WM0501488_Application_20220602

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: 6/2/22
2. County: Wake
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Geological Resources Inc. Telephone: [phone]
Applicant's Mailing Address: 3502 Hayes Road, Monroe NC 28110
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
Applicant's Email Address (if available): rtb©geologicalresourcesinc.com
5. Contact Person (if different than Applicant): Rae Troiano Brown
Telephone: [phone]
Contact Person's Mailing Address: 3502 Hayes Road, Monroe NC 28110
Contact Person's Email Address (if available): rtb©geologicalresourcesinc.com
6. Property Owner (if different than Applicant): NC DOT Telephone: [phone]
Property Owner's Mailing Address: 1555 Mail Service Center, Raleigh, NC
Property Owner's Email Address (if available): NA
7. Property Physical Address (Including PIN Number) 900 Poole Drive (PIN 1710387331) /1400 Aversboro Road (PIN 1710386088)
City Garner County Wake Zip Code 27529
8. Reason for Well(s): assessment ground water contamination
(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: petroleum retail facility
(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).
No
11. Type of contaminants being monitored or recovered: petroleum
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 5
Existing Monitoring or Recovery Well Construction Permit No(s).: N/A
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 25'
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: Geological Resources, Inc. Certification No.: 3270A
Well Contractor Address: 3502 Hayes Road, Monroe NC 28110
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. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth f. Grout horizons
c. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured?
material: 3
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 3
(add answers from 2 and 3)
Bolted manhole cover with locking well cap
6. Estimated beginning construction date: June 2022
7. Estimated construction completion date: June 2022
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. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
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
Project Manager, P.G.
Signature of Applicant or "Agent Title of Applicant or Agent
Rae Troiano Brown
" 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 DOT NC DOT
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]
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]
GW-22MR Rev. 3-1-2016

Property
Raleigh Sewer
d Sewer Manhole Sewer Manhole
Gravity Sewer Gravity Sewer
USGS Blue Line Streams
World Imagery
World Imagery
Disclaimer
0 25 50 100 ft iMaps makes every effort to produce and publish
the most current and accurate information possible.
i i i I i i i , However, the maps are produced for information purposes,
and are NOT surveys. No warranties, expressed or implied
,are provided for the data therein, its use, or its interpretation.
1 inch equals 50 feet

TYPE II MO\ITOI\G WELL
TYPICAL CONSTRUCTION DETAILS
CONCRETE PA
GROUND SURFACE
GROUT CEMENT
BENTONITE SEAL
d
4
4
4
e
MANHOLE COVER
Traffic bearing; flush mounted; domestic steel
LOCKING WELL CAP
44
a
4
2 /NCH DIAMETER
SCHEDULE 40 PVC CAS/NG
(PROPOSED CAS/NG LENGTH
OF 2 FEET)
4 4 TOP OF BENTON/TE 2' BGS
SAND FILTER PACK
PROPOSED WELL DEPTH 20' BGS
TOP OF SAND PACK 3' BGS
0.010 /NCH SLOTTED
2 /NCH DIAMETER
SCHEDULE 40 PVC SCREEN
(PROPOSED SCREEN LENGTH
OF 10 FEET)
END CAP
GR
Geological Resources, /nc.
Webb's Mini Mart
900 Poole Drive
Garner, Wake County
GRI 5456
Note:
1. This diagram is not to scale.

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
ROY COOPER J. ERIC BOYETTE
GOVERNOR SECRETARY
May 23, 2022
County: Wake
Subject: Encroachment Contract
SR 2710
E051-092-22-00105
Geological Resources Inc
3502 Hayes Road
Monroe, NC 28110
Dear Sire or Madam,
Attached for your files is a copy of Right of Way Encroachment Agreement, which has been properly
executed. This contract covers the following:
3 type II monitoring well
CONTINUING INDEMNITY BOND REQUIRED
This encroachment is approved subject to the Standard and Special Provisions which are attached to
and made a part of the Encroachment Contract.
Sincerely
Jeremy Warren Digitally signed by Jeremy Warren
Date: 2022.05.23 11:44:55 -04'00'
Jeremy Warren, PE, District Engineer
for B. H. Jones, PE, Division Engineer
BHJ/JLW/sdw
cc: Jeremy Warren (w/ orig)
Attachment
Mailing Address: Telephone: [phone] Location:
NC DEPARTMENT OF TRANSPORTATION Fax: [phone] DISTRICT DRIVE
DIVISION 5 — DISTRICT 1 Customer Service: 1-877-368-4968 RALEIGH, NC 27607
1575 MAIL SERVICE CENTER
RALEIGH, NC 27699-1575
Website: www.ncdot.gov

Encroachment Special Provisions
1. A Continuing Indemnity Bond of $100,000.00 shall be posted and in place with the NCDOT State
Utilities Manager. Each monitoring well will have $5000.00 bond associated with it and shall
remain in place until the monitoring well(s) have been removed to the satifaction of the NCDOT's
District Engineer's Office issuing the Encroachment Agreement. Provide written request for the
bond reduction per well once removed, to the issuing District Engineer's Office referencing the
Encroachment Agreement number.
2. Notify the District Office at 919-733-3213 a minimum of 48 hours prior to beginning work.
3. NCDOT WORK ZONE TRAFFIC CONTROL QUALIFICATIONS AND TRAINING PROGRAM:
A. Effective July 1, 2010, all flagging operations within NCDOT Right of Way require qualified
and trained Work Zone Flaggers.
B. Effective July 1, 2011, qualified and trained Work Zone Traffic Control Supervisors will be
required on Significant Projects.
C. Training for this certification is provided by NCDOT approved training sources and by private
entities that have been pre -approved to train themselves. If you have questions, contact our web
site at http://www.ncdot.org/doh/preconstruct/wztc/WZTCTrainingProgram/default.html, or
contact Stuart Bourne, P.E. with NCDOT Work Zone Traffic Control Unit at [phone] or
[e-mail].
4. Before work begins, please forward the contact information of the general contractor to the Senior
Assistant District Engineer, Sean Brennan, P.E. at [e-mail]. Include contact name,
emergency phone number and email.
5. This encroachment agreement only covers work within the NCDOT Right -of -Way as shown on
the attached plans.
6. Any personnel or equipment working within five feet of a travel lane shall require a full lane
closure. No lane of traffic shall be closed or restricted between the hours of 6:00 AM to 9:00 AM
and 4:00 PM to 7:00 PM Monday thru Friday, during any time of inclement weather, holiday, or
upon District Engineers' directive. Traffic shall be maintained at all times. Any violation of these
hours will result in termination of the encroachment agreement and liquidated damages in the
amount of $5,000.00 per hour or any portion thereof will be assessed by the District Engineers
Office.
7. All (cast -in -place and/or pre -cast) splice boxes, handholes, manholes, drainage structures and
other appurtenances within NCDOT Right of Way shall be of a NCDOT approved design for
traffic bearing, HS-20 loading, and shall be flush mounted. Manholes, handholes and vaults shall
not be placed in the ditch -line, side slopes of the ditch or in the pavement.
All frames, grates, rings, covers, etc. are to be manufactured in accordance with the requirements
of Section 106-1B - "Domestic Steel". Foreign castings are not approved for use within NCDOT
Right of Way.
8. The roadway shall be kept free of mud, dirt and debris at all times.
E051-092-22-00105
Page 2 of 8

9. This encroachment only covers the monitoring wells shown on the attached plan. Any additional
wells within NCDOT right of way at this location shall require an encroachment revision.
The proposed wells shall be placed as shown on the attached plans. Monitoring wells shall be flush
mounted with the ground/pavement surface in areas within the clear recovery area and the routine
mowing boundaries and shall not be placed in the ditch line, side slopes of the ditches or in the
pavement.
All costs for adjustments at the proposed monitoring wells due to relocation, resurfacing, highway
construction or other improvements shall be the responsibility of the encroaching party.
Any contaminated soils encountered in construction as spoil from the well installation shall be
removed from the Right of Way prior to completion of the wells.
After any monitoring well has served its intended purpose, the encroaching party shall fill the well
in a manner approved by the Division of Environmental Management. Any above ground
obstructions shall also be removed from the right of way.
NCDOT accepts no responsibility for proposed monitoring wells. All costs and/or maintenance of
proposed borings shall be the responsibility of the encroaching party.
10 All bare and disturbed areas must have a sufficient stand of vegetation. Address any erosion issues
that may arise during time of construction. Monitor these areas as needed to assure this
requirement is satisfied.
11 Current and future state projects take precedence over this encroachment.
E051-092-22-00105
Page 3 of 8

Encroachment Standard Provisions
1. An executed copy of this encroachment agreement will be present at the construction site at all
times during construction. NCDOT reserves the right to stop all work unless evidence of approval
can be shown.
2. NCDOT reserves the right to revise, restrict, suspend and/or void this encroachment agreement if
the execution and/or operation of said permit is found to be a hazard to the traveling public.
3. This encroachment agreement only covers work within NCDOT Right -of -Way. The encroacher is
responsible for verifying all right of way. NCDOT does not guarantee the right of way on this
road. If the right of way was not obtained by the fee simple method, it is the responsibility of the
encroacher to obtain permission from the underlying property owner/owners.
Encroacher shall be responsible for obtaining all necessary permanent and/or temporary
construction, drainage, utility and/or sight distance easements. All Right of Way and easements
necessary for construction and maintenance shall be dedicated to NCDOT with proof of dedication
furnished to the District Engineer prior to beginning work.
4. The encroacher is responsible for any claim for damages brought by any property owner by reason
of the installation.
5. Notify the District Engineer's Office at [phone] or at 4009 District Drive, Raleigh, NC
27607, prior to beginning and after completion of work.
6. The Encroacher shall notify the public, including all adjacent property owners and businesses, a
minimum of 2 weeks prior to beginning work.
7. Any and all changes noted in red on the plans shall be incorporated into and made part of the
approved permit.
8. The encroaching party shall comply with all applicable local, state and federal environmental
regulations, and shall obtain all necessary state and federal environmental permits, including but
not limited to, those related to sediment control, storm water, wetland, streams, endangered
species, and historical sites.
9. All materials and construction shall be in accordance with NCDOT standards and specifications,
including but not limited to, the NCDOT Standard Specifications for Roads and Structures 2018,
the NCDOT Roadway Standards Drawings, and NCDOT Policies and Procedures for
Accommodating Utilities on Highway Rights of Way.
E051-092-22-00105
Page 4 of 8

10 The encroacher 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 road
users 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 Structures and Amendments or Supplements thereto. When there is no guidance
provided in the Roadway Standard Drawings or Specifications, comply with the Manual on
Uniform Traffic Control Devices for Streets and Highways and Amendments or Supplements
thereto. No work shall be performed in the Right of Way unless this requirement is satisfied.
NCDOT reserves the right to require a written traffic control plan for encroachment operations.
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.
11 No parking or material storage shall be allowed along the shoulders of any NCDOT roadways.
12 Two-way traffic shall be maintained at all times.
13 No lane closures shall be permitted between the hours of 6:00 AM to 9:00 AM and 4:00 PM to
7:00 PM, Monday through Friday unless otherwise specified in the Special Provisions of this
encroachment agreement.
14 At the end of each working day, equipment shall be parked outside of the clear recovery zone in
order to avoid any obstruction to the travelling public. This clear recovery zone is measure from
the edge of the nearest travel lane.
15 Work shall not be performed on both sides of the road simultaneously within the same area.
16 Ingress and egress shall be maintained to all businesses and dwellings at all times.
17 The paving of this roadway shall be in accordance with the revised NCDOT 2012 Standard
Specifications, Sections 610, 1012 and 1020. The Contractor shall follow all procedures of the
attached Quality Management System (QMS) for asphalt pavement - Maintenance Version. The
Contractor must adhere to all testing requirements and quality control requirements specified. The
Contractor shall contact the NCDOT Division 5 QA Supervisor at [phone] prior to
producing plant mix and make the Supervisor aware that the mix is being produced for a future
NCDOT road. Only NCDOT approved mix designs will be acceptable. A quality control plan
shall be submitted to the District Engineer's Office prior to asphalt production. Use form QMS-
MV1 for the Quality Control Plan submittal. Failing mixes and/or densities are subject to
penalties including monetary payments or removal and replacement.
18 Roadway certification reports sealed by a Professional Engineer shall be submitted to the North
Carolina Department of Transportation at 4009 District Drive, Raleigh, North Carolina, indicating
the following:
* Pavement thickness by type
* Pavement density, core and/or test locations
* Base thickness
* Base density
* Subgrade density
Test frequency and method shall be in conformance with the NCDOT "Materials and Tests"
Manual. Test must be performed by a Certified Technician including name and Certification
number on report.
E051-092-22-00105
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19 Any existing driveways, pavement, sidewalk, curb and gutter or drainage structures that are
damaged during construction shall be repaired to their original condition.
20 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.
21 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. All earth areas shall be re -graded and seeded in accordance with
NCDOT Standards Specifications for Roads and Structures 1995. Seeding rates per acre shall be
the following:
* Year Round Mixture: 50# Pensacola Bahia Grass; 50# KY 31 Tall Fescue; 5# Centipede; 500#
10-20-20 Fertilizer; 4000# Limestone;
* 2:1 Slopes Standard Mix: Use Year Round Mixture (Delete Centipede); Add 25# Service
Lespedeza;
* If Using Crown Vetch on 2:1 Slope (September -May): Use Year Round Mixture; Add Crown
Vetch 15 lbs./Ac.; (Delete Centipede and Bahia)
22 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 (USACE) 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. Additional information can
be obtained by contacting the USACE or NCDWQ.
23 The applicant is responsible for avoiding impacts to federally protected species during project
construction. Bald eagle, Michaux's sumac, smooth coneflower, dwarf wedgemussel, harperella,
red -cockaded woodpecker and tar spinymussel are federally protected species that have been
identified within NCDOT right-of-way in Durham, Person, Granville, Wake, Franklin, Vance, and
Warren counties. Additional information can be obtained by contacting the North Carolina
Natural Heritage Program or the United States Fish and Wildlife Services.
24 The applicant is responsible for complying with the Neuse and Tar -Pamlico 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.
25 Existing drainage patterns shall be maintained at all times throughout the proposed construction.
The encroacher shall keep the roadway clean of dirt and debris at all times throughout the duration
of the project.
26 All proposed landscaping and plantings located within the NCDOT right of way shall be approved
by the Division Roadside Environmental Unit. Contact Corey Sudderth at [phone].
In the event these plants require relocation or removal for highway construction, reconstruction, or
maintenance of safety, such removal or relocation will be done immediately by the permittee upon
notification by the NCDOT entirely at the expense of the permittee.
E051-092-22-00105
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27 The Division Traffic Engineer, shall be notified at [phone] prior to any excavation within
500 feet of a signalized intersection or if there are existing NCDOT signs in or near the proposed
work zone. All traffic signal or detection cables must be located prior to excavation. All signal
work and traffic signs shall be coordinated with the Division Traffic Engineer. Costs to relocate,
replace, or repair NCDOT signs, signals, or associated equipment shall be the responsibility of the
Encroacher.
28 All temporary and final pavement markings, reflective pavement markings and signage are the
responsibility of the Encroacher. All final pavement markings shall be thermoplastic. Any
pavement markings that are damaged or obliterated shall be restored at no expense to NCDOT.
29 All Traffic signs moved shall be reinstalled as soon as possible to meet NCDOT specifications.
30 Strict compliance with the Policies and Procedures for Accommodating Utilities on Highway Right
of Way manual shall be required.
31 It shall be the responsibility of the Encroacher to determine the location of other utilities within the
encroachment area. The Encroacher shall be responsible for notifying other utility owners and
providing protection and safeguards to prevent damage or interruption to existing facilities and to
maintain accessibility to existing utilities.
32 All earth areas disturbed shall be re -graded and reseeded in accordance with Division of Highways
Standards and Specifications.
33 The Encroacher shall remove all trees, stumps and vegetative material from the right of way and
dispose of in a licensed landfill or disposal site.
34 Excavated material shall not be placed on the roadway at any time.
35 Trenching, bore pits and/or other excavations shall not be left open or unsafe overnight. The
Contractor shall comply with all OSHA requirements and provide a competent person on site to
supervise excavation at all times.
36 All excavations inside the theoretical 1:1 slope from the existing edge of pavement to the bottom of
the nearest excavation wall should be made in accordance with the following conditions. Traffic
should be moved to a travel lane outside the limits of a theoretical one-to-one slope from the
bottom of the nearest trench wall to the pavement surface. Active 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 an engineer registered in North Carolina. Trench
boxes shall not be accepted as shoring. The trench backfill material should meet the Statewide
Borrow Criteria.
37 Excavated areas adjacent to pavement having more than a 2 inch drop shall be made safe with a
6:1 or flatter slope and shall be designated by appropriate delineation during periods of
construction inactivity, including, but not limited to, night and weekend hours.
38 Backfill material is to be placed at a maximum of 6 inch loose layers and each layer thoroughly
compacted. All embankment backfill shall be compacted to 95% density and all subgrade to 100%
density in accordance with AASHTO T-99 as modified by NCDOT. They shall be signed by a
Professional Engineer and sent to the District Engineers Office at 4009 District Drive, Raleigh, NC
27607.
E051-092-22-00105
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39 No commercial advertising shall be allowed within NCDOT Right of Way.
40 Guardrail shall be installed where warranted and in accordance with the guidelines shown in the
2012 Highway Design Branch Roadway Standard Drawings.
Guardrail removed or damaged during construction shall be replaced or repaired to their original
condition.
41 Poles shall be located/relocated at or as near as possible to the right-of-way line, shall be set
outside the Clear Recovery Area as outlined by AASHTO and outside sight distance triangles.
Poles located within guardrail sections shall be installed a minimum of 5 feet behind any
guardrail. When applicable, poles shall be placed behind sidewalk.
Any associated guy wires to ground anchors and stub poles shall not be placed between a pole and
the travel way and should be located outside the clear recovery area.
Minimum vertical clearance shall be 18' for aerial crossings over NCDOT roadways and 15'-6" for
installations parallel to the roadway.
42 Fire Hydrants shall be of the break -away type. Hydrants shall be placed a maximum of one foot
inside the right of way in ditch sections or a minimum of 6 feet behind the curb in curb and gutter
sections.
43 Retaining walls or other vertical structures shall not be permitted inside NCDOT right of way.
E051-092-22-00105
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ROUTE SR 2710
STATE OF NORTH CAROLINA
PROJECT Webb's Mini Mart COUNTY OF Wake
DEPARTMENT OF TRANSPORTATION
-AND-
Geological Resources, Inc.
3502 Hayes Road
Monroe, NC 28110
RIGHT OF WAY ENCROACHMENT AGREEMENT
FOR NON -UTILITY ENCROACHMENTS ON
PRIMARY AND SECONDARY HIGHWAYS
THIS AGREEMENT, made and entered into this the 23rd day of May , 20 22
of Transportation, party of the first part; and Geological Resources, Inc.
WITNESSETH
, by and between the Department
party of the second part,
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 2710 , located Garner, Wake County
with the construction and/or erection of: Three Type II Monitoring Wells for the purpose of assessing petroleum impacted ground
ground water associated with Webb's Mini Mart
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 herei n
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 (Revised February 2021)

R/W (161A) : Party of the Second Part certifies that this agreement is true and accurate copy of the form
R/W (161A) incorporating all revisions to date.
IN WITNESS WHERE -OF, each of the parties to this agreement has caused the same to be executed the day and
year first aba_w veritte i.
�, .�
ATTEST ORVVItNESS° -'
Geological Resouces, Inc Geological Resouces, Inc.
.4411
Secretary
JtLL►1/4A
Vice President. Account Management
DEPARTMENT OF TRANSPORTATION
`�A`/ Digitally signed by Jeremy Warren
BY: Jeremy • ` �� Date: 2022.05.23 11:44:42 -04'00'
for DIVISION ENGINEER, Brandon H. Jones, PE
Second Party
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
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 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.

Property
Raleigh Sewer
d Sewer Manhole Sewer Manhole
Gravity Sewer Gravity Sewer
USGS Blue Line Streams
World Imagery
World Imagery
Disclaimer
0 25 50 100 ft iMaps makes every effort to produce and publish
the most current and accurate information possible.
i i i I i i i , However, the maps are produced for information purposes,
and are NOT surveys. No warranties, expressed or implied
,are provided for the data therein, its use, or its interpretation.
1 inch equals 50 feet

TYPE II MO\ITOI\G WELL
TYPICAL CONSTRUCTION DETAILS
CONCRETE PA
GROUND SURFACE
GROUT CEMENT
BENTONITE SEAL
d
4
4
4
e
MANHOLE COVER
Traffic bearing; flush mounted; domestic steel
LOCKING WELL CAP
44
a
4
2 /NCH DIAMETER
SCHEDULE 40 PVC CAS/NG
(PROPOSED CAS/NG LENGTH
OF 2 FEET)
4 4 TOP OF BENTON/TE 2' BGS
SAND FILTER PACK
PROPOSED WELL DEPTH 20'8GS
TOP OF SAND PACK 3' BGS
0.010 /NCH SLOTTED
2 /NCH DIAMETER
SCHEDULE 40 PVC SCREEN
(PROPOSED SCREEN LENGTH
OF 10 FEET)
END CAP
GR
Geological Resources, /nc.
Webb's Mini Mart
900 Poole Drive
Garner, Wake County
GRI 5456
Note:
1. This diagram is not to scale.