WM0801193_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: Columbus
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): [e-mail]
6. Property Owner (if different than Applicant): NC DOT Telephone:[phone]
Property Owner's Mailing Address: 1555 Mail Service Center, Raleigh, NC / PO Box 674, Tabor City, NC 28463
Property Owner's Email Address (if available): NA
5010 James B. White Boulevard South (PIN 0179.04-72-5283.000)
7. Property Physical Address (Including PIN Number) 5053 James B. White Boulevard South (PIN 0179.04-82-9127.000)
City Whiteville County Columbus Zip Code 28472
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).
Incident no. 43180
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, 11
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): 45'
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): 150'
15. Well Contractor: Geological Resources, Inc.
Well Contractor Address: 3502 Hayes Road, Monroe NC 28110
Certification No.: 3270A
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: 4
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 4
(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
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 permit 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

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TYPE II CVO\ITORI\G WELL
TYPICAL CONSTRUCTION DETAILS
CONCRETE PA
GROUND SURFACE
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GROUT CEMENT
BENTONITE SEAL
SAND FILTER PACK
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PROPOSED WELL DEPTH 12' BGS
MANHOLE COVER
Traffic bearing; flush mounted; domestic steel
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0.010 /NCH SLOTTED
2 /NCH DIAMETER
SCHEDULE 40 PVC SCREEN
(PROPOSED SCREEN LENGTH
OF 10 FEET)
END CAP
Time Saver #4
SR 1004/ James B White Highway
Whiteville, Columbus County
GRI 4950
Geological Resources, Inc.
Note:
1. This diagram is not to scale.

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
ROY COOPER J. ERIC BOYETTE
GOVERNOR SECRETARY
May 24, 2022
COUNTY: Columbus
SUBJECT: U.S. Hwy. 701 (James B. White Hwy. S.) Time Saver # 4 — (3) Monitoring Wells
NCDOT # E063-024-22-00066
Mrs./Ms. Lisa Hilbish
Geological Resources, Inc.
3502 Hayes Road
Monroe, N.C. 28110
Dear Mrs./Ms. HIlbish,
Attached for your files is a copy of the Right of Way Encroachment Contract properly executed. This
contract covers the following:
The right to encroach on the right of way of the public road designated as U.S. Hwy. 701 (James B. White
Hwy. S.) located in the intersection of N.C. Hwy. 701 (James B. White Hwy. S.) and S.R. 1004 (Rough
and Ready Road) with the construction and/or erection of:
Three Type II Monitoring Wells to determine the extent of ground water contamination from the service
Station, (Time Saver # 4) Ref. attached plans.
APPROVED SUBJECT TO: Attached Special Provisions (Pre -Construction)
Sincerely,
H.L. Cox, PE
DIVISION ENGINEER
HLC/KLC/s1n
cc: Kenneth L. Clark, P.E. (District Engineer)
Barry Gelezinsky (County Maintenance Engineer)
Mailing Address: Telephone: [phone] Location:
NC DEPARTMENT OF TRANSPORTATION Fax: [phone] PRISON CAMP ROAD
DWISION OF HIGHWAYS Website: www.ncdot.gov WHITEVILLE, NC 28472
1194 PRISON CAMP ROAD
WHITEVILLE, NC 28472

STATE OF NORTH CAROLINA
ROUTE James White Hghway/US 701 PROJECT Time Saver #4 COUNTY OF Columbus
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 25 th day of May , 20 22 , by and between the Department
of Transportation, party of the first part; and Geological Resources, Inc.
WITNESSETH
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) , located Whiteville,Columbus County
with the construction and/or erection of: Three Type -II monitoring well to determine the extent of ground water
contamination associated with Time Saver #4.
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 waming 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 (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 WHEREOF, each of the parties to this agreement has caused the same to be executed the day and
year first above written.
ATTEST OR WITNESS:
Geological Resources, Inc.
gad/10;0U tlewa--
Project Manager, P.G.
DEPARTMENT OF TRANSPORTATION
BY: ` 4-
DIVISION ENGINEER
Geological Resourcps, Inc.
Secretary/► instiativ ' Dirgctor
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.

Pre -Construction
Contact Offices & Outside Agency issues/contacts/info
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.
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] or email to
snobles(.ncdot.gov 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, Blythe L. Jordan at (910) 788-
5300 or email to [e-mail].
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.
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.
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.
5. The encroaching party shall notify the appropriate municipal office prior to beginning any work
within the municipality's limits of jurisdiction.
6. This installation is within the Toll NC XXX right of way. The encroaching party shall notify the
North Carolina Turnpike Authority (NCTA) at telephone [phone] or e-mail
ncta [e-mail] at least ten (10) business days prior to beginning construction. The NCTA
fiber trunk line shall be located prior to any excavation or boring within the Toll NC XXX right of
way. The cost to repair or relocate any signage, cables, signals or associated equipment due to this
installation shall be the responsibility of the encroaching party.
7. The encroaching party is made aware that the XXXXXX Expressway is a toll facility and as such, toll
revenue is required to operate and maintain the facility. If any NCTA owned asset is damaged as a
result of the encroaching party's construction, it shall be repaired at no cost to NCTA. Additionally,
if the damage results in the failure or hindrance of NCTA to properly collect toll revenue (damaged
toll fiber, road closure, safety concern, etc.) the encroaching party will be sought to reimburse NCTA
for the lost revenue.
Page I 1

8. This installation is within the NCDOT Division XX Interstate Corridor right of way. The encroaching
party shall notify the following at least ten (10) business days prior to beginning construction:
NCDOT Division XX Interstate Maintenance: Name, [e-mail] or by phone at XXX-
XXX-XXXX.
9. This installation is within the Mobility Partners (NCDOT Contractor) Managed I-77 Toll Corridor
right of way. The encroaching party shall notify the following at least ten (10) business days prior to
beginning construction:
a. Mobility Partners: David Hannon, dhannonta i77partners.com or by phone at 980-337-
2396 AND [e-mail].
b. NCDOT Division 10 Interstate Maintenance: Michael Mariano, mamariano'a ncdot.gov or by
phone at 980-262-6260.
c. The North Carolina Turnpike Authority (NCTA) at telephone [phone] or e-mail
ncta [e-mail].
The NCTA fiber trunk line shall be located prior to any excavation or boring within the Toll I-77
right of way. The cost to repair or relocate any structure, signage, cables, signals or associated
equipment due to this installation shall be the responsibility of the encroaching party.
10. Excavation within 1000 feet of a signalized intersection will require notification by the encroaching
party to the Division Traffic Engineer at telephone number (###) ###-#### 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.
11. 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.
12. At the option of the District Engineer, a preconstruction meeting including representatives of
NCDOT, the encroaching party, contractors and municipality, if applicable, shall be required.
A pre -construction conference held between a municipality (or other facility owner) and a contractor
without the presence of NCDOT personnel with subsequent construction commencing may be subject
to NCDOT personnel ceasing any work on NCDOT right-of-way related to this encroachment until
such meeting is held. Contact the District office to schedule.
13. At the discretion of the District Engineer, a NO 111,ICATION FOR UTILITY / NON -UTILITY
ENCROACHMENT WITHIN NCDOT R/W form (See corresponding attachment) with the
scheduled pre -construction meeting and associated construction schedule details must be completed
and submitted to the District Engineer's office a minimum of one week prior to construction.
14. At the discretion of the District Engineer, the encroaching party (not the utility contractor) shall make
arrangements to have a qualified inspector, under the supervision of a Professional Engineer
registered in North Carolina, on site at all times during construction. The registered Professional
Engineer shall be required to submit a signed and PE sealed certification that the utility was installed
in accordance with the encroachment agreement.
Legal & Right -of -Way Issues
Page 2

15. 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.
16. 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.
17. Encroaching party shall be responsible for obtaining all necessary permanent and/or temporary
construction, drainage, utility and/or sight distance easements.
18. 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.
19. No commercial advertising shall be allowed within NCDOT Right of Way.
20. The encroaching party shall obtain proper approval from all affected pole owners prior to attachment
to any pole.
21. The installation within the Control of Access fence shall not adversely affect the design, construction,
maintenance, stability, traffic safety or operation of the controlled access highway, and the utility
must be serviced without access from the through -traffic roadways or ramps.
Bonds
22. A Performance and Indemnity Bond in the amount of $2,000.00 shall be posted with the District
Engineer's Office by the Party of the Second Part prior to beginning any work within the NCDOT
Right of Way. The bond shall be held for a minimum of one year after a satisfactory final inspection
of the installation by NCDOT. The bond may be held for a period longer than one year after
completion if, in the opinion of NCDOT, the size or complexity of the installation warrants a longer
period.
23. The release of the bond is subject to a final inspection by NCDOT. Contact the District office to
schedule a Final Inspection and to request release of the bond.
Work Zone Traffic
24. Traffic control shall be coordinated with the District Engineer and the Division Traffic Engineer, Mr.
Kenneth 1,. Clark at telephone [phone], prior to construction.
25. 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).
Page 3

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/Pales/Training.aspx or call the NCDOT Work Zone Traffic
Control Section [phone].
26. 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:
a. Manual on Uniform Traffic Control Devices (MUTCD) — North Carolina has adopted the
MUTCD to provide basic principles and guidelines for traffic control device design,
application, installation, and maintenance. North Carolina uses the MUTCD as a minimum
requirement where higher supplemental standards specific to North Carolina are not
established. Use fundamental principles and best practices of MUTCD (Part 6, Temporary
Traffic Control).
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.
27. If the Traffic Control Supervisor determines that portable concrete barrier (PCB) is required to shield
a hazard within the clear zone, then PCB shall be designed and sealed by a licensed North Carolina
Professional Engineer. PCB plans and design calculations shall be submitted to the District Engineer
for review and approval prior to installation.
28. 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.
29. 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.
30. 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.
31. 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
Page 14

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.
32. Work requiring lane or shoulder closures shall not be performed on both sides of the road
simultaneously within the same area.
33. 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.
34. At the discretion of the District Engineer, a traffic control plan shall be developed and submitted
under the seal and signature of a Licensed North Carolina Professional Engineer prior to construction.
The plan shall be specific to the site and adequately detailed. Issues such as the close proximity to
intersections shall be addressed.
35. Temporary and fmal pavement markings are the responsibility of the encroaching party. Final
pavement markings and sign plans shall be submitted with the encroachment request to the Division
Traffic Engineer prior to construction. Final pavement markings shall be thermoplastic unless
otherwise directed by the Division Traffic Engineer or District Engineer.
36. Any pavement markings that are damaged or obliterated shall be restored by the encroaching party at
no expense to NCDOT.
37. 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=A0uYa5IW3dg&feature=y outu.be
Roadside Environmental
38. 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 910-364-0603.
39. 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.
40. 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
Page 15

professional engineer who has verified that all appropriate environmental permits (if applicable) have
been obtained and all applicable environmental regulations have been followed.
41. 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.
42. 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.
43. 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.
44. 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. 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.
45. 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.
46. The contractor shall perform all monitoring and record keeping and any required maintenance of
erosion and sediment control measures to maintain compliance with stormwater regulations.
STIP (or Division Managed) Projects
47. State Transportation Improvement Project (STIP) **-XXXXXX is scheduled for future construction.
Any encroachment determined to be in conflict with the construction of this NCDOT project shall be
removed and/or relocated at the encroaching party's expense.
Page 16

Construction
General
48. 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.
49. 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.
50. Any REVISIONS marked in RED on the attached non -PE sealed plans shall be incorporated into and
made part of the approved encroachment agreement.
51. 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.
52. 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.
53. A minimum of 5 feet clearance is required for utility installations beneath or near drainage pipes,
headwalls, and a minimum of two -foot clearance below the flowline of streams. If directional
drilling, a minimum ten -foot clearance distance is required from drainage structures and a minimum
of 5 feet below flowline of streams.
54. 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.
55. 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 Zone. Also, during non -working hours, no parking
or material storage shall be allowed along the shoulders of any state -maintained roadway.
56. No access to the job site, parking or material storage shall be allowed along or from the Control of
Access Roadway.
57. 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.
58. The resetting of the Control of Access fence shall be in accordance with the applicable NCDOT
standard and as directed by the Division Engineer or their representative.
59. Right of Way monuments disturbed during construction shall be referenced by a registered Land
Surveyor and reset after construction.
Page 17

60. All Traffic signs moved during construction shall be reinstalled as soon as possible to the satisfaction
of the Division Engineer or their representative.
61. 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.
62. 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.
63. All driveways disturbed during construction shall be retumed to a state comparable with the condition
of the driveways prior to construction.
64. Conformance with driveway permit review should be required in conjunction with this encroachment
agreement. In the event there is a conflict between the driveway permit and the encroachment
agreement, the District Engineer should resolve the conflict and notify the parties involved.
65. 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.
66. The encroaching party and their construction contractor must sign and submit the NCDOT
Workforce Safety Plan for Encroachment Activities: COVID-19 form to the District Engineer
prior to construction.
67. The attached Duke Energy response to the NCDOT COVID-19 Workforce Safety Plan shall be
applied for all employees on the job site unless otherwise directed by the District Engineer.
Engineering
68. 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.
69. Prior approval for any blasting must be obtained from the Division Engineer or their representative.
70. Regulator stations, metering stations, cathodic test stations, and anode beds are not permitted within
NCDOT right of way. Header wires are permitted.
71. Non -Utility Communication and Data Transmission installations (ground mounted type or Small Cell
pole -mounted type) must adhere to guidelines in the Utilities Accommodations Manual and, when
located within municipal jurisdictions, are subject to review and approval by municipal ordinances
and any additional municipal approval for proximity to historic districts and landmarks. All wiring
and related telecommunications work shall conform to the latest regulations by the Federal
Communications Commission.
Pagel 8

72. All wiring and related electrical work shall conform to the latest edition of the National Electrical
Safety Code.
Location within R/W
73. 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.
74. Fire Hydrants shall be of the breakaway type. Hydrants shall be placed near the right of way line. In
curb and gutter sections with written approval from the District, the hydrants may be placed at 6'
behind the back of the curb or minimum 2' back of sidewalk.
75. Luminaire and/or utility poles and guy wires shall be set as close to the Right of Way line as practical
and outside the Clear Zone in accordance with the latest version of the AASHTO Roadside Design
Guide (See corresponding attachment) or made breakaway in accordance with the requirements of
NCHRP Report 350. Any relocation of the utility poles from the original design due to Clear Zone
requirements shall require a re -submittal for the utility design.
76. Luminaire and/or utility poles shall be set a minimum of 5'-6" behind face of any guardrail or
otherwise sufficiently protected. However, standard placement may be reduced to 3'-6" behind face
of guardrail when posts are spaced 3'-1 'h", or where speed limit is less than 55 MPH.
77. 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.
78. Sprinkler heads shall be located a minimum of 10 feet from the edge of pavement, edge of shoulder,
or back of curb whichever is greater and shall be directed so that water does not spray or drain on the
roadway surface, sidewalk, or passing vehicles at any time. Upon completion of the installation and
prior to activation of the system, the Encroacher shall contact the District Engineer to schedule a test
of the system to verify the spray pattern. Sprinkler systems shall not be operated during periods of
high wind or freezing weather, or to the extent that the subgrade adjacent to the pavement structure
becomes saturated. NCDOT reserves the right to require immediate termination and removal of any
sprinkler system which in its judgement and opinion adversely affects safety, maintenance, or
operation of the roadway.
Excavation
79. Excavation material shall not be placed on pavement.
Page 19

80. 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.
81. 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. 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.
Traffic in Outside Lane
Lane Open to
T raffia5 ft
Cni ,-rain
Traffrc Shifted (Outside Lane Closure)
Lane Cpen to
ie Traffic
Lane Closed
1
—I min
4 ,—Existing Ground
Line
Edge of
Pavement
Theoretical
2:1 fd-t:V) Slope
If the 2:1 slope plus 5 feet requirement above
is ,-net 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 wail. This rule of thumb should be
used vwth caution and does not apply to all
subsurface conditions, s. surcharge loadings and
excavation geornetriies Mditfrnal guidance
provided helm_
Page l 10
/eAr
Bottom of
Exoavat?on
Theoretical
2:1 (H:V) Slope
Existing Ground
Line
*Theoretical
1:1 (RN) Elope
(from Edge of
Pavement)
Bottom of
Excevatlon

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 shall be designed and constructed in accordance with current NCDOT Standard
Temporary Shoring provisions (refer to
http s://connect.ncdot. gov/resources/Specifications/Pages/2018-S pecifications-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, design calculations, and subsurface investigation report.)
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 two -to -one slope plus 5 feet
requirement, 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.
c. 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.
d. At the discretion of the Division Engineer, a qualified NCDOT inspector shall be on the site
at all times during construction. The encroaching party shall reimburse NCDOT for the cost
of providing the inspector. If NCDOT cannot supply an inspector, the encroaching party (not
the utility contractor) should make arrangements to have a qualified inspector, under the
supervision of a licensed North Carolina Professional Engineer, on the site at all times. The
Professional Registered Engineer shall certify that the utility was installed in accordance with
the encroachment agreement and that the backfill material meets the Statewide Borrow
Criteria.
e. The length of parallel excavation shall be limited to the length necessary to install and
backfill one joint of pipe at a time, not to exceed twenty-five (25) feet.
82. All material to a depth of 8 inches below the finished surface of the subgrade shall be compacted to a
density equal to at least 100% of that obtained by compacting a sample of the material in accordance
with AASHTO T99 as modified by the Department. The subgrade shall be compacted at a moisture
content which is approximately that required to produce the maximum density indicated by the above
test method. The contractor shall dry or add moisture to the subgrade when required to provide a
uniformly compacted and acceptable subgrade. The option to backfill any trenches with dirt or either
#57 stone or #78 stone with consolidation with a plate tamp and without a conventional density test
may be pursued with.the written consent of the District Engineer. If this option is exercised, then
roadway ABC stone and asphalt repair as required will also be specified by the District Engineer.
Pagel 11

Directional bore
83. 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.
84. When Horizontal Directional Drilling (HDD) 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
(Backream)
2" to 6"
Minimum Depth of Cover
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)
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.
e. Directional boring is allowed beneath embankment material in naturally occurring soil.
f. Any parallel installation utilizing the directional boring method shall be made at a minimum
depth of five (5') 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.
i. Detection wire shall be installed with non-ferrous material.
j. HDPE pipe installed by directional boring shall not be connected to existing pipe or fittings
for one (1) week from the time of installation to allow tensional stresses to relax.
Page 112

Aerial clearances
85. Vertical clearance of overhead power and communication lines shall meet the National Electrical
Safety Code requirements except the minimum vertical clearance shall be 18' for crossings over
NCDOT roadways (24' over Fully Controlled Access roadways) and 16' for parallel installations.
86. In relation to the bridge, the utility line shall be located with minimum clearances as indicated on the
attachment for NCDOT Required Clearances for Aerial Installations by Encroachment Near
Bridge Structures.
Pavement Detail and Repair
87. The paving of this roadway shall be in accordance with the latest version of NCDOT Standard
Specifications, Sections 610, 1012 and 1020. The Contractor shall follow all procedures of the
Quality Management System (QMS) for asphalt pavement - Maintenance Version (see
https://connect.ncdot.gov/resources/Materials/MaterialsResources/2018%20QMS%20Asphalt%20Ma
nual.pdf). The Contractor must adhere to all testing requirements and quality control requirements
specified. The Contractor shall contact the NCDOT Division QA Supervisor prior to producing plant
mix and make the Supervisor aware that the mix is being produced for a future NCDOT road.
Contact the District Engineer to determine the NCDOT Division QA Supervisor. Only NCDOT
approved mix designs will be acceptable. A Quality Control Plan shall be submitted (as Directed by
the District Engineer) to the District Engineer's Office prior to asphalt production utilizing form
QMS-MV1. Failing mixes and/or densities are subject to penalties including monetary payments or
removal and replacement. To minimize traffic queuing in construction areas, the possibility of traffic
detours may be considered when working on high traffic routes even if traffic control is used. The
District Engineer may require traffic detours.
88. When paving beyond utility installation is involved, a Roadway certification report sealed by a
Professional Engineer shall be submitted to the District Engineer's office 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.
89. "Potholing" pavement cores to expose existing utilities shall be made with an 18" diameter keyhole
pavement core. Pavement core locations shall not be placed in the wheel path whenever
possible. Vacuum excavation shall be utilized to expose underground utilities. Pavement cores shall
be repaired within the same working day. The pavement core shall be retained and reused to fill the
core hole.
The excavation shall be backfilled and compacted with select material to the bottom of the existing
pavement structure or as indicated by the District Engineer. The retained core shall be placed in the
hole and secured with a waterproof, mechanical joint. If the pavement core is damaged and cannot be
re -used, the core may be replaced with the surface mix, S9.5B. The asphalt patch shall match the
thickness of the existing asphalt or four inches, whichever is greater. All materials must be listed on
the NCDOT Approved Products List (APL) found at:
https://apps.ncdot.gov/vendor/approvedproducts/.
Page 113

90. The minimum pavement design for pavement repair shall be according to NCDOT Standard Drawing
654.01
(https://connect.ncdot.gov/resources/Specifications/2018StandardRdwvDrawings/Division%2006%2
0Asphalt%20Bases%20and%20Pavements.pdf) and shall include a mechanical overlay extent to be a
minimum of 25 feet each side of the pavement repair area OR as directed by the District Engineer.
91. Pavement cuts shall be repaired the same day the cuts are made unless an asphalt patch cannot be
accomplished the same day due to material availability or time restrictions. When the asphalt patch is
not feasible, the following apply:
a. The pavement cut shall be filled to the surface with ABC stone or Flowable Fill per
NCDOT's Standards and Specifications.
b. Once the cut is filled, a minimum %-inch steel plate shall be placed and pinned to prevent
moving. Plates shall be designed large enough to span a minimum of 1-foot on all sides on
the pavement cut.
c. When flowable fill is used, it shall cure for 24 hours prior to any asphalt material placement.
Flowable fill bleed water shall not be present during paving operations. Paving shall not
cause damage (shoving, distortion, pumping, etc.) to the flowable fill.
d. Install and leave `BUMP" signs according to MUTCD until the steel plate has been removed.
Once the flowable fill has cured, remove the steel plate, and mill/fill according to the
directions of the District Engineer.
e. All pavement cuts must be sealed with NCDOT approved sealant to prevent future pavement
separation or cracking.
92. 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 fmal) are the responsibility of the Encroaching Party.
Post Construction
Close out/ Inspection
93. The Encroaching party shall notify the District Engineer's office within 2 business days after
construction is complete. The District Engineer may perform a construction inspection. Any
deficiencies may be noted and reported to the encroaching party to make immediate repairs or resolve
any issues to restore the right-of-way to a similar condition prior to construction, including pavement,
signage, traffic signals, pavement markings, drainage, structures/pipes, or other highway design
features.
94. At the discretion of the District Engineer, a final inspection report may be provided to the
encroaching party upon satisfactory completion of the work.
95. A written acknowledgement of the completed work by the District Engineer's office begins the one-
year warranty period associated with the performance bond.
Page 114

96. If the actual construction differs from the approved plans associated with this encroachment, a copy
of "as -built" plans shall be submitted to the District Engineer's office in a PDF format and in a
current ESRI GIS format within 4 weeks of construction.
97. The encroaching party shall provide the North Carolina Turnpike Authority (NCTA) with an
electronic copy of coordinate correct as -built plans within two weeks of installation completion.
Failure to provide the as -built plans may jeopardize future approvals within NCTA right of way.
98. A copy (in PDF format) of the completed ground water analysis shall be given to the District
Engineer, including detailed drawings of the "as -built" wells showing location, depth and water level
in well.
Page 115

ATTACHMENT FORM
NOTIFICATION FOR UTILITY / NON -UTILITY ENCROACHMENT WITHIN NCDOT R/W
Instructions for use:
This form must be completed in its entirety and submitted directly to the designated personnel in the District Engineer's
office via email, fax or hand delivery a minimum of one week prior to construction for the encroachment. If the
designated NCDOT personnel names are unknown by the person completing this form, please contact the District
Engineer's office to determine that contact info.
Date: Submitted by Name:
To: District Personnel Name: _Stephen L. Nobles
District Personnel Email: [e-mail]
District Fax No.: [phone]
This notification is to inform you that we (encroaching party or their contractor) will begin construction
work on the following project in a minimum of one week.
Encroachment number
(assigned by NCDOT) for the project: E063-024-22-00066
Construction start date:
Approximate ending date:
Contact NCDOT inspector a minimum of 72 hrs. in advance to set-up Preconstruction meeting in the
District Engineer's office or other location as directed by the District Engineer
Preconstruction meeting date & time:
Preconstruction meeting address:
Type of project:
[Examples: power, telecommunication, water, sewer, gas, petroleum, other (describe)]
Contact Info for this project:
Contractor Company Name:
Contractor Contact Name:
Contractor Phone Number:
Contractor Email:
NCDOT Utility Inspector Name:
NCDOT Utility Inspector Phone:
NCDOT Utility Inspector Email:
NCDOT Utility Project Manager Name:
NCDOT Utility Project Manager Phone:
NCDOT Utility Project Manager Email:

Attachment for Clear Zone Guidelines from AASHTO
Roadside Design Guide
Clear Zone 'Table
TABLE 3.1 (Cont'd)
.S. Custonta:•v Units
DESIGN
SPEED
DESIGN
ADT
FORESLOPES
BACKSLOPES
IV:6H
or flatter
1V:5H10
1 V:411
IV:311
1V:311
1V:SHTO
1 V:4H
IV:611
or flatter
40rnph
UNDER750
7-10
7-10
••
7-10 J
7-10
7-110
yr
750-1500
10-12
12-14
••
10-12
10-12
10-12
less
1500-6000
12-14
14-16
*'
12-14
12-14
12-14
OVIR6000
14-16
16--18
*•
14-16
14-16
14--16
45-50
UNDER 750
10-12
12-14
••
8-10
8-10
10-12
mph
750 -1500
14 -16
16 - 20
sus
10-12
1 12-14
14 -16
1500-6000
16-18
20 - 26
*•
12-14
' 14-16
16 _ 18
0VER6000
20-22
24-28
*•
14-16
18-20
20-22
55mph
UNDER750
12-14
14-18
**
8-10 -
10-12
10-12
750 -- 1500
16 - 18
20 - 24
**
10 -12
14 --16
16-18
1500-6000
20-22
24 - 30
**
14.16
16 -18
20 - 22-
OVER600a
22-24
26-32•
*•
16-18
20-22
22-24
60.mpt
UNDER750
16-18
20-24
*4.
10-12
12-14
r
14-16
750--1500
20-24
26-32•
**
12-14
16-18
20-22
1500-6000
26-30
32 - 40 •
**
14-18
18 - 22
24 - 26
OVER6000
30-32*36-44•
*•
20-22
24-26
26-28
65-70
UNDER750
18-20
20-26
*•
10-12
14-16
14--16
mph
750-1500
24-26
28-•36•
**
12-16
18-20
20-22
1500 - 6000
28 - 32 "
34 - 42 *
**
16 - 20
22 - 24
26 - 28
OVER 6000
30 - 34 *
38 - 46 *
**
22 - 24
26-30
28 - 30
'" Where a site specific investigation indicates a high probability of continuing crashes, or such occurrences are indicated by crash
history, Me designer may provide clear=zorte distancesgreater than the clear -zone shown in 'fable 3.1. Clear zones may be limited to
30 ft for practicality and to provide a consistent roadway template if previous experience with similar projects or designs indicates
satisfactory performance.
#• Since recovery is less likely an the unshielded, I-avetsaable IV:3H slopes, fixed Objects should not be present in the vicinity oldie toe
of these slopes. Recovery of high-speed vehicles that encroach beyond the edge of the shoulder may be expected to occur beyond the
toe of slope. Determination of the width of the recovery area at the toe of slope should take into consideration right-of-way
availability, environmental concerns, economic factors, safety needs, and crash histories Also,, the distance between the edge ot'the
through traveled lane and the beginning of the I V:3H slope should influence the recovery arta provided at the toe of slope. While the
application may be limited by several factors, the foreslope parameters which may ender into determining a maximum desirable
recovery area are illustrated in Figure 3.2.

NCDOT Required Clearances for Aerial Installations Near Bridge Structures
NOT
TO
SCALE
Any variation to this detail must be
approved by the Division Engineer
and/or State Utilities Manager.
Published by NCDOT Utilities Unit
June 2020
A
**Minimum
sag clearance
height (See
Note 2)
Bridge Rail
(design varies)
Utility Pole (Typical -Power
and/or Telecommunications)
Varies
!� a
Horizontal
Clearance to
wire nearest
bridge***
■ ■
Minimum =
8 Feet + Table 'A'
for power OR
telecommunications.
Any exception must
be coordinated with
Division Bridge
personnel prior to
■ ( construction.
Bridge Deck
**See
Note
2
Table A — Minimum Horizontal Clearance Distances to POWER Lines
(from OSHA)
VOLTAGE
(nominal, kV, alternating
current)
MINIMUM CLEARANCE
(feet)
Upto50
10
Over 50 to 200
15
Over 200 to 350
20
Over 350 to 500
25
Over 500 to 750
35
Over 750 to 1000
45
Over 1000
As established by the utility
owner/operator or registered
professional engineer who is a qualified
person with respect to electrical power
transmission and distribution
Energized Phase
Conductor
Power Lines (Typical)*
Neutral Conductor
_
(Varies in location attached to
pole)*
Telecommunications line(s)
mounted below any power line OR
on dedicated telecommunication
poles without power lines*
*Note 1: Aerial lines extending to
next pole with lowest elevation at sag
point. Aerial lines drawn as 3-D effect
to represent typical minimum parallel
installation to bridge. structure.
Top of bridge deck extended
Distance varies
to ground
where pole is
installed
**Note 2- MINIMUN SAG CLEARANCE
HEIGHT is 25 feet (applies to
telecommunications AND power).
***Note 3: HORIZONTAL CLEARANCE EXCEPTION. If vertical sag clearance height for power above bridge deck is >_
45 feet AND voltage is < 350kV, then Minimum Horizontal Clearance may be reduced to 3 feet. Any telecommunications
attachment to power pole allowed in this exception must have a minimum 25 feet sag clearance height above bridge deck.

SEEDING AND MULCHING: (East)
The kinds of seed and fertilizer, and the rates of application of seed, fertilizer, and
limestone, shall be as stated below. During periods of overlapping dates, the kind of seed
to be used shall be determined. All rates are in pounds per acre.
March 1 - August 31
50# Tall Fescue
10#
25#
500#
4000#
All Roadway Areas
Centipede
Bermudagrass (hulled)
Fertilizer
Limestone
September 1 - February 28
50# Tall Fescue
10# Centipede
35# Bermudagrass (unhulled)
500# Fertilizer
4000# Limestone
Waste and Borrow Locations
March 1 — August 31
75# Tall Fescue
25# Bermudagrass (hulled)
500# Fertilizer
4000# Limestone
September 1 - February 28
75# Tall Fescue
35#
500#
4000#
Bermudagrass (unhulled)
Fertilizer
Limestone
Note: 50# of Bahiagrass may be substituted for either Centipede or Bermudagrass only
upon Engineer's request.
Adventure
Adventure II
Airlie
Amigo
Anthem
Anthem II
Apache
Apache II
Arid
Arid II
Arid III
Aztec II
Barfexas
Barfexas II
Barrera
Barrington
Bingo
Bravo
Approved Tall Fescue Cultivars
Brookstone
Bonanza
Bonanza I1
Bulldog 51
Chapel Hill
Chesapeake
Chieftain
Coronado
Crossfire II
Debutante
Duster
Escalade
Falcon
Falcon III
Finelawn
Finelawn I
Finelawn Petite
Genesis
Grande
Guardian
Houndog
Inferno
Jaguar
Jaguar III
Kentucky 31
Kitty Hawk
Monarch
Montauk
Mustang
Olympic
Pacer
Paraiso
Pixie
Pyramid
Quest
Rebel
Rebel Jr
Rebel II
Red Coat
Renegade
Safari
Shelby
Shenandoah
Southern Choice II
South Paw
Tempo
Titan
Tomahawk
Tacer
Trailblazer
Tribute
Trooper
Wolfpack
Wrangler

On cut and fill slopes 2:1 or steeper Centipede shall be applied at the rate of 5 pounds per
acre and add 20# of Sericea Lespedeza from January 1 - December 31.
Fertilizer shall be 10-20-20 analysis. Upon written approval of the Engineer, a different
analysis of fertilizer may be used provided the 1-2-2 ratio is maintained and the rate of
application adjusted to provide the same amount of plant food as a 10-20-20 analysis.
TEMPORARY SEEDING:
Fertilizer shall be the same analysis as specified for Seeding and Mulching and applied at
the rate of 400 pounds and seeded at the rate of 50 pounds per acre. Sweet Sudan Grass,
German Millet or Browntop Millet shall be used in summer months and Rye Grain during
the remainder of the year. The Engineer will determine the exact dates for using each
kind of seed.
FERTILIZER TOPDRESSING:
Fertilizer used for topdressing on all roadway areas except slopes 2:1 and steeper shall be
10-20-20. Upon written approval of the Engineer, a different analysis of fertilizer may be
used provided grade and shall be applied at the rate of 500 pounds per acre. Upon the 1-
2-2 ratio is maintained and the rate of application adjusted to provide the same amount of
plant food as 10-20-20 analysis.
Fertilizer used for topdressing on slopes 2:1 and steeper and waste and borrow areas shall
be 16-8-8 grade and shall be applied at the rate of 500 pounds per acre. Upon written
approval of the Engineer, a different analysis of fertilizer may be used provided the 2-1-1
ratio is maintained and the rate of application adjusted to provide the same -amount of
plant food as 16-8-8 analysis.
SUPPLEMENTAL SEEDING:
The kinds of seed and proportions shall be the same as specified for Seeding and
Mulching, with the exception that no centipede seed will be used in the seed mix for
supplemental seeding. The rate of application for supplemental seeding may vary from
25# to 75# per acre. The actual rate per acre will be determined prior to the time of
topdressing and the Contractor will be notified in writing of the rate per acre, total
quantity needed, and areas on which to apply the supplemental seed. Minimum tillage
equipment, consisting of a sod seeder shall be used for incorporating seed into the soil as
to prevent disturbance of existing vegetation. A clodbuster (ball and chain) may be used
where degree of slope prevents the use of a sod seeder.
MOWING:
The minimum mowing height on this project shall be 4 inches.

TYPE II MONITORING WELL
TYPICAL CONSTRUCTION DETAILS
CONCRETE PA
GROUND SURFACE._
0'
GROUT CEMENT
BENTON/TE SEAL
SAND FILTER PACK
Ow-
PROPOSED WELL DEPTH 12' BGS
Geological Resources, Inc.
. •
F
---MANHOLE COVER
,i Traffic bearing; flush mounted; domestic steel
.--LOCK/NG WELL CAP
0'
2 /NCH DIAMETER
SCHEDULE 40 PVC CASING
(PROPOSED CAS/NG LENGTH
OF 2 FEET)
TOP OF BENTON/TE 2' 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
Time Saver #4
SR 1004! James B White Highway
Whiteville, Columbus County
GRI 4950
Note:
1. This diagram is not to scale.

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