SIZE/MODEL 35 mm
KEY CODE/COMBINATION Key
GROUND
SURFACE
STEEL MANHOLE COVER
DEPTH TO TOP OF
BENTONITE SEAL
36
DEPTH TO TOP OF
GRANULAR MATERIAL
37
THREADED COUPLING
SCREEN
GRANULAR BACKFILL
CAP
A
LENGTH OF
SOLID SECTION
40
1
CEMENT
BENTONITE
RISER
LENGTH OF
SLOTTED SECTION
5
NOT TO SCALE
TOTAL DEPTH
OF WELL
45
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
FEET
BELOW TOP OF
INNER CASING
MEASURED ON
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina
Completed By: Mike Flanik Date: 5/12/2021

PROPOSED MONITORING WELL CONSTRUCTION
JOB NAME High Point Former MGP JOB NUMBER 7812-21-0626
WELL NUMBER
T-1 Intermediate (3 total)
LOCATION (LAT, LONG)
INSTALLATION DATE TBD
TBD
TOP OF CASING ELEVATION (FT AMSL) TBD
GRANULAR BACKFILL MATERIAL #2 Sand SLOT SIZE 0.010 in
SCREEN MATERIAL PVC SCREEN DIAMETER 2 in
RISER MATERIAL PVC RISER DIAMETER 2 in
DRILLING TECHNIQUE Rotary Sonic DRILLING CONTRACTOR Geologic Exploration
BOREHOLE DIAMETER $vi WOOD FIELD
REPRESENTATIVE TBD
LOCK BRAND "Dolphin lock" padlock SIZE/MODEL 35 mm
KEY CODE/COMBINATION Key
GROUND
SURFACE
STEEL MANHOLE COVER
DEPTH TO TOP OF N
BENTONITE SEAL
16
DEPTH TO TOP OF
GRANULAR MATERIAL
17
THREADED COUPLING
SCREEN
GRANULAR BACKFILL
CAP
A
LENGTH OF
SOLID SECTION
20
1
CEMENT
BENTONITE
RISER
LENGTH OF
SLOTTED SECTION
5
NOT TO SCALE
TOTAL DEPTH
OF WELL
25
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
FEET
BELOW TOP OF
INNER CASING
MEASURED ON
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina
Completed By: Mike Flanik Date: 5/12/2021

PROPOSED MONITORING WELL CONSTRUCTION
JOB NAME High Point Former MGP JOB NUMBER 7812-21-0626
WELL NUMBER
T-1 Shallow (3 total)
LOCATION (LAT, LONG)
INSTALLATION DATE TBD
TBD
TOP OF CASING ELEVATION (FT AMSL) TBD
GRANULAR BACKFILL MATERIAL #2 Sand SLOT SIZE 0.010 in
SCREEN MATERIAL PVC SCREEN DIAMETER 2 in
RISER MATERIAL PVC RISER DIAMETER 2 in
DRILLING TECHNIQUE Rotary Sonic DRILLING CONTRACTOR Geologic Exploration
BOREHOLE DIAMETER $vi WOOD FIELD
REPRESENTATIVE TBD
LOCK BRAND "Dolphin lock" padlock SIZE/MODEL 35 mm
KEY CODE/COMBINATION Key
GROUND
SURFACE
STEEL MANHOLE COVER
DEPTH TO TOP OF
BENTONITE SEAL
1
DEPTH TO TOP OF
GRANULAR MATERIAL
2
THREADED COUPLING
SCREEN
GRANULAR BACKFILL
CAP
A
LENGTH OF
SOLID SECTION
5
a
1
CEMENT
BENTONITE
RISER
LENGTH OF
SLOTTED SECTION
5
NOT TO SCALE
TOTAL DEPTH
OF WELL
10
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
FEET
BELOW TOP OF
INNER CASING
MEASURED ON
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina
Completed By: Mike Flanik Date: 5/12/2021

PROPOSED MONITORING WELL CONSTRUCTION
JOB NAME High Point Former MGP JOB NUMBER 7812-21-0626
WELL NUMBER
T-2 Deep (3 total)
LOCATION (LAT, LONG)
INSTALLATION DATE TBD
TBD
TOP OF CASING ELEVATION (FT AMSL) TBD
GRANULAR BACKFILL MATERIAL #2 Sand SLOT SIZE 0.010 in
SCREEN MATERIAL PVC SCREEN DIAMETER 2 in
RISER MATERIAL PVC RISER DIAMETER 2 in
DRILLING TECHNIQUE Rotary Sonic DRILLING CONTRACTOR Geologic Exploration
BOREHOLE DIAMETER $vi WOOD FIELD
REPRESENTATIVE TBD
LOCK BRAND "Dolphin lock" padlock SIZE/MODEL 35 mm
KEY CODE/COMBINATION Key
GROUND
SURFACE
STEEL MANHOLE COVER
DEPTH TO TOP OF
BENTONITE SEAL
36
DEPTH TO TOP OF
GRANULAR MATERIAL
37
THREADED COUPLING
SCREEN
GRANULAR BACKFILL
CAP
A
LENGTH OF
SOLID SECTION
40
1
CEMENT
BENTONITE
RISER
LENGTH OF
SLOTTED SECTION
5
NOT TO SCALE
TOTAL DEPTH
OF WELL
45
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
FEET
BELOW TOP OF
INNER CASING
MEASURED ON
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina
Completed By: Mike Flanik Date: 5/12/2021

PROPOSED MONITORING WELL CONSTRUCTION
JOB NAME High Point Former MGP JOB NUMBER 7812-21-0626
WELL NUMBER
T-2 Intermediate (3 total)
LOCATION (LAT, LONG)
INSTALLATION DATE TBD
TBD
TOP OF CASING ELEVATION (FT AMSL) TBD
GRANULAR BACKFILL MATERIAL #2 Sand SLOT SIZE 0.010 in
SCREEN MATERIAL PVC SCREEN DIAMETER 2 in
RISER MATERIAL PVC RISER DIAMETER 2 in
DRILLING TECHNIQUE Rotary Sonic DRILLING CONTRACTOR Geologic Exploration
BOREHOLE DIAMETER $vi WOOD FIELD
REPRESENTATIVE TBD
LOCK BRAND "Dolphin lock" padlock SIZE/MODEL 35 mm
KEY CODE/COMBINATION Key
GROUND
SURFACE
STEEL MANHOLE COVER
DEPTH TO TOP OF
BENTONITE SEAL
21
DEPTH TO TOP OF
GRANULAR MATERIAL
22
THREADED COUPLING
SCREEN
GRANULAR BACKFILL
CAP
A
LENGTH OF
SOLID SECTION
25
1
CEMENT
BENTONITE
RISER
LENGTH OF
SLOTTED SECTION
5
NOT TO SCALE
TOTAL DEPTH
OF WELL
30
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
FEET
BELOW TOP OF
INNER CASING
MEASURED ON
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina
Completed By: Mike Flanik Date: 5/12/2021

PROPOSED MONITORING WELL CONSTRUCTION
JOB NAME High Point Former MGP JOB NUMBER 7812-21-0626
WELL NUMBER
T-2 Shallow (3 total)
LOCATION (LAT, LONG)
INSTALLATION DATE TBD
TBD
TOP OF CASING ELEVATION (FT AMSL) TBD
GRANULAR BACKFILL MATERIAL #2 Sand SLOT SIZE 0.010 in
SCREEN MATERIAL PVC SCREEN DIAMETER 2 in
RISER MATERIAL PVC RISER DIAMETER 2 in
DRILLING TECHNIQUE Rotary Sonic DRILLING CONTRACTOR Geologic Exploration
BOREHOLE DIAMETER $vi WOOD FIELD
REPRESENTATIVE TBD
LOCK BRAND "Dolphin lock" padlock SIZE/MODEL 35 mm
KEY CODE/COMBINATION Key
GROUND
SURFACE
STEEL MANHOLE COVER
DEPTH TO TOP OF
BENTONITE SEAL
1
DEPTH TO TOP OF
GRANULAR MATERIAL
2
THREADED COUPLING
SCREEN
GRANULAR BACKFILL
CAP
A
LENGTH OF
SOLID SECTION
5
a
1
CEMENT
BENTONITE
RISER
LENGTH OF
SLOTTED SECTION
5
NOT TO SCALE
TOTAL DEPTH
OF WELL
10
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
FEET
BELOW TOP OF
INNER CASING
MEASURED ON
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina
Completed By: Mike Flanik Date: 5/12/2021

HAY AVE
500 1,000
2,000
Feet
NORTH AVE
LEGEND
Parcel Boundary
• BA RBEE AVE
DAY HE
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LruN4NAPrJ AVE4YE - --f
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USGS The National Map: National Boundaries Dataset, 3DEP Elevation
Program, Geographic Names Information System, National Hydrography
Dataset, National Land Cover Database, National Structures Dataset, and
National Transportation Dataset; USGS Global Ecosystems; U.S. Census
Bureau TIGER/Line data; USFS Road Data; Natural Earth Data; U.S.
Department of State Humanitarian Information Unit; and NOAA National Centers
for Environmental Information, U.S. Coastal Relief Model. Data refreshed
December, 2019.
SITE LOCATION MAP
High Point MGP Site
100 North Centennial Street
High Point, North Carolina
wood.
PREPARED BY: LMM
DATE: 5/21/2020
CHECKED BY: DRH
DATE: 5/21/2020
PROJECT NO.:
7812-20-0395
FIGURE NO.:
1

Holdings
PINa7800357844
90 Feet
MW--02_
Railroad
MW-08-WT
Right -of -Way
STORAGE
HOLDE'.
MW-06D
GAS HOLDER
GAS HOLDERS f
OIL
TANK
NCDOT
Right -of -Way
Highway Commission
MW-05 PIN:7800450993
aye r Credit
PINa7800451792
Orthoimagery
wood.
The map shown here has been created with all due and
reasonable care and is strictly for use with Wood project
number 7812-20-0395 . Wood assumes no liability,
direct or indirect, whatsoever or any such third party or
unintended use.
Notes:
1. Coordinate System: NC State Plane (NAD 1983, feet)
2. Railroad Right -of -Way obtained from Utility Plat by Stantec
dated 5/12/08
F:\AMEC_Projects\2020\7812 20-0395 High Point\MXD\FigurelProposedLocations.mxd, User: leanna.muroski; Checked by: DH Date: 3/4/2021
SITE BOUNDARY
PARCELS
1-1 HISTORICAL SITE FEATURES
- - - - - RAILROAD RIGHT-OF-WAY
LEGEND
▪ MONITORING WELL
▪ PROPOSED TEMPORARY MONITORING
WELL CLUSTER LOCATION
MONITORING WELL ASSUMED
TO BE DESTROYED
PROPOSED DNAPL INVESTIGATION
SOIL BORING
•
PROPOSED TEMPORARY MONITORING WELL
CLUSTER LOCATIONS
HIGH POINT MGP SITE
100 NORTH CENTENNIAL STREET
HIGH POINT, NORTH CAROLINA
PROJECT NO:
7812-20-0395
FIGURE NO:
1
DUKE
ENERGY®

DocuSign Envelope ID: A634D3D7-B178-4E44-B012-C727343B8ACA
NS Law File No. ROE00226
ENVIRONMENTAL RIGHT OF ENTRY AGREEMENT
FIFTH EXTENSION
This Amendment is entered into as of April16 , 2021, between DUKE ENERGY
CAROLINAS, LLC ("Licensee"), a North Carolina Limited Liability Company, and NORFOLK
SOUTHERN RAILWAY COMPANY ("Company"), a Virginia corporation.
WHEREAS Company and Licensee have entered into an Environmental Right of Entry
Agreement, made as of June 10, 2011 and as amended by First Extension dated June 10,
2012, Second Extension dated June 10, 2013, Third Extension dated June 15, 2016 and a
Fourth Extension dated June 20, 2019 (collectively, the "Agreement"), covering the entry of
Licensee onto Company's Property between adjacent to a facility of Licensee at 500-510
Leonard Avenue, High Point, North Carolina for the purpose stated in the original Agreement.
WHEREAS, Licensee wishes to amend the scope of work covered by the Agreement to
include installation and monitoring of additional wells, subject to the terms and conditions set
forth in the Agreement and as set forth in this Fifth Extension..
NOW, THEREFORE, the parties, acknowledging mutual consideration and intending to
be legally bound, agree as follows:
1. The scope of work covered by the Agreement is amended to include the installation and
monitoring of additional monitoring wells, as set forth in the Scope of Work in Exhibit A
hereto. Figure 1 to Exhibit A depicts the approximate location of the monitoring wells.
2. Paragraph 3 of the Agreement is hereby modified to reflect that Company's Division
Engineer is James Erickson at [phone].
3. In the event of any inconsistency or ambiguity between the provisions of the Agreement
and those of this Fifth Extension, the provisions of this Fifth Extension shall prevail.
However, except as expressly modified by this Fifth Extension, the terms and conditions
of Agreement shall continue in full force and effect.
Each of the parties therefore has caused this Fifth Extension to be executed by its duly
authorized representative.
NORFOLK SOUTHERN RAILWAY DUKE ENERGY CAROLINAS INC.
COMPANY
By Kathleen smith By: nib .) AG/A,
Vice President Business Development and Real Estate Title:y �/rTitle: r.‹./✓ PL Date: April 16, 2021 Date: 0/0,o?oa

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
ROY COOPER J. ERIC BOYETTE
GOVERNOR SECRETARY
Guilford
Subject:
June 22, 2021
Encroachment Agreement - Duke Energy - Installation of (3) 2" ID PVC Temporary
Monitoring Wells in the right of way on SR 1113 (Martin Luther King, Jr. Drive - formerly
known as Kivett Dr.) east of Centennial St. (non -system road), EA210653 (E072-041-21-
00109)
Mr. Tim Huie, Senior Real Estate
Duke Energy
526 South Church Street
Charlotte, NC 28202
Dear Mr. Huie:
Attached is a Right of Way Encroachment which has been properly executed.
The Department of Transportation does not guarantee the right of way on this road, nor will it be
responsible for any claim for damages brought by any property owner by reason of the installation.
Approval is contingent upon adhering to the attached special provisions.
If you need additional information, please advise.
WRA/bin/ew
Attachments
cc: B.L. Norris, PE, District Engineer
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
DISTRICT II OFFICE
P. O. BOX 14996
GREENSBORO, NC 27415
Sincerely,
W. R. Archer III, P.E.
Division Engineer
Telephone: [phone]
Fax: [phone]
Customer Service: 1-877-368-4968
Website: www.ncdot.gov
Location:
1584 YANCEYVILLE ST.
GREENSBORO, NC 27405

Special Provisions
16.1A, EA210653 (E072-041-21-00109)
Duke Energy
SR 1113 (Martin Luther King Jr. Drive)
All lanes of traffic are to be opened during the hours of 6:00 A.M. to 9:00 A.M. and from
4:00 P.M. to 6:00 P.M. Traffic will be maintained at all times. No road closure shall be
allowed. No work shall be allowed during holidays.
An executed copy of this Encroachment Agreement shall be present at the construction
site at all times during construction. If safety or traffic conditions warrant such an
action, NC DOT reserves the right to further limit, restrict or suspend operations within
the right of way.
Any work (equipment and or personnel) within 5' of the roadway (pavement) shall
require a lane closure.
This approval is for the portion inside the right of way (R/W) on SR 1113 only. Any
proposed wells in the railroad R/W will need to be approved by the owner of the railroad
and any wells on private property shall need permission from the property owner.
NC DOT does not guarantee the right of way on this road, nor will it be responsible for
any claims for damages brought about by any property owner by reason of this
installation.
Contact Mr. James Marley with the Greensboro District Office (336-487-0100 or
jimarlevlitncdot.gov) 3 business days prior to beginning work in the right of way
on this state maintained road.
All suitable backfill material shall be compacted to 95% density in the shoulder areas,
100% density under pavement areas and in accordance with AASHTO T99 as modified
by the North Carolina Department of Transportation.
Excavation material shall not be placed on the pavement. Drainage structures shall not
be blocked with excavation material.
The encroaching party is required to contact the appropriate Utility Companies involved
and make satisfactory arrangements to adjust the utilities in conflict with the proposed
work prior to beginning construction. No cost to adjust, relocate or repair utilities shall
be borne by the North Carolina Department of Transportation.
Strict compliance with the "Policies and Procedures for Accommodating Utilities on
Highways Rights of Way" manual shall be required.
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, endanger species and historical sites.
The party of the second part shall provide traffic control devices, lane closures, road
closures, positive protection and/or any other warning or positive protection devices
necessary for the safety of motorists and workers during construction and any
subsequent maintenance. This shall be performed in conformance with the latest
NCDOT Roadway Standard Drawings and Standard Specifications for Roads and

Special Provisions
16.1A, EA210653 (E072-041-21-00109)
Duke Energy
SR 1113
page 2
Structures and Amendments or Supplements thereto. When there is no guidance
provided in the Roadway Standard Drawings and Specifications, comply with the
Manual on Uniform Traffic Control Devices for Streets and Highways and Amendment
or Supplement thereto. Information as to the above rules and regulations may be
obtained from the Division Engineer of the party of the first part.
All personnel performing an activity inside of the highway right of way
(R/W) 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.
All flagging, spotting or operating Automated Flagger Assist Devices
(AFAD) inside the highway R/W 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 in charge of overseeing work zone Temporary Traffic Control
operations and installations inside the R/W are required to be qualified
and trained Work Zone Supervisors. Training for this certification is
provided by NCDOT approved training resources.
For questions and/or additional information regarding this training
program please refer to our web site at
https://connect.ncdot.gov/projects/WZTC/Pages/Training.aspx or call J.
S. (Steve) Kite, PE at [phone] or [e-mail] or Roger Garrett
at [phone] or rmgarrettAncdot.gov, both with the NCDOT Work
Zone Traffic Control Section.
NCDOT (or its contractors) shall not be responsible for damage to monitoring wells
due to roadway construction or maintenance activities.
Ground water monitoring wells shall not be allowed in the pavement, medians, or traffic
islands.
Well caps shall be flush mounted with the ground surface with the frames and covers of
a NCDOT approved design for HS 20 loading when installed within clear recovery area
or within routine mowing boundaries.
Wells proposed outside of the clear recovery area and outside of the boundaries of
routine mowing shall be flush mounted but are not required to be designed for HS 20
loading.
Any conversion of a monitoring well to an extraction or remediation system will require
a separate encroachment agreement requiring review by NCDOT's Project Services Unit.

Special Provisions
16.1A, EA210653 (E072-041-21-00109)
Huffman Oil Company
SR 2510
page 3
Spoils from the well installation shall be disposed of outside NCDOT right of way at an
approved site. Any contaminated soils encountered in construction as spoiled from the
well installation shall be removed from NCDOT right of way immediately upon
discovery and properly disposed of in accordance with the governing regulations.
A copy of all tests from the well(s) within the NCDOT right of way shall be made
available to the NCDOT District Engineer's Office.
After the monitoring well(s) has served its intended purpose, the well(s) shall be filled in
a manner approved by NCDENR and NCDOT. Any flush mounted or above ground
obstructions shall be removed from the right of way and the site shall be returned to a
condition satisfactory to the District Engineer.
Any drainage structure disturbed or damaged shall be restored to its original condition
as directed by the District Engineer.
Excavation within 500 feet of a signalized intersection will require notification by
the party of the second part to Ms. Dawn McPherson, Division Traffic Engineer at
[phone]. All traffic signal or detection cables must be located prior to
excavation.
Ingress and Egress shall be maintained to all businesses and dwellings affected by this
project.
All driveways altered during construction shall be returned to a state comparable with
the condition of the driveway prior to construction.
Any and all roadway signs that are removed due to construction shall be reinstalled as
soon as possible.
All disturbed areas shall be repaired with the following rates of seed, fertilizer, and
limestone in pounds per acre, and the areas properly mulched and tacked:
25# Reliant Hard Fescue
100# Alta of Ky. 31 Tall Fescue
25# Kenblue Ky. Bluegrass
100# 5-10-10 Fertilizer
4000# Limestone

ROUTE SR 1113
�2 cam,
PROJECT Duke Energy
Former MGP
oc-t STATE OF NORTH CAROLINA
COUNTY OF
GUILFORD
DEPARTMENT OF TRANSPORTATION
-AND-
DUKE ENERGY CAROLINAS, LLC
526 South Church Street
Charlotte, North Carolina 28202
THIS AGREEMENT, made and entered into this the ZZ41' day of JUL(.E20 Z f , by and betweerr he-Bepart+rtertl`—
of Transportation, party of the first part; and DUKE ENERGY CAROLINAS, LLC
party of the second part,
RIGHT OF WAY ENCROACHM
FOR NON -UTILITY ENCROAC
PRIMARY AND SECONDARY
_AGREEMENT
HWAY li
NTS? ri i7 f Th1
MAR 11 2K 1 IL J
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) SR 1113 (East Marin Luther King Jr. Drive) , located Approximately 260-450 feet east of the intersection
of SR 1311 (East Martin Luther King Jr. Drive, former East Kivett Drive) and North Centennial Street
with the construction and/or erection of: Focused vegetation clearing and installation of 2" iD PVC temporary monitoring well clusters of three, with
the following depths 10', 25', and 45' bgs. Four separate well clusters will be drilled. A sonic technique drilling rig will advance a 6" OD borehole, drill cuttings
will be removed from the ROW. The borehole annular space will be filled with sand and grout. Six of the temporary wells will be become permanent, finished
with a 2'x2' concrete pad and a 2' tall protective metal stick-up post. The other temporary wells will be abandoned by a licensed driller by filling with grout to
surface.
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 said party 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 part, and if at any time the
party of the first part shall require the removal of or changes in the location of the said facilities, that the said party of the second
part binds himself, his successors and assigns, to promptly remove or alter the said facilities, in order to conform to the said
requirement, without any cost to the party of the first 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 party of the first part.
That the party of the second part hereby agrees to indemnify and save harmless the party of the first part from all damages
and claims for damage that may arise by reason of the installation and maintenance of this encroachment.
it is clearly understood by the party of the second part that the party of the first part will assume no responsibility for any
damage that may be caused to such facilities, within the highway rights of way limits, in carrying out its construction and
maintenance operations.
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 rules and
regulations of the North Carolina Division of Environmental Management, North Carolina Sedimentation Control Commission, and
with ordinances and regulations of various counties, municipalities and other official agencies relating to pollution prevention and
control. When any installation or maintenance operation disturbs the ground surface and existing ground cover, the party of the
second part agrees to remove and replace the sod or otherwise reestablish the grass cover to meet the satisfaction of the Division
Engineer of the party of the first 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 encroaching 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 stop 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 party of the first part unless written waiver is secured by the
party of the second part from the party of the first part.
FORM R/W 16.1A (January, 1981)

RAN (161A) : Party of the Second Part certifies that this agreement is true and accurate copy of the form
RNV (161A) incorporating all revisions to date.
IN WITNESS WHEREOF, each of the parties to this agreement has caused the same to be executed the day and
year first above written.
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DEPARTMENT OF TRANSPORTATION
BY:
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INSTRUCTIONS
When the applicant is a corporation or a municipality, this agreement must have the corporate seal and
be attested by the corporation secretary or by the empowered city official, unless a waiver of corporate
seal and attestation by the secretary or by the empowered City official is on file in the Raleigh office of the
Manager of Right of Way. In the space provided in this agreement for execution, the name of the
corporation or municipality shall be typed above the name, and title of all persons signing the agreement
should be typed directly below their signature.
When the applicant is not a corporation, then his signature must be witnessed by one person. The
address should be included in this agreement and the names of all persons signing the agreement
should be typed directly below their signature.
This agreement must be accompanied, in the form of an 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 proposed encroachment.
4. Length and type of encroachment.
5. Location by highway survey station number. If station number cannot be obtained, location
should be shown by distance from some identifiable point, such as a bridge, road,
intersection, etc. (To assist in preparation of the encroachment plan, the Department's
roadway plans may be seen at the various Highway Division Offices, or at the Raleigh
office.)
6. Drainage structures or bridges if affected by encroachment.
7. Typical section indicating the pavement design and width, and the slopes, widths and
details for either a curb and gutter or a shoulder and ditch section, whichever is applicable.
8. Horizontal alignment indicating general curve data, where applicable.
9. Vertical alignment indicated by percent grade, P.I. station and vertical curve length, where
applicable.
10. Amount of material to be removed and/or placed on NCDOT right of way, if applicable.
11. Cross -sections of all grading operations, indicating slope ratio and reference by station
where applicable.
12. All pertinent drainage structures proposed. Include all hydraulic data, pipe sizes, structure
details and other related information.
13. Erosion and sediment control.
14. 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.
15. The Department's Division Engineer should be given notice by the applicant prior to actual
starting of installation included in this agreement.
16. Method of handling traffic during construction where applicable.
17. Scale of plans, north arrow, etc.