WM0801236_Application_20231106

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: October 31, 2023
4
County:
Columbus
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant:
The Chemours Company FC LLC
Applicant's Mailing Address: 22828 NC Highway 87W, Fayetteville, NC 28306
5.
H
7
A
a
Applicant's Email Address (if available): [e-mail]
Telephone: [phone]
Contact Person (if different than Applicant): Savannah Volkoff Telephone: [phone]
Contact Person's Mailing Address: 2501 Blue Ridge Rd, Suite 430, Raleigh, NC, 27607
Contact Person's Email Address (if available):
[e-mail]
Property Owner (if different than Applicant): NCDOT ROW Enroachment
Property Owner's Mailing Address: See attached
Property Owner's Email Address (if available): NA
Telephone: [phone]
Property Physical Address (Including PIN Number) Multiple locations - See attached figures & approved DOT permit
City See attached figures/DOT permit County See attached figures/DOT permit Zip Code See figs/permit
Reason for Well(s): Groundwater Monitoring Wells
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed: NA
(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).
NA
11. Type of contaminants being monitored or recovered: PFAS
(ex: organics, nutrients, heavy metals, etc.)
12
13
Are there any existing wells associated with the proposed well(s)? If yes, how many? No
Existing Monitoring or Recovery Well Construction Permit No(s).: NA
Distance from proposed well(s) to nearest known waste or pollution source (in feet): None
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Possible private residence wells
15
If yes, give distance(s):
Well Contractor: SAEDACCO
Well Contractor Address: 9088 Northfield Dr., Fort Mill, SC 29707
Certification No.: 4220
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
material: 6
3. Number of wells to be constructed in bedrock:
a
How will the well(s) be secured? Flush -mount well vault
6. Estimated beginning construction date: November 1, 2023
4. Total Number of wells to be constructed: 6 7. Estimated construction completion date: November 1, 2024
(add answers from 2 and 3)
ADDITIONAL INFORMATION
1. 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 assumes total responsibility for ensuring that the well(s) will be located, constructed, maintained, and abandoned in
accordance with 15A NCAC 02C.
Sathya Yalvigi 1ig41yaigne°1y Sathya Vaivigl
DN. ­Sathya Va gi, -US, o= CM1emours Company, ou=Corporate
Reme°iation Group, email-SatM1ya [e-mail]
4.11 Ofi fl]-3fi:0f1-f15'Ofl'
Signature of Applicant or *AgentDa1e z
Sathya Valvigi
Printed name of Applicant or *Agent
Title of Applicant or *Agent
* If signing as Agent, attach authorization agreement stating
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
well(s) as outlined in this Well Construction Permit application and acknowledges that it shall be the responsibility of the Applicant to
ensure that the well(s) will be located, constructed, maintained, and abandoned in accordance with 15A NCAC 02C.
Signature of Property Owner (if different than Applicant)
NCDOT (See Attached Encroachment Agreement for Signature)
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 Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [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]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
GW-22M/R (Rev. 5-26-2022)

STATE OF NORTH CAROLINA
DEPARTN MNT OF TRANSPORTATION
ROY COOPER
GOVERNOR
September 5, 2023
COUNTY: Columbus
NCDOT # E063-024-23-00127
REFERENCE: Groundwater Monitoring Wells (Teledyne ISCO model 6712)
Sathya Yalvigi (Sr. Remedial Project Mgr.)
The Chemours Company FC LLC
Fayetteville Works
22828 NC Highway 87 W
Fayetteville, NC 28306
Dear Sathya Yalvigi,
J. ERIC BOYETTE
SECRETARY
Attached for your files is a copy of the Right of Way Encroachment Contract properly executed.
This contract covers the following:
Proposed along Route NC905 between Bug Hill and Pireway Townships, located in Columbus
County with the construction and or/erection of: environmental, groundwater monitoring wells.
APPROVED SUBJECT TO: Attached Special Provisions
Sincerely,
P' L . L-e� 0--\�
H.L. Cox, PE,
DIVISION ENGINEER
HLC/KLC/bww
Attachments
cc: Kenneth L. Clark, PE (District Engineer)
Jonathan Blackwell (County Maintenance Engineer)
Mailing Address: Telephone: [phone] Location:
NC DEPARTMENT OF TRANSPORTATION Fax: [phone] PRISON CAMP ROAD
DIVISION OF HIGHWAYS Website: www.ncdot.gov WHITEVIILE, NC 28472
1194 PRISON CAMP ROAD
WHITEVILLE, NC 28472

STATE OF NORTH CAROLINA
ROUTE multiple (see attached) PROJECT E063-024-23-00127 COUNTY OF Columbus
DEPARTMENT OF TRANSPORTATION
-AND-
The Chemours Company, FC LLC- Fayetteville Works
22828 NC Highway 87 W
Fayetteville, NC 28306
RIGHT OF WAY ENCROACHMENT AGREEMENT
FOR NON -UTILITY ENCROACHMENTS ON
PRIMARY AND SECONDARY HIGHWAYS
THIS AGREEMENT, made and entered into this the 6 day of Sent. , 20 23 by and between the Department
of Transportation, party of the first part; and The Chemours Company, FC LLC - Fayetteville Works
party of the second part,
WITNESSETH
THAT WHEREAS, the party of the second part desires to encroach on the right of way of the public road designated as
Route(s) multiple (see attached figures) , located in Columbus
with the construction and/or erection of: environmental, groundwater monitoring wells
WHEREAS, it is to the material advantage of the party of the second part to effect this encroachment, and the
party of the first part in the exercise of authority conferred upon it by statute, is willing to permit the encroachment
within the limits of the right of way as indicated, subject to the conditions of this agreement;
NOW, THEREFORE, IT IS AGREED that the party of the first part hereby grants to the party of the second
part the right and privilege to make this encroachment as shown on attached plan sheet(s), specifications and
special provisions which are made a part hereof upon the following conditions, to wit:
That the said party of the second part binds and obligates himself to install and maintain the encroaching facility in such safe
and proper condition that it will not interfere with or endanger travel upon said highway, nor obstruct nor interfere with the proper
maintenance thereof, to reimburse the party of the first part for the cost incurred for any repairs or maintenance to its roadways
and structures necessary due to the installation and existence of the facilities of the party of the second part, and if at any time the
party of the first part shall require the removal of or changes in the location of the said facilities, that the said party of the second
part binds himself, his successors and assigns, to promptly remove or alter the said facilities, in order to conform to the said
requirement, without any cost to the party of the first part.
That the party of the second part agrees to provide during construction and any subsequent maintenance proper signs, signal
lights, flagmen and other warning devices for the protection of traffic in conformance with the latest Manual on Uniform Traffic
Control Devices for Streets and Highways and Amendments or Supplements thereto. Information as to the above rules and
regulations may be obtained from the Division Engineer of the party of the first part.
That the party of the second part hereby agrees to indemnify and save harmless the party of the first part from all damages
and claims for damage that may arise by reason of the installation and maintenance of this encroachment.
It is clearly understood by the party of the second part that the party of the first part will assume no responsibility for any
damage that may be caused to such facilities, within the highway rights of way limits, in carrying out its construction and
maintenance operations.
That the party of the second part agrees to restore all areas disturbed during installation and maintenance to the satisfaction of
the Division Engineer of the party of the first part. The party of the second part agrees to exercise every reasonable precaution
during construction and maintenance to prevent eroding of soil; silting or pollution of rivers, streams, lakes, reservoirs, other water
impoundments, ground surfaces or other property; or pollution of the air. There shall be compliance with applicable rules and
regulations of the North Carolina Division of Environmental Management, North Carolina Sedimentation Control Commission, and
with ordinances and regulations of various counties, municipalities and other official agencies relating to pollution prevention and
control. When any installation or maintenance operation disturbs the ground surface and existing ground cover, the party of the
second part agrees to remove and replace the sod or otherwise reestablish the grass cover to meet the satisfaction of the Division
Engineer of the party of the first part.
That the party of the second part agrees to assume the actual cost of any inspection of the work considered to be necessary
by the Division Engineer of the party of the first part.
That the party of the second part agrees to have available at the encroaching site, at all times during construction, a copy of
this agreement showing evidence of approval by the party of the first part. The party of the first part reserves the right to stop all
work unless evidence of approval can be shown.
Provided the work contained in this agreement is being performed on a completed highway open to traffic; the party of the
second part agrees to give written notice to the Division Engineer of the party of the first part when all work contained herein has
been completed. Unless specifically requested by the party of the first part, written notice of completion of work on highway
projects under construction will not be required.
That in the case of noncompliance with the terms of this agreement by the party of the second part, the party of the first part
reserves the right to stop all work until the facility has been brought into compliance or removed from the right of way at no cost to
the party of the first part.
That it is agreed by both parties that this agreement shall become void if actual construction of the work contemplated herein
is not begun within one (1) year from the date of authorization by the party of the first part unless written waiver is secured by the
party of the second part from the party of the first part.
FORM R/W 16.1A (Revised February 2021)

R/W (161 A) : 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.
C h e ri I rl Digitally signed by
ATTEST OR WITNESS: y cherilynMertes
Date: 2023.08.27
Mertes 15:41:51-04'00'
Cherilyn Mertes, Sr. Scientist
Geosyntec Consultants
DEPARTMENT OF TRANSPORTATION
BY: f i , L- Cal ~
DIVISION ENGINEER
Sathya =. ­Y==un
Yalvigi Uw 0701aW
Sathya Yalvigi, Sr. Remedial Project Manager
1007 Market Street, Wilmington, DE, 19898
INSTRUCTIONS
Second Party
When the applicant is a corporation or a municipality, this agreement must have the corporate seal and
be attested by the corporation secretary or by the empowered city official, unless a waiver of corporate
seal and attestation by the secretary or by the empowered City official is on file in the Raleigh office of the
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.

SPECIAL PROVISIONS
Special Provisions for groundwater monitoring wells being installed under the
North Carolina Department of Environment and Natural Resources (NCDENR)
Ivry Cleaning Solvent Cleanup Act (DSCA) Program should include as applicable,
but not be limited to the following Special Provisions.
1. The encroaching party shall notify the NCDOT District Engineer's Office at telephone
[phone] prior to beginning construction and after construction is complete.
2. An executed copy of this encroachment agreement shall be present at the construction site at
all times during construction. If safety or traffic conditions warrant such an action,
NCDOT reserves the right to further limit, restrict or suspend operations within the right of way.
3. A letter provided by the NCDENR/DSCA Program Project Manager, identifying the encroaching
party as an authorized contractor for the specific site shall be present at the installation site at all times
during installation and subsequent monitoring,
4. A Continuing Indemnity Bond of $100.000.00 shall be on file with the NCDOT Utility Coordination
Unit prior to beginning any installation within the NCDOT right of way,
5. 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.
6. The encroaching party is required to contact the appropriate Utility Companies involved and make
satisfactory arrangements to adjust the utilities in conflict with the proposed work prior to beginning
construction. No cost to adjust, relocate or repair utilities shall be borne by NCDOT.
7, Excavation, including boring or drilling, within 500 feet of a signalized intersection will require
notification by the party of the second part to the Division Traffic Engineer at telephone number
[phone]. All traffic signal or detection cables must be located prior to excavation.
8. The encroaching party shall comply with all applicable Federal, State and local environmental
regulations and shall obtain all necessary Federal, State and local environmental pelmits, including but
not limited to, those related to sediment control, stormwater, wetland, streams, endangered species and
historical sites.
9. The contractor shall not begin the construction until after the traffic control and erosion control
devices have been installed to the satisfaction of the District Engineer.
10. 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.
11. All fill areas/backfill shall be compacted to 95% density in accordance with AASHTO T99 as
modified by the NCDOT.
12. Vegetative cover shall beestablished on all disturbed areas in accordance with the recommendations of
the Division Roadside Environmental Engineer.

Special Provisions
(Cont.) Page2
13. Proper temporary and permanent measures shall be used to control erosion and. sedimentation
in accordance with all local, State and Federal regulations.
14. No wells shall be installed that may interfere with the proper drainage or maintenance of
any drainage structure. Any drainage structure disturbed or damaged shall be restored to its
original condition as directed by the District Engineer.
15. Any disturbed guardrail shall be reset according to the applicable standard or as directed
by the District Engineer.
16. All driveways altered during construction shall be returned to a state comparable with the
condition of the driveways prior to construction.
17. Right of Way monuments and property comers disturbed during construction shall be
referenced by a registered Land Surveyor and reset after construction.
18. Proper traffic control devices, signs, etc. shall be installed to ensure public safety in accordance
with the latest edition of the Manual on Uniform Traffic Control Devices and any supplements
thereto and NCDOT Roadway Standard Drawings.
19. All lanes of traffic are to be open during the hours of 6:00 A.M. to 9:00 A.M. and from 4:00 P.M.
to 6:00 P.M. Traffic will be maintained at all times.
20. Ingress and egress shall be maintained to all businesses and dwellings affected by the
project. Special attention shall be paid to police and fire stations, fire hydrants and
hospitals.
21. Any work requiring equipment or personnel within 5' of the edge of any travel lane of an undivided
facility and within 10' of the edge of any travel lane of a divided facility shall require a lane closure
with appropriate tapers.
22. No parking or material storage shall be allowed along NCDOT maintained roadways.
23. During non -working hours, equipment shall be parked as close to the right of way line as possible
and be properly barricaded in order not to have any equipment obstruction within the Clear
Recovery Area.
24. All roadway signs that are removed due to construction shall be reinstalled as soon as possible.
25. Excavation material or spoils from drilling shall not be placed on the pavement. Drainage
structures shall not be blocked with excavation materials.
26. Only the well (s) shown on the attached plan is approved by this agreement. Additional wells
at the site will require a revision to this agreement or a separate encroachment agreement.
27. Any and all costs for adjustments to the proposed wells due to NCDOT construction shall be the
responsibility of the encroaching party.

Special Provisions (Cont.)
Page3
28. NCDOT or its contractors shall not be held responsible for damage to monitoring wells due to
roadway construction or maintenance activities.
29. Ground water monitoring wells shall not be allowed in pavement, medians, or traffic islands.
30. Well caps shall be flush mounted with the ground surface with the frames and covers of a NCDOT
approved design for HS 20 loading when installed within clear recovery area or within routine
mowing boundaries.
31. Wells proposed outside of the clear recovery area and outside of the boundaries of routine mowing
shall be flush mounted but are not required to be designed for HS 20 loading.
32. Any conversion of a monitoring well to an extraction or remediation system will require a separate
encroachment agreement requiring review by NCDOT's Project Services Unit.
33. Spoils from the well installation shall be disposed of outside NCDOT right of way at an approved
site. Any contaminated soils encountered in construction as spoil from the well installation shall be
removed from the NCDOT right of way immediately upon discovely and properly disposed of in
accordance with the appropriate governing regulations.
34. A copy of all test results from the well (s) within the NCDOT right of way shall be made available to
the NCDOT District Engineer's Office.
35. After the monitoring well(s) has served its intended purpose, the well(s) shall be filled in a manner
approved by NCDENR and NCDOT. Any flush mounted or above ground obstructions shall be removed
from the right of way and the site shall be returned to a condition satisfactory to the District Engineer.
Rev. 12/04/2006

Geosynteccl
consultants
Geosyntec Consultants of NC, PC
Geosyntec Consultants of NC, PC
2501 Blue Ridge Road, Suite 430
Raleigh, North Carolina 27607
PH 919.870.0576
FAX [phone]
www.goosyntcc.com
August 22, 2023
Mr. Kenneth Clark, PE
District Engineer
NCDOT
1194 Prison Camp Road
Whiteville, NC 28472
Subject: Request for Right of Way Encroachments in Columbus County
Dear Mr. Clark,
On behalf of our client, The Chemours Company FC, LLC, (Chemours), Geosyntec Consultants
of NC, P.C. (Geosyntec) has prepared this request for a Right of Way (ROW) encroachment
at one location in Columbus County. Installation of environmental groundwater monitoring
wells along with soil and groundwater sampling is proposed as directed by the North
Carolina Department of Environmental Quality (NCDEQ). Specifically, Chemours is
requesting encroachment agreements to install three (3) permanent monitoring wells on
NC Route 905 between Bug Hill and Pireway Townships, shown in Attachment 1. The
location shown on the figure may be moved up to 10 feet during drilling to accommodate
conflicts with existing utilities and/or access issues with the drill rig.
A completed Standard Encroachment Plan Checklist, typical well plans and construction details,
a completed VCER-1, and a signed Encroachment Agreement Form are attached to this
application (Attachments 2-5). The proposed permanent monitoring wells will be installed by a
North Carolina -licensed driller under the direction of Geosyntec. Wells will generally be
constructed as shown in the schematics and plans in Attachment 3 and in accordance with
applicable well construction regulations. The final well locations depend on the presence of
existing utilities and other possible obstacles to the safety of drilling activities and field crew
members.
Your cooperation in this matter is appreciated. Please contact me at [phone] or
mschott��geosyntec.com if you need any additional information or have any questions.
Sincerely,
Michael Schott, PE, PMP
Attachments
Attachment 1
Proposed Sampling Location
Attachment 2
NCDOT checklist
Attachment 3
Plans & Details
Attachment 4
VCER-1 Form
Attachment 5
Encroachment Agreement Form

Attachment 1
Proposed Sampling Location
Request for Right of Way Encroachments in Columbus County

Attachment 2
NCDOT Checklist
Request for Right of Way Encroachments in Columbus County

North Carolina Department of Transportation
Standard Encroachment Plan Checklist
Intent
This checklist is not all inclusive of the requirement for other agencies. The Applicant shall comply with all
applicable local, state, and federal environmental regulations, and shall obtain all necessary local, state, and
federal environmental permits associated with this installation. This checklist aids in promoting consistency in
submittals and reviews and in expediting the process by understanding the requirements and providing
sufficient information.
The highlighted items on the checklist are provided for Utility Encroachments only. Please complete the full
checklist for Utility Encroachments and disregard the highlighted items for Non -Utility Encroachments.
General
Submit only properly formatted, complete drawings with sufficient, applicable information with encroachment
requests. If proper plans are not submitted, encroachment requests may be returned to the Applicant and
encroachment review will not begin until proper plans are resubmitted. Large encroachments which span
multiple Districts shall be separated by County and by Encroachment Agreement Type.
Professional Engineer Seals and Other Information
Certain utility encroachment requests require plans to be sealed by a licensed North Carolina Professional
Engineer. Guidance on what requests have this requirement can be found in the NCDOT Utilities
Accommodations Manual. For more information on Utility Encroachment Plan requirements, click here.
Certain non -utility encroachment requests require plans to be sealed by a licensed North Carolina
Professional Engineer. Specific instances include when a retaining wall is associated with sidewalk installation
as well as a Gateway Sign standard practice that requires an encroachment agreement and may require PE
Seal for a traffic safety analysis.
Cover Letter
EX Contact Person / Engineering Firm
E)� Phone Number with Area Code
KI Email Address
[X Applicant Project Name / Information / Number
IN County
❑ Proposed Schedule Not Applicable -
- - less than 1 acre
on ro Ian approved by NC DEQ (if 1 acre or more is disturbed) OR
install proper erosion control measures (if less than 1 acre is disturbed)
Plan Format
[X Plans should be legible
[X Plans should show the entire project limits
Plan sheet size to engineering scale of 11"x17" or 8.5"x11" is preferred. Submit full size plan
sheets only if requested
[X Submit only applicable plan and detail sheets. Remove plan sheets and details for work outside of
NCDOT right of way, including work on city and non-NCDOT maintained roadways from the submittal
Continued
Page 1 of 3 April 2021

Plan Title Sheet
L Location / Vicinity Map: Include a vicinity map in the submittal to provide a quick and easy
reference to the location of the proposed work. Include the following aspects in the vicinity map:
■ North arrow
• Label roads
■ Label proposed work area
L County name
X Contact information: This information should consist of names, telephone numbers, and email
addresses of key people involved in encroachment plan development and encroachment construction
and should, whenever possible, include a 24-hour contact to address issues during construction
❑ Utility owner project number
❑ Engineering firm information
General Notes
If applicable, general notes should reflect NCDOT requirements.
Legend / Symbology
All features shown within the plan set should have a corresponding symbol. The legend should include all
applicable symbols and line styles.
Detail Sheets
Include NCDOT standard details, if applicable. If no standard details are applicable, provide site- specific
details.
❑ Aerial detail with minimum vertical clearance: Include this aerial detail even if the proposed work is an
overlash of an existing crossing
❑ Minimum bury depth
❑ Road crossing detail for controlled access and/or non -controlled access roadways, depending on
which is applicable
❑ Culvert crossing detail
❑ Utility Structures — NCDOT product number:
■ Provide applicable details for handholes, vaults, manholes and other utility structures proposed
• Use of a structure included on the NCDOT Approved Products List is preferred. When using a
structure from the NCDOT Approved Products List, include the NCDOT Product
number with the structure detail
■ If proposing to use a utility structure that is not included on the NCDOT Approved
Not Applicable posed structure must be approved by NCDOT prior to use in the right of way
■ u i i y s ruc ures are proposed to be installed within the sidewalk, include an
installation/sidewalk repair detail
❑ Bore pit detail: This detail should note the standard size and depth of proposed bore pits
❑ Bore detail: This detail should show maximum proposed bore diameter
IX Other utility details as applicable
Continued
Page 2 of 3 April 2021

i
General Plan View
LX
North arrow
E�k
State routes labeled
EEC
Scale / Dimension. All plans should either be to engineering scale or properly and accurately
dimensioned:
■ Scale should be shown
■ Scale should be no greater than 1" = 100'
❑
ils: See Attachment 3 for typical construction
■ Length, size, material, type o details.
■ Installation method See Attachment 3 for typical post-
__ __ _-v-_construction appearance.
■ Utility structures with dimensions, if applicable
■ Bore diameter
■ Bore pit locations, including dimensions of bore pit and offsets from all roadway features
❑ <
Existipq Roadway Details with proposed facility offsets (provide dimensions): See Attachment 1 for
■ Edge of pavement and/or back of curb, with roadway width Existing Roadway
■ Right of way line and/or control of access line, with right of way width Details
• Guardrail
■ Storm drainage features (e.g. drainage pipes and structures), with culvert diameters
■ Ditch line and/or toe of fill
Structure -
Existing Utilities. Show and dimension all existing utility features near to or impacted bythe proposed
encr foment
Existing utilities will be
General Profile View located by NC 811
A profile view is required when crossing a roadway or other NCD public utility locator.
Wells will be moved up
❑
Installation method to 10 feet with the ROW
❑
Prominent features to avoid any identified
utilities.
❑
Roadway
❑
Right of way limits
❑
The entire crossing section through the right of way
❑
Minimum vertical dimensions
❑
Bore pit locations
❑
Elevations, sizes and materials for potential utility conflicts
❑
Grade and/or cover on proposed utilities
❑
Scale of profile view
❑
Rim and invert elevations for proposed utility structures
❑
1:1 slope from the edge of pavement
❑
Maximum bore diameter
Submittal Acknowledgement
®
I have reviewed all policies and guidelines and this submittal package is in compliance.
Page 3 of 3 April 2021

Attachment 3
Plans & Details
Request for Right of Way Encroachments in Columbus County

Et1'1$INI{!V IN �0.11IY('l)UN
NV W/II:S SAYS gPiMfiSF PRfK:0.SM
TYPICAL
FLUSH -MOUNT GROUNDWATER MONITORING WELL
CONSTRUCTION DIAGRAM
N(MOM:. Et Iti1(�a
onx><u ce�i
Ecrr
?FEET
IUFEET
W
E'
F
BOLTED MANHOLE COVER
CONCRETE PAD
MANHOLE SLEEVE
LOCKING WELL CAP
Z SCHEDULE 40 PVC PIPE
BENTONITE GROUT
BENTONITE SEAL
TYPE
SAND PACK
GRAIN SIZE
Z SLOTTED SCHEDULE
40 PVC SCREEN
BOTTOM CAP
BOTTOM OF BORING
ANNULUS
Figure 1: Typical Well Construction

Figure 2: Typical Appearance of a Completed Well at Grade

Attachment 4
VCER-1 Form
Request for Right of Way Encroachments in Columbus County

VERIFICATION OF COMPLIANCE WITH
ENVIRONMENTAL REGULATIONS
(Check Appropriate Box)
Permits from the N.C. Department of Environmental Quality and the
U.S. Army Corp of Engineers are not required for this project. However,
all applicable federal and state regulations have been followed.
❑ The required permits from the N.C. Department of Environmental
Quality and the U.S. Army Corp of Engineers have been obtained for this
project. Copies of the permits are attached.
V/All applicable NPDES Stormwater Permit requirements have been or will
be met for this project.
I� The project is in compliance with all applicable sedimentation and
erosion control laws and regulations.
Project Name: FW 4C Assessment
Township: County: Columbus
Project Engineer: Michael Schott Phone Number e
Project Contact: Michael Schott
Applicant's Name: The Chemours Company, FC LLC P.E. Seal
Date Submitted: g ` 2— ��'� �� Rot;'%
o :•��ssio••.1,
ti .�
EAL r: -
j0356
�-=
Form VCER-1 c
June 2016 iygE��
is-Z�i - 2�

Geosyntec '�'
consultants
Geosyntec Consultants of NC, PC
Geosyntec Consultants of NC, PC
2501 Blue Ridge Road, Suite 430
Raleigh, North Carolina 27607
PH 919.870.0576
FAX [phone]
www.geosyntec.com
October 20, 2023
Mr. Kenneth Clark, PE
District Engineer
NCDOT
1194 Prison Camp Road
Whiteville, NC 28472
Subject: Request for Right of Way Encroachments in Columbus County
Dear Mr. Clark,
On behalf of our client, The Chemours Company FC, LLC, (Chemours), Geosyntec Consultants
of NC, P.C. (Geosyntec) has prepared this request for Right of Way (ROW) encroachments at
one location in Columbus County. Installation of environmental groundwater monitoring wells
along with soil and groundwater sampling is proposed as directed by the North Carolina
Department of Environmental Quality (NCDEQ). Specifically, Chemours is requesting
encroachment agreements to install the monitoring wells at the following approximate locations
listed below and shown in Figures 1 a-d of Attachment 1. Locations shown on figures may be
moved up to 10 feet during drilling to accommodate conflicts with existing utilities and/or access
issues with the drill rig.
a)
Figure 1 a
— 1 temporary well on Jockey Road, Hallsboro, NC 28442
b)
Figure lb
— 1 temporary well on New Britton Hwy E., Nakina, NC 28455
c)
Figure 1 c
— 3 permanent wells on Carver Moore Rd, Hallsboro, 28450
d)
Figure I
— 1 temporary well on Intersection of Miller Rd and Ramsey Ford Rd, Bug Hill
Township,
NC 28455
A completed Standard Encroachment Plan Checklist, typical well plans and construction details,
a completed VCER-1, and a signed Encroachment Agreement Form are attached to this
application (Attachments 2-5). The proposed permanent monitoring wells will be installed by a
North Carolina -licensed driller under the direction of Geosyntec. Wells will generally be
constructed as shown in the schematics and plans in Attachment 3 and in accordance with
applicable well construction regulations. The final well locations depend on the presence of
existing utilities and other possible obstacles to the safety of drilling activities and field crew
members.
Your cooperation in this matter is appreciated. Please contact me at [phone] or
mschott(&,geosyntec.com if you need any additional information or have any questions.
Sincerely,
9"A�
Michael Schott, PE, PMP

Attachments
Attachment 1 Proposed Monitoring Well Installation Locations (Figures 1 a through 1 d)
Attachment 2 NCDOT checklist
Attachment 3 Plans & Details
Attachment 4 VCER-1 Form
Attachment 5 Encroachment Agreement Form

Attachment 1
Proposed Sampling Location
Request for Right of Way Encroachments in Columbus County

N
Legend
$ Proposed Well Location
= Tax Parcel Boundary
-- it
-78.60869, 34.31282 - alb
-10 ft from edge of pavement „_�, l
Notes:
1. Investigative locations are approximate and may be adjusted based on
accessibility and on decision authority of Geosyntec field personnel.
2. County Boundaries were downloaded from OneMap site
(https://www.nconemap.gov).
3. The well location may be adjusted slightly due to conflicts with
existing utilities and / or access issues with the drill rig.
4. Basemap provided by the ESRI community 2023.
5. Columbus County.
200 100 0 200 Feet
RP Proposed B-01 Sampling Location
GeosyntecO Geosyntec Consultants of NC, P.C. Figure
consultants NC License No.: C 3500 and C 295
1a
,woo ".O!� Raleigh, North Carolina September 2023

Dr
-78.548304, 34.403388
-10 ft from edge of pavement
IL
f,
-78.548086, 34.40339
-10 ft from edge of pavement
-78.548214, 34.40339
-10 ft from edge of pavement
Legend
$ Proposed Well Location
= Tax Parcel Boundary
Notes:
1. Investigative locations are approximate and may be adjusted based on
accessibility and on decision authority of Geosyntec field personnel.
2. County Boundaries were downloaded from OneMap site
(https://www.nconemap.gov).
3. The well location may be adjusted slightly due to conflicts with
existing utilities and / or access issues with the drill rig.
4. Basemap provided by the ESRI community 2023.
200 100 0 200 Feet
Proposed B-03 Sampling Location
Geosyntec'% Geosyntec Consultants of NC, P.C. Figure
consultants NC License No.: C 3500 and C 295
1c
Raleigh, North Carolina October 2023

-78732743, 34.044078
—35 ft. from edge of pavement
0180.00-18-1943.000
0180.00-18-1943.000
Legend
Proposed Well Location
Tax Parcel Boundary
Notes:
1. Investigative locations are approximate and may be adjusted based on
accessibility and on decision authority of Geosyntec field personnel.
2. County Boundaries were downloaded from OneMap site
(https://www.nconemap.gov).
3. The well location may be adjusted slightly due to conflicts with
existing utilities and / or access issues with the drill rig.
4. Basemap provided by the ESRI community 2023.
5. Columbus County
100 50 0 100 Feet
Proposed B-04 Sampling Location
Geosyntec'- Geosyntec Consultants of NC, PC. Figure
consultants NC License No.: C 3500 and C 295
1d
Raleigh, North Carolina I October 2023

Attachment 2
NCDOT Checklist
Request for Right of Way Encroachments in Columbus County

North Carolina Department of Transportation
Standard Encroachment Plan Checklist
Intent
This checklist is not all inclusive of the requirement for other agencies. The Applicant shall comply with all
applicable local, state, and federal environmental regulations, and shall obtain all necessary local, state, and
federal environmental permits associated with this installation. This checklist aids in promoting consistency in
submittals and reviews and in expediting the process by understanding the requirements and providing
sufficient information.
The highlighted items on the checklist are provided for Utility Encroachments only. Please complete the full
checklist for Utility Encroachments and disregard the highlighted items for Non -Utility Encroachments.
General
Submit only properly formatted, complete drawings with sufficient, applicable information with encroachment
requests. If proper plans are not submitted, encroachment requests may be returned to the Applicant and
encroachment review will not begin until proper plans are resubmitted. Large encroachments which span
multiple Districts shall be separated by County and by Encroachment Agreement Type.
Professional Engineer Seals and Other Information
Certain utility encroachment requests require plans to be sealed by a licensed North Carolina Professional
Engineer. Guidance on what requests have this requirement can be found in the NCDOT Utilities
Accommodations Manual. For more information on Utility Encroachment Plan requirements, click here.
Certain non -utility encroachment requests require plans to be sealed by a licensed North Carolina
Professional Engineer. Specific instances include when a retaining wall is associated with sidewalk installation
as well as a Gateway Sign standard practice that requires an encroachment agreement and may require PE
Seal for a traffic safety analysis.
Cover Letter
EX Contact Person / Engineering Firm
E)� Phone Number with Area Code
K] Email Address
EX Applicant Project Name / Information / Number
IN County
❑ Proposed Schedule Not Applicable -
less than 1 acre
77:7on ro Plan approved by NC DEQ (if 1 acre or more is disturbed) OR
install proper erosion control measures (if less than 1 acre is disturbed)
Plan Format
EX Plans should be legible
IX Plans should show the entire project limits
EX Plan sheet size to engineering scale of 11"x17" or 8.5"x11" is preferred. Submit full size plan
sheets only if requested
IX Submit only applicable plan and detail sheets. Remove plan sheets and details forwork outside of
NCDOT right of way, including work on city and non-NCDOT maintained roadways from the submittal
Continued
Page 1 of 3 April 2021

Plan Title Sheet
( Location / Vicinity Map: Include a vicinity map in the submittal to provide a quick and easy
reference to the location of the proposed work. Include the following aspects in the vicinity map:
■ North arrow
■ Label roads
■ Label proposed work area
L County name
lX Contact information: This information should consist of names, telephone numbers, and email
addresses of key people involved in encroachment plan development and encroachment construction
and should, whenever possible, include a 24-hour contact to address issues during construction
❑ Utility owner project number
❑ Engineering firm information
General Notes
If applicable, general notes should reflect NCDOT requirements.
Legend / Symbology
All features shown within the plan set should have a corresponding symbol. The legend should include all
applicable symbols and line styles.
Detail Sheets
Include NCDOT standard details, if applicable. If no standard details are applicable, provide site- specific
details.
❑ Aerial detail with minimum vertical clearance: Include this aerial detail even if the proposed work is an
overlash of an existing crossing
❑ Minimum bury depth
❑ Road crossing detail for controlled access and/or non -controlled access roadways, depending on
which is applicable
❑ Culvert crossing detail
❑ Utility Structures — NCDOT product number:
■ Provide applicable details for handholes, vaults, manholes and other utility structures proposed
■ Use of a structure included on the NCDOT Approved Products List is preferred. When using a
structure from the NCDOT Approved Products List, include the NCDOT Product
number with the structure detail
■ If proposing to use a utility structure that is not included on the NCDOT Approved
Not Aple posed structure must be approved by NCDOT prior to use in the right of way
■ u i i YE
ures are proposed to be installed within the sidewalk, include an
/' installadewalk repair detail
❑ Bore pit detail: This detail should note the standard size and depth of proposed bore pits
❑ Bore detail: This detail should show maximum proposed bore diameter
[X Other utility details as applicable
Continued
Page 2 of 3 April 2021

General Plan View
L
North arrow
4C
State routes labeled
EC
Scale / Dimension. All plans should either be to engineering scale or properly and accurately
dimensioned:
■ Scale should be shown
■ Scale should be no greater than 1" = 100'
❑
ils: See Attachment 3 for typical construction
■ Length, size, material, type o details.
See Attachment 3 for typical post -
Installation method
Installation appearance.
■ Utility structures with dimensions, if applicable
■ Bore diameter
■ Bore pit locations, including dimensions of bore pit and offsets from all roadway features
❑ <
Existing Roadway Details with proposed facility offsets (provide dimensions): See Attachment 1 for
■ Edge of pavement and/or back of curb, with roadway width Existing Roadway
■ Right of way line and/or control of access line, with right of way width Details
■ Guardrail
■ Storm drainage features (e.g. drainage pipes and structures), with culvert diameters
■ Ditch line and/or toe of fill
■ Structure
Existing Utilities. Show and dimension all existing utility features near to or impacted bythe proposed
enc t
Existing utilities will be
General Profile View located by NC 811
A profile view is required when crossing a roadway or other NCD public utility locator.
Wells will be moved up
❑
Installation method to 10 feet with the ROW
❑
Prominent features to avoid any identified
utilities.
❑
Roadway
❑
Right of way limits
❑
The entire crossing section through the right of way
❑
Minimum vertical dimensions
❑
Bore pit locations
❑
Elevations, sizes and materials for potential utility conflicts
❑
Grade and/or cover on proposed utilities
❑
Scale of profile view
❑
Rim and invert elevations for proposed utility structures
❑
1:1 slope from the edge of pavement
❑
Maximum bore diameter
Submittal Acknowledgement
X
I have reviewed all policies and guidelines and this submittal package is in compliance.
Page 3 of 3 April 2021

Attachment 3
Plans & Details
Request for Right of Way Encroachments in Columbus County

�n�na�aumrru vxur�enob
H4L�RDOl�4 S]]4SAL�ONSY PROGAATI
TYPICAL
FLUSH -MOUNT GROUNDWATER MONITORING WELL
CONSTRUCTION DIAGRAM
BOLTED MANHOLE COVER
CONCRETE PAD
MANHOLE SLEEVE
LOCKING WELL CAP
�r�gaa osr�s
Z SCHEDULE 40PVC PIPE
BENTONITB GROUT
Mr _
2 FEET S�S}� ��} HEN70NITE SEAL
TYPE
7FEET
SAND PACK
GRAIN SIZE
2 SLOTTED SCHEDULE
46 PVC SCREEN
1u FEET
BOTTOM CAP
BOTTOM OF BORING
ANNULUS
Figure 1: Typical Well Construction

Figure 2: Typical Appearance of a Completed Well at Grade

Attachment 4
VCER-1 Form
Request for Right of Way Encroachments in Columbus County

VERIFICATION OF COMPLIANCE WITH
ENVIRONMENTAL REGULATIONS
(Check Appropriate Box)
Permits from the N.C. Department of Environmental Quality and the
U.S. Army Corp of Engineers are not required for this project. However,
all applicable federal and state regulations have been followed.
❑ The required permits from the N.C. Department of Environmental
Quality and the U.S. Army Corp of Engineers have been obtained for this
project. Copies of the permits are attached.
VAII applicable NPDES Stormwater Permit requirements have been or will
be met for this project.
I� The project is in compliance with all applicable sedimentation and
erosion control laws and regulations.
Project Name:
Township:
Project Engineer:
Project Contact:
Applicant's Name:
Date Submitted:
Form VCER-1
June 2016
FW 4C Assessment
Michael Schott
Michael Schott
County:
Phone Number
The Chemours Company, FC LLC
g-Z1-23
Columbus
rj1`7 &IZV -IgZ�
P.E. Seal
��\1idll111/
C A R O �I
/ ,�I
0 .p
EAL 9r-:
' 0356 -
M J . SC+����
A,
��1"11160

Attachment 5
Encroachment Agreement Form
Request for Right of Way Encroachments in Columbus County

ROUTE multiple (see attached) PROJECT
STATE OF NORTH CAROLINA
COUNTY OF Columbus
DEPARTMENT OF TRANSPORTATION
-AND-
The Chemours Company, FC LLC- Fayetteville Works
22828 NC Highway 87 W
Fayetteville, NC 28306
THIS AGREEMENT, made and entered into this the
RIGHT OF WAY ENCROACHMENT AGREEMENT
FOR NON -UTILITY ENCROACHMENTS ON
PRIMARY AND SECONDARY HIGHWAYS
day of 120 23 , by and between the Department
of Transportation, party of the first part; and The Chemours Company, FC LLC - Fayetteville Works
party of the second part,
WITNESSETH
THAT WHEREAS, the party of the second part desires to encroach on the right of way of the public road designated as
Route(s) multiple (see attached figures)
, located in Columbus county
with the construction and/or erection of: environmental, groundwater monitoring wells
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 HighwaVs 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
Cherilyn
Digitally signed by
Cherilyn Mertes
Date: 2023.08.27
Mertes
15:41:51-04'00'
Cherilyn Mertes, Sr. Scientist
Geosyntec Consultants
DEPARTMENT OF TRANSPORTATION
,01
DIVISION ENGINEER
S y
Sathya Digitally signed by VaNigi
DN: cn=Sathya by ti, c=US, -The
Chemo_ Company, o =Corporate
YalvidDatel 02308251120 01 e04'00' om
Sathya Yalvigi, Sr. Remedial Project Manager
1007 Market Street, Wilmington, DE, 19898
INSTRUCTIONS
Second Party
When the applicant is a corporation or a municipality, this agreement must have the corporate seal and
be attested by the corporation secretary or by the empowered city official, unless a waiver of corporate
seal and attestation by the secretary or by the empowered City official is on file in the Raleigh office of the
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.