WM0801235_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: Pender
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)? Yes - one public supply; possible private
If yes, give distance(s): Public supply well 140 ft NE of drilling location B-15
15. Well Contractor: SAEDACCO Certification No.: 4220
Well Contractor Address: 9088 Northfield Dr., Fort Mill, SC 29707
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]-3. 29-f15'Ofl'
Signature of Applicant or *AgentDa1e 2
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)

STATEm
STATE OF NORTH CAROLWA
DEPARTMENT OF TRANSPORTATION
Roy COOPER J.R. "JOEY" HOPKINs
GOVERNOR SECRETARY
October 27, 2023
The Chemours Company, FC LLC-Fayetteville Works
22828 NC Highway 87 W
Fayetteville, NC 28306
SUBJECT: Encroachment Agreement on SR-1522, SR-1318, SR-1307, and SR-1205
Onslow/Pender County (E031-071-23-00332)
Dear Michael Schott,
Attached for your files is a copy of Right of Way Encroachment contract properly
executed. This contract covers the following:
Located in Pender County. (Monitoring Wells) With the construction and/or erection of
3 temporary environmental ground monitoring wells and 3 permanent environmental
ground monitoring wells. This approval is subject to this work being done in accordance
with the attached plan sheet and special provisions.
• No lane closures shall be allowed between the hours of 6:00 am to 9:00
am, and 4:00 pm to 7:00 pm (peak hours restricted). Further restrictions do
apply; see the attached Standard Provisions. No lane closures to be placed
on the weekends.
The Continuing Indemnity Bond (9422949) posted with the North
Carolina Department of Transportation is hereby obligated to cover work
under this encroachment agreement. The applicant shall notify NCDOT at
910-467-0500 upon completion of the work for a final inspection to be
performed by NCDOT personnel. After the project has been completed for
ONE YEAR, and upon request by the applicant, NCDOT personnel will
conduct a final inspection. If found satisfactory, the bond will be released.
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
295A WILMINGTON HIGHWAY
JACKSONVILLE, NC 28540
Telephone: [phone]
Fax: [phone]
Customer Service: 1-877-368-4968
Website: www.ncdot.gov
Location:
295 A WILMINGTON HIGHWAY
JACKSONVILLE, NC 28540

Sincerely,
EP
DocuSigned by:
b+S OJ ra6W-
B0327AD7C80B486...
Douglas W. Racine
Deputy District Engineer
For Chad Kimes, P.E.
Division Engineer
CK/DWR/gom
Attachments
cc: Jeff Garrett, Pender County Maintenance Engineer (Electronic File)

ROUTE multiple (see attached) PROJECT
STATE OF NORTH CAROLINA
COUNTY OF Pender
DEPARTMENT OF TRANSPORTATION RIGHT OF WAY ENCROACHMENT AGREEMENT
FOR NON -UTILITY ENCROACHMENTS ON
-AND- PRIMARY AND SECONDARY HIGHWAYS
The Chemours Company, FC LLC- Fayetteville Works
Michael Schott
22828 NC Highway 87 W 919-424-1824
Fayetteville, NC 28306 [e-mail]
THIS AGREEMENT, made and entered into this the 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 Pender County
with the construction and/Or erection of: 3 temporary environmental ground monitoring wells and 3 permanent environmental ground 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.
DEPARTMENT OF TRANSPORTATION
Se�" for Chad Kimes, P.E.
BY:
Digitally signed DIVISION ENGINEER
C h e ri I yn by Cheri lyn
ATTEST OR WITNESS: Mertes Sthya DIptal1, 51g1
ed by Sa'hya Y111 i
a
Mertes Date:2023.08.27 DN:� F,.thyavam,9,­os,o=rhe
Chemoura Company, ou=Co,po,ate
15:43:05 04'00' Ya I vi g i Remed thy Croup,
a=sathya.o yaw 9 @ohemo :.00m
Date: 2023.08.25 11'.51'.22-04'00'
Cherilyn Mertes, Sr. Scientist Sathya Yalvigi, Sr. Remedial Project Manager
Geosyntec Consultants 1007 Market Street, Wilmington, DE 19898
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.

Encroachment Agreement Standard Conditions
District Office Contact Information:
295 Wilmington Hwy
Jacksonville, NC 28540
[phone]
The Standard Conditions in this document apply to this and all encroachment agreements issued by District 1.
Pre -Construction
SC1 A Pre -Construction Meeting is required prior to beginning work. Contact the District Office to schedule.
SC2 This permit along with all terms and agreements shall be incorporated into any lease or sales agreement.
SC3 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.
SC4 If the approved permit encroaches within the limits of an active construction project the Encroaching Party will be
required to coordinate with the NCDOT contractor as well as secure a hold harmless agreement prior to
commencing work. If the approved permit encroaches within the limits of a project in preconstruction, the
Encroaching Party will be required to coordinate with the Department's Project Development Unit to ensure no
conflicts are created with the installation.
SCS 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 div3distl @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, Daniel Waugh at [phone] or email
dqwaughl @ncdot.gov.
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.
SC6 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.
SC7 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.
SC8 The encroaching party shall notify the appropriate municipal office prior to beginning any work within the
municipality's limits of jurisdiction.
SC9 NC 811 services DOES NOT provide locates of traffic signal cables. Excavation within 1000 feet of a signalized
intersection will require notification by the encroaching party to the Division Traffic Engineer's Office at telephone
number [phone] no less than one week prior to beginning work. All traffic signal or detection cables must
be located prior to excavation. Cost to replace or repair NCDOT signs, signals, pavement markings or
associated equipment and facilities shall be the responsibility of the encroaching party.
SC10 If modifications to a traffic signal are required under this encroachment agreement, a separate traffic agreement is
required prior to work. Contact the Division Traffic Engineer or Deputy Division Traffic Engineer at [phone].
SC11 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.
SC12 At the discretion of the District Engineer, a NOTIFICATION FOR UTILITY / NON -UTILITY ENCROACHMENT WITHIN
NCDOT R/W form (See corresponding attachment) with the scheduled pre -construction meeting and associated
Division 3, District 1 Updated 09/12/2022

construction schedule details must be completed and submitted to the District Engineer's office a minimum of one
week prior to construction.
SC13 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
SC14 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. No alteration of the approved plan will be allowed without written approval by
NCDOT. All design plan changes proposed by the contractor shall be prepared by the Engineer of Record and
submitted by the Owner/Permittee to NCDOT for review to ensure that the Engineer and Owner participate in all
construction changes. Field changes constructed without prior written approval by NCDOT will not be accepted by
NCDOT during the inspection process.
SC15 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.
SC16 Encroaching party shall be responsible for obtaining all necessary permanent and/or temporary construction,
drainage, utility and/or sight distance easements.
SC17 It shall be the responsibility of the property owner or local municipality to maintain any proposed sidewalk that will
be placed within the NCDOT Right of Way. It is the responsibility of the Encroaching Party to place the sidewalk and
wheelchair ramps per NCDOT standards and the latest edition of the Americans with Disabilities Act. This
maintenance requires an encroachment agreement through the District Office.
SC18 No commercial advertising shall be allowed within NCDOT Right of Way.
SC19 The encroaching party shall obtain proper approval from all affected pole owners prior to attachment to any pole.
SC20 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.
SC21 It shall be unlawful to place any highway obstruction, including a driveway headwall, fence, rural mailbox, newspaper
delivery box, or other roadside obstruction, so as to interfere with the traffic or maintenance of the roads and
highways of the state highway system. See North Carolina Administrative Code 19A NCAC 2E.0404.
Bonds
SC22 A Performance and Indemnity Bond posted with the North Carolina Department of Transportation is hereby
obligated to cover work under this encroachment agreement. This bond is only for work within NCDOT Right of
Way.
SC23 An Initial Construction Inspection is required after the completion of the work. An Initial Inspection Report will be
issued upon satisfactory completion of the work and begins the one year warranty period. Contact the District Office
to schedule an inspection.
SC24 A Final inspection is required after one year and prior to release of the bond. Contact the District Office three
months prior to the end of the one year bonding period for final inspection and creation of a list of deficiencies; this
should provide enough time for corrective action prior to the end of one year. A Final Inspection Acceptance will be
issued once the work has been completed and any deficiencies addressed.
SC25 All bonds will be held for a minimum of one year from the time of the Initial Construction Inspection Acceptance. At
the end of that time period, the bond may be released at the request of the applicant pending Final Inspection
Acceptance.
Division 3, District 1 Updated 09/12/2022

Work Zone Traffic
SC26 WORK ZONE TRAFFIC CONTROL QUALIFICATIONS AND TRAINING PROGRAM
All personnel performing any activity inside the highway right of way are required to be familiar with the NCDOT
Maintenance / Utility Traffic Control Guidelines (MUTCG). No specific training course or test is required for
qualification in the Maintenance /Utility Traffic Control Guidelines (MUTCG).
All flagging, spotting, or operating Automated Flagger Assist Devices (AFAD) inside the highway right of way
requires qualified and trained Work Zone Flaggers. Training for this certification is provided by NCDOT approved
training resources and by private entities that have been pre -approved to train themselves.
All personnel involved with the installation of Work Zone Traffic Control devices inside the highway right of way are
required to be qualified and trained Work Zone Installers. Training for this certification is provided by NCDOT
approved training resources and by private entities that have been pre -approved to train themselves.
All personnel in charge of overseeing work zone Temporary Traffic Control operations and installations inside the
highway right of way are required to be qualified and trained Work Zone Supervisors. Training for this certification
is provided by NCDOT approved training resources and by private entities that have been pre -approved to train
themselves.
For questions and/or additional information regarding this training program please refer to
https://connect.ncdot.gov/projects/WZTC/Pages/Training.aspx or call the NCDOT Work Zone Traffic Control Section
[phone].
SC27 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.
SC28 There shall be no lane closures, narrowing of lanes, detaining and/or altering the traffic flow on or during holidays,
holiday weekends, special events or any other time when traffic is unusually heavy, including the following
schedules:
a. For unexpected occurrence that creates unusually high traffic volumes, as directed by the Engineer.
b. For New Year's Day, between the hours of 6:00 AM December 3111 and 7:00 PM January 2nd. If New
Year's Day is on a Friday, Saturday, Sunday, or Monday, then until 7:00 PM the following Tuesday.
c. For Easter, between the hours of 6:00 AM Thursday and 7:00 PM Monday.
d. For Memorial Day, between the hours of 6:00 AM Friday and 7:00 PM Tuesday.
e. For Independence Day, between the hours of 6:00 AM the day before Independence Day and 7:00 PM
the day after Independence Day.
If Independence Day is on a Friday, Saturday, Sunday, or Monday, then between the hours of 6:00 AM
the Thursday before Independence Day and 7:00 PM the Tuesday after Independence Day.
f. For Labor Day, between the hours of 6:00 AM Friday and 7:00 PM Tuesday.
g. For Thanksgiving, between the hours of 6:00 AM Tuesday and 7:00 PM Monday.
h. For Christmas, between the hours of 6:00 AM the Friday before the week of Christmas Day and 7:00 PM
the following Tuesday after the week of Christmas Day.
These restrictions are in addition to any lane closure restrictions list in the Encroachment Special Provisions.
SC29 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.
Division 3, District 1 Updated 09/12/2022

SC30 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.
SC31 Two-way traffic shall be maintained at all times unless designated by the District Engineer. Traffic shall not be
rerouted or detoured without the prior written approval from the District Engineer. No utility work will be allowed
on state holidays from 7:00 PM the night before through 9:00 AM the day prior to, following or during local
events without prior approval from the District Engineer. If the construction is within 1000 feet of a school
location or on a designated bus route, the construction shall be coordinated with the school start and end times
to avoid traffic delays.
SC32 Work requiring lane or shoulder closures shall not be performed on both sides of the road simultaneously within
the same area.
SC33 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.
SC34 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.
SC35 If pavement markings are required under this encroachment agreement, the Encroaching Party shall have the
pavement markings pre -marked, inspected, and approved by NCDOT personnel prior to the placement of final
pavement markings. Contact Traffic Services at [phone] for pre -marking inspections or field changes.
SC36 All temporary and final pavement markings are the responsibility of the encroaching party. Centerline pavement
markings shall be installed the same day resurfacing is accomplished. All other pavement markings shall be
completed within five days of resurfacing. 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.
SC37 Any pavement markings that are damaged or obliterated shall be restored by the encroaching party at no expense
to NCDOT.
SC38 All concrete or paved channelization islands shall have a 12 inch diameter round or square smooth wall hole drilled,
cored, formed, or air -hammered to the subgrade and backfilled with soil placed a minimum of 10 feet from the nose
of each end of the island (see Roadway Standard Drawing 904.50), or as directed by the engineer. All sign supports
that are to be erected in existing or proposed concrete or paved channelization islands shall meet the same
requirements. If necessary, contact Traffic Services at [phone] to mark core locations.
SC39 Sidewalk closures shall be installed, as necessary. Pedestrian traffic shall be detoured around these closures and
shall be signed appropriately and in accordance with The American with Disabilities Act Accessibility Guidelines.
The encroaching party must adhere to the guidelines for accommodating pedestrians in encroachment work
zones as described in the NCDOT Pedestrian Work Zone Accommodations Training found at
https://www.youtube.com/watch?v=AOuYa5lW3dg&feature=youtu.be.
Roadside Environmental
SC40 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 Division Environmental Office regarding the North Carolina Natural
Heritage Program or the United States Fish and Wildlife Services. Contact the Division Environmental Office at
[phone].
SC41 The Verification of Compliance with Environmental Regulations (VCER-1) form is required for all non -utility
encroachment agreements or any utility encroachments. The VCER-1 form must be signed and/or sealed by a NC
registered professional engineer (PE), registered land surveyor (RLS), or authorized personnel who has verified that
all appropriate environmental permits (if applicable) have been obtained and all applicable environmental
regulations have been followed.
SC42 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
Division 3, District 1 Updated 09/12/2022

Engineer. Any plants, vegetation or trees in the NCDOT planted sites that is destroyed or damaged as a result of
this encroachment shall be replaced with plants, vegetation or trees of like kind or similar shape. Contact the
Division Roadside Environmental Engineer at 910-259-4919.
SC43 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.
SC44 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.
SC45 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.
SC46 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
SC47 State Transportation Improvement Projects (STIP) — If encroachment falls within a STIP that is active or in design
when installation takes place coordination with Division Utility Coordinator is required. If project is specifically
within an active STIP then a hold harmless letter from NCDOT's contractor will be required. Any encroachment
determined to be in conflict STIP construction shall be removed and/or relocated at the encroaching party's
expense.
Construction
General
SC48 An executed copy of the encroachment agreement, provisions and approved plans shall be present at the
construction site at all times. NCDOT reserves the right to stop all work unless evidence of approval can be shown.
Additionally, 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.
SC49 The Encroaching Party and/or their Contractor shall comply with all OSHA requirements and provide a
competent person on site to supervise excavation at all times. 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.
SC50 The Encroaching Party shall follow any and all revisions shown in RED on attached plan(s).
SC51 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.
SC52 All drainage structures disturbed, damaged or blocked shall be restored to its original condition as directed by the
Division Engineer or their representative.
SC53 All pipes placed within the NCDOT Right of Way shall be NCDOT approved materials. All joints shall be sealed with
mortar or other NCDOT approved material. Backfill compaction shall meet NCDOT Standardized Testing Method.
SC54 Throughout the life of the project, the Encroaching Party shall maintain all drop-offs within the work zone such that
they do not exceed the maximum of 2".
SC55 All removed curb, driveways, and shoulder areas shall be backfilled at a 6:1 slope or flatter at the end of the days'
production.
SC56 Abandoned pipes 12" in diameter and larger in fills 20' or less shall be removed and backfilled, filled with grout, or
plugged, as directed by the Manager of Right -of -Way, Division Engineer or State Design Services Engineer. There
may be unusual circumstances where the same requirements will apply on pipes smaller than 12".
Division 3, District 1 Updated 09/12/2022

SC57 For trenching excavations within the typical ditch cross-section, positive drainage shall be restored within the
existing ditch by grading between driveway pipe invert elevations or by re-establishing the original hydraulic grade
line.
SC58 Material shall NOT be unloaded or stockpiled on the roadway at any time without proper lane closure during the
project. Work is not permitted when the shoulder material is wet or during adverse weather conditions.
SC59 The placement of curb and gutter is not allowed within shoulder sections of roadway.
SC60 A minimum of 5 feet (10 feet desirable) 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.
SC61 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.
SC62 Unless specified otherwise, during non -working hours, equipment shall be located away from thejob site or
parked as close to the right of way line as possible and be properly barricaded in order not to have any equipment
obstruction within the Clear Recovery Area. Also, during non -working hours, no parking or material storage shall
be allowed along the shoulders of any state -maintained roadway.
SC63 No access to thejob site, parking or material storage shall be allowed along or from the Control of Access
Roadway.
SC64 Guardrail removed or damaged during construction shall be replaced or repaired by an NCDOT approved
guardrail contractor to its original condition, meeting current NCDOT standards or as directed by the Division
Engineer or their representative.
SC65 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.
SC66 Right of Way monuments disturbed during construction shall be referenced by a registered Land Surveyor and
reset after construction.
SC67 All Traffic signs moved during construction shall be reinstalled as soon as possible to the satisfaction of the
Division Engineer or their representative.
SC68 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.
SC69 Any sewer manholes, telephone vaults or valve vaults that are to be abandoned shall either be removed or broken
down two (2) feet below subgrade, plugged and filled with suitable material.
SC70 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.
SC71 All driveways disturbed during construction shall be returned to a state comparable with the condition of the
driveways prior to construction.
SC72 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.
SC73 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.
Engineering
SC74 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.
SC75 Prior approval for any blasting must be obtained from the Division Engineer or their representative.
SC76 Regulator stations, metering stations, cathodic test stations, and anode beds are not permitted within NCDOT
right of way. Header wires are permitted.
SC77 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
Division 3, District 1 Updated 09/12/2022

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.
SC78 All wiring and related electrical work shall conform to the latest edition of the National Electrical Safety Code.
Location within R/W
SC79 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.
SC80 Proposed manholes, handholes, valves or other appurtenances shall be installed flush to match the elevation of
the existing ground and shall not be located in the existing ditch line, front slope of a ditch, or in a manner that
would restrict the maintenance or flow of the existing ditch line.
SC81 Fire Hydrants shall be of the breakaway type. Fire Hydrant(s) shall be placed a maximum of 1 foot from the right-of-
way line. (STD. 1515.02 in the NCDOT Roadway Standard Drawings).
SC82 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.
SC83 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 1/2", or where speed limit is less than 55 MPH.
SC84 Hot box (aka ASSE 1060) or Safe-T-Cover type enclosures covering utility main pipejoints, 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.
SC85 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 itsjudgement and opinion adversely affects
safety, maintenance, or operation of the roadway.
Excavation
SC86 Excavation material shall not be placed on pavement.
SC87 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.
SC88 The utility shall be installed within 5 feet of the right of way line and outside the 5-foot minimum from travel lane
plus theoretical 2:1 slope from the edge of pavement to the bottom of the nearest excavation wall for temporary
shoring. If the 2:1 slope plus 5 feet requirement above is met for traffic, then temporary shoring is typically only
necessary to protect roadways from damage when a theoretical 1:1 slope from the edge of pavement intersects
the nearest excavation wall. This rule of thumb should be used with caution and does not apply to all subsurface
conditions, surcharge loadings and excavation geometries. Situations where this 1:1 slope is not recommended
include groundwater depth is above bottom of excavation or excavation is deeper than 10 feet or in Type B or C
soils as defined by OSHA Technical Manual. Temporary shoring may be avoided by locating trenches, bore pits,
and other excavations far enough away from the open travel lane, edge of pavement and any existing structure,
support, utility, property, etc. to be protected. Temporary shoring is required when a theoretical 2:1 slope from the
bottom of excavation will intersect the existing ground line less than 5 feet from the outside edge of an open
travel lane as shown in the figure below or when a theoretical 2:1 slope from the bottom of excavation will
intersect any existing structure, support, utility, property, etc. to be protected.
Division 3, District 1 Updated 09/12/2022

Traffic in Ouitside Lane
Lane Open to
Traffic 5 ft xisUng Ground
rni n Line
H '
' Bottom of
Excavation
Edge of 2-1 (H:V) Slope
Pavement
Traffic Shifted (Outside Lane Closure)
Lane Open to Lane Closed
Traffc xistin� Ground
_ Line
rnn� --
1f _
H� f3ot yn of
Theoretical Excavation
2:1 (H:V)Slope
'If the 2:1 slope plus 5 reel requirement above
is ma[ for traffio, [hen temporary shoring is
typicaly only neoesr ary In pmrec[ raadways
fram damage when a theorefical 1:1 slope from
the edge of pavamant intersects the nearest
excavation wall_ Thin Fule of thumb should be
used with raudion and does not apply to all
subsurface conditions, surcharge Ioadngs end
excavation geome[ries Additional guidenca
provided below.
'Theoretical
1.1 (H:V) Slope
(from Edge of
Pavement)
Temporary shoring shall be designed and constructed in accordance with current NCDOT Standard Temporary
Shoring provisions (refer to httl2s://connect.ncdot.gov/resources/Specifications/Pages/2018-Specifications-and-
Special- Provisions.aspx and see SP11 R002).
a. Temporary excavation shoring, such as sheet piling, shall be installed. The design of the shoring shall include
the effects of traffic loads. The shoring system shall be designed and sealed by a licensed North Carolina
Professional Engineer. Shoring plans and design calculations shall be submitted to the Division Engineer for
review and approval prior to construction. (See NCDOT Utilities Accommodations Manua( for more
information on requirements for shoring plans and design calculations.) Trench boxes shall not be accepted
as temporary shoring and will not be approved for use in instances where shoring is required to
protect the highway, drainage structure, and/or supporting pavement or structure foundation.
b. All trench excavation inside the limits of the theoretical one-to-one slope, as defined by the policy, shall be
completely backfilled and compacted at the end of each construction day. No portion of the trench shall be
left open overnight. Any excavation that is not backfilled by the end of the workday must address any safety
and traveling public concerns including accommodations for bicycles, pedestrians and persons with
disabilities.
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.
Division 3, District 1 Updated 09/12/2022

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.
SC89 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.
Directional bore
SC90 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.
SC91 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 Minimum Depth of Cover
(Backream)
2" to 10" 10 feet
>10" to 15" 12 times hole diameter (e.g. 11-inch hole means 11 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.
Division 3, District 1 Updated 09/12/2022

k. There shall be no bore pits within 20 feet of the signal pole foundation or the traffic control cabinet. There
shall be no open cuts or trenching within 10 feet of the signal pole foundation and the traffic control cabinet.
Aerial clearances
SC92 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.
SC93 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
SC94 The paving of roadways 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.ciov/resources/Materials/MaterialsResources/2018%20QMS%20Asphalt%20Manual.r)df).
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. 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.
SC95 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.
SC96 "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, S9.513. 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/.
SC97 The minimum pavement design for pavement repair shall be according to NCDOT Standard Drawing 654.01
(https://connect.ncdot.gov/resources/Specifications/2018StandardRdwyDrawings/Division%2006%20Asphalt%20B
ases%20and%20Pavements. pdfl 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. Any open cutting of pavement shall be
repaired using the following method:
• Pavements shall be cut full depth and removed.
• After trench work is complete, the edges of the existing pavement along the trench shall be recut a
minimum of 1' wider on each side of the trench. If the pavement is undermined, the edges of the existing
pavement along the trench shall be recut to 1' beyond the undermined portion and the pavement removed.
The design section stated below is to be placed in those areas.
• The pavement repair shall be performed using the following method and pavement design section:
Division 3, District 1 Updated 09/12/2022

0 11.0" B25.00 Asphalt Concrete Base Course (accomplished in 2 lifts minimum) according to NCDOT
Standard 654.01.
o Mill the entire area a depth of 2.0", starting from 15' in front of the edge of the final pavement cut.
o Overlay entire area (a minimum 50' length mechanical overlay) with 2.0" S9.5C or S9.513 Asphalt Concrete
Surface Course for a total asphalt depth of 13". Butt joints are required with no feathering of joints.
All open cuts shall be backfilled, paved and traversable prior to removing lane closure.
SC98 Pavement cuts shall be repaired the same day the cuts are made.
SC99 Any pavement damaged because of settlement of the pavement or damaged by equipment used to perform
encroachment work, shall be re -surfaced to the satisfaction of the District Engineer. This may include the removal of
pavement and a 50' mechanical overlay. All pavement work and pavement markings (temporary and final) are the
responsibility of the Encroaching Party. Centerline pavement markings shall be installed the same day resurfacing is
accomplished. All other pavement markings shall be completed within five days of resurfacing.
SC100 For projects with open cuts and roadway improvements, a PE certification may be required. When applicable, upon
completion of construction, a certification memo that has been signed and sealed as appropriate under General
Statute 89C-16 by a North Carolina Professional Engineer or Registered Land Surveyor shall be submitted to the
District Engineer prior to opening the access connection for public use. Supporting documentation shall be attached
certifying that improvements for the driveway access(s) meet the approved plan and NCDOT standards. All
documentation shall be dated and initialed by the contractor. Verification will include inspection reports, testing
reports, or any supporting documentation and calculations. Verification will cover, but is not limited to, subgrade,
pavement structure, drainage, and traffic control items.
Post Construction
Close out/ Inspection
SC101 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.
SC102 At the discretion of the District Engineer, a final inspection report may be provided to the encroaching party upon
satisfactory completion of the work.
SC103 A written acknowledgement of the completed work by the District Engineer's office begins the one-year warranty
period associated with the performance bond.
SC104 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.
SC105 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.
SC106 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.
Division 3, District 1 Updated 09/12/2022

ATTACHMENT FORM
NOTIFICATION FOR UTILITY NON-UTII.ITY ENCROACHMENT WITHIN NCDDT R-
Imhu.ctions for use:
This form must be completed in its entirety and submitted direcftto the designated personnel m' the District En_iueer's
office via email~ fax or hand delivery a minimum of one week prior to ocnstructim for the encroachment_ Ifthe
designated NCDOT personnel names ue uahmo%.n by the person completing this farm, please contact the District
E,uginecr's office to determine that contact info.
Date:
Submitted by Name:
To: District Personnel Natue:
District Personnel Email:
District Fax No.:
This notification is to infxm you that -%-e (encroa-ching party cr their contractor) mill begin construction
irk on the fb1lon;ing project in a rninimum of one week -
Encroachment number
{assigned b}- NCI T) far the project:
Construction start date:
Approximate eading date:
Crrntact NCDOT iflspector a minimum of 72 hrs. in advance to set-up Pre=structicm meeting in the
District Engineer's office or -other location as directed by the District Engineer
Preconstruction meeting date & time:
Preconstmc.tion meeting address:
Type of project:
{ 5ra fes: � err lelecommunieafr-on, -water, 5awer, gz, petroleum, other (describe)]
Contact Info for this project:
GzNntractor Company Facie:
Contractor Contact Marne:
Contractor Plione Dumber:
contractor Email:
NCDGT Utility Inspector Name:
NCDOT Utiilitv Inspector Fbore:
NCDOT Utility inspector Email:
NCDGT Utilit+r Project hLmagerName:
NCDOT Utility Project Manager Phone:
NCDOT Utility Project Manager Email:
Division 3, District 1 Updated 09/12/2022

Table 4-5 6i,ggoatad Clear-Zam bletancae from Edlgo of Throi,gh Trawolod Larnin
fedige
Foreslopes
Bachaiopaa
Speed
D�rxlgn
ADT
1 V:6H
1V:6H to
IV:6H to
I V, 8H
r dater
iVAH
i V..3H
MSH
iV:+lH
or Saf r
Under750c
7-10
7-10
7-10
7-10
7- 10
756-1500
10-12
12-14
10-12
110-12
10-12
40
Sec Note b
_
15M-6000
12- 14
14-16
12-14
112-14
12-14
Over6000
14- 16
16-15
14-16
14-16
14-16
Under7%:
10- 12
12-14
6-10
6-10
10-12
750-1500
14- 16
16-210
10-12
12-14
14-16
45 - 50
SE* Note b
1506-6000
16- 1B
20-26
12-14
14-16
16-18
Ovar 6000
20 - 22
24 - 26
14 -16
18 - 20
20 - 22
UndeIr750�:
12- 14l
14-18
6-10
10-12
10-12
756-1541)
1a- 1B
20-24
10-12
14-16
15-18
55
6ee Nw* b
1500-6000
20-22
24-so
14-16
16-16
20-22
Over 6000
22 - 24
26 - 32'
16 -15
20 - 22
22 - 24
Under750:
16- 16
20-24
10-12
12-14
14-16
750-15b0
20-24
26-322
12-14
16-18
20-22
60
See flute b
1500 - 6000
26 - 30
32 - 409
14 - 1 B
16 - 22
24 - 26
Over 6000
30 - 32'
36 - 44°
20 - 22
24 - 26
26 - 28
Under 750{
16 - 20
26 - 26
10-12
14 -16
14 - y6
756-1500
24-26
28-36,1
12-15
18-20
20-22
65 - TOJ
see Note b
15 0 - 6000
26 - 32i
34 - 42-1
16 - 20
22 - 24
26 - 28
Over 6DDO
30 -:W
38 - 462
22 - 24
26 - 30
26 - 30
Notas:
a. When a srie-apeciirr, investigation indicatea s high probabdity of continuing crashes or when such ooarirences are indicated by
crash hiritoryr, me designer may prflvide dear-znrre distsnoe5 greater than the dear zone shown in Table 4-& Clear zones may
be limilsd to 30 feet for practicaity and to pruwide a consistent roadway template if previous experienca with similar projecII& or
desiign& indicates &atislaotnry pmfomnan+ce_
b. Bemuse recovery is leas iicalk on the unshielded, traversable 1 VAH fill alopert, fixed objects shed not be present in the
vicinity of Ihs toe of Ihsse slope's Recovery of high-speed vehicles that encroach beyond Ihs edge of the shoulder may be
eapecled to float beyond the Ioe of slope- Determinaion of the width of the recovery area al the toe of slope should consider
Fight of way availability, envirormentsl aonaerns. eD3nomic factors, safety needs, and crash hialories. Also, Ihs dimence
between the edge of the through [reveled lane end the beg*ning of Ihs I V:3H slope should influence the reemary area
provided at the tie of slops. While the application may be limited by several factors, the forealope parameters that may enter
iffb deler fining a maximum desirable recovery area are ihurrtrsted in Figure 4-:5. A 1 0-foot recovery area at the toe of slope
should be provided for all trsvarsable, nar�rac rersblefid slopes.
c, For ruadwayrr with low volumes, it may not be practical to apW raven the minimum values found in Table 4-5. Refer to
RDG Chapter 12 far addrdcnal csansiderations for low -column roadways and RDG Chapter 10 for additional guidance for urban
applications.
d. When design speeds are greener then the values prcuidsd, the wri finer may pro -Ada clear -zone distances greater men thflae
shown in Table 4�5.
Soures: RD-G Chapler3 Section 3.1 Table 3-1
The above Clear -Zone table is from the Roadway Design Manual, November 2021.
Division 3, District 1 Updated 09/12/2022

NCDOT Required Clearances for Aerial InstaHatiuns Near Bridge Structures
NOT
TO
SC ski _F
Amy -vmriatrontD this detail mintbe
approved by the Di-visionEnginr+ar
and. or State Utilities R{amger.
Publishedby NCDOTUtihbes Unit
June 2020
x x� iL1717]ti1IDti
Sae elearanAm
hit (See
Note 2)
Bridge Rail
(design -v)
Enid Ee
Horizontal
C lea ran ce to
-wire nearest
�I1il�exxx
hfinimum =
8 Feet — Table' A:
foT p im OR
tehKo=nniraftol a
_4my a wffptimi mwt
be cowdiurted nith
Di%!:!!mi BT die
Pffson al Puiw to
Uti&ty Pale (Ty pical-P-Dr
an&.DrTic.Dmm1X1- atiDns)
Varies
**Sea
Note
r a b le A- Mi n im u m H ur iaontal C lemance Distances to POWER L ines
from QSHA
VOLTAGE
MINIMUM CLEARANCE
{nominal, W, alternating
j f eel)
Mont)-
Cu Mont)-
10
Up to 50
Up
o+e( 50 to 200
1 15
Over 200 to 350
20
Over 35+0 to 500
25
Over 500 to 750
35
Over 75+0 to 1000
45
Over 1000
As established by the utility
ownc4operator or registered
pr0feS3kmA6G englneef ++moo r$ a q Ual Ified
person with respect to electrical power
Iraimamisslon and distribulion
E ngr Elzed FLme
Conductor
Pmti�er T .inaa M-Picel)*
Neutral Con(1ue Dr
(% eries im locum 9ched to
Pam)*
Teleaommnnirous lim(s)
mounted belawany poorer lime OR
ondedimiedi leo�nimnmczimn
pals without pow line; *
*Note 1: _ o ial lines ceding to
nest pole %nth 1mi-est eles"= m at sag
poi-mt. Aerial tines dmim as 3-D effect
torepmemait t}picalminim,im pzaM
imstallatiam to bmdgZ stmctwe-
Top of bridge deek emended
Distance Tories
tD ground
where pole is
installed
* *Note 2- IXIK TI�IUJN &JiG CLEARANCE
HEIGHT is'A feet (apphim to
tel mmunic on3 AND power.
* * *Note 3: HORIZONTAL CLEAR.ANCEEXCEPTION.lf-v tieal sag clearame heiebf £Drpoiver above bridge deekis
fieet AIdI? G�Dltage 13 35OkV, then hExi mom HonzDntalClmrame may be reducedtD 3 feet. Any telem=imimtioms
attachment to pm erpoleallowedin this exoTtiommust haw a mininnn„ 2 5 feet sag clearame het ht abovebridge deck
Division 3, District 1 Updated 09/12/2022

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.
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
Pender
5 ( I yZy - t4r,24
P.E. Seal
c AR 0 fi
a SEAL r•
040356
'�'l���iti ,wi�``.

N
B-14
SAMPSON
B- 55
BLADEN
COLUMBUS
BRUNSWICK
11111»1\
►1XhUa_10411111ILT51:11C7
1*10690U►Jt
Legend
Proposed Permanent Well
Proposed Temporary Well
Cape Fear River
QFayetteville Works Site Boundary
Four Counties Boundary
Surrounding North Carolina County
Notes:
NCDOT - North Carolina Department of Transportation
1. County boundaries and major hydrography waterbodies were downloaded from
NC OneMap site (https://www.nconemap.gov).
2. Basemap source: Esri, HERE, Garmin, (c) OpenStreetMap contributors, and the
GIs user community.
F",Itr.c: l ,�
1, PENDER
li�m
4 2 0 4 Miles
Proposed Groundwater Well Locations
In Pender County
Four Counties Assessment
North Carolina
Geosyntec" Geosyntec Consultants of NC, PC. Figure
consultants NC License No.: C 3500 and C 295
1
Raleigh September 2023
DRAFT; Privileged and Confidential; Attorney Client Work Product; For Discussion Purposes Only.

3
2
t
CO
N
h
CO
200 ft. to
A ~ � Lodge Rd
AM
1 J `.
-77.811184, 34.552591
—15 ft from edge of pavement
-77.811217, 34.552527
—15 ft from edge of `/mm not
-77.81122'
—15 ft from edge
-%M
Lodge Rd
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-12 Sampling Location
Geosyntec'- Geosyntec, Consultants of NC, P.C. Figure
consultants NC License No.: C 3500 and C 295
la
Raleigh, North Carolina September 2023

N
Legend
Proposed Well Location
Tax Parcel Boundary
-77.9032, 34.6435
-5 ft from edge of pavement
1,405 ft. to
Mallard Roost Dr
SR-1318 Croo
msbridge Rd
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. Pender County.
i�
200 100 0 200 Feet
Proposed B-13 Sampling Location
Geosyntec'- Geosyntec Consultants of NC, PC. Figure
consultants NC License No.: C 3500 and C 295
_ 1b
�. Raleigh, North Carolina September 2023

2394-37-4899-0000
PZ M M WZ-M f'Tbalililill
-78.0227, 34.7005
—8 ft from edge of pavement
171 ft to
rd Rd
1001),
Willard Rd (SR100I)
Legend
-o�- 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. Pender County.
50 25 0 50 Feet
Proposed B-14 Sampling Location
GeosyntecO Geosyntec Consultants of NC, P.C. Figure
consultants NC License No.: C-3500 and C-295
1c
Raleigh, North Carolina I August 2023

N
Legend
$ Proposed Well Location
Tax Parcel Boundary
2
-78.1749, 34.5281
sm� —5 ft from edge of pavement
s�
.N
0
5V
e�o
0
m
s�
163 fVto
W \Henry St
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. Pender County.
100 50 0 100 Feet
Proposed B-15 Sampling Location
Geosyntec'- Geosyntec Consultants of NC, PC. consultants Figure
FI
NC License No.: C 3500 and C 295
g
1d
Raleigh, North Carolina August 2023

xenxronwwsu rxa�Emm
n.xnxoaua s��res xe�arrsa rnocanM
TYPICAL
FLUSH -MOUNT GROUNDWATER MONITORING WELL
CONSTRUCTION DIAGRAM
BOLTED MANHOLE COVER
CONCRETE PAA
MANHOLESLEEVE
LOCKING WELL CAP
2" SCH EDUL E 40 PVC PIPE
BENTONME GROUT
BENTONITE SEAL
TYPE
SAND PACK
GRAIN SIZE
T SLOTTED SCHEDULE
aU PVC SCREEN
BOTTOM GAP
BOTTOM OF BO RIN G
ANNULUS
Figure 1: Typical Well Construction

Figure 2: Typical Appearance of a Completed Well at Grade

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
August 22, 2023
Ms. Kristen Spirakis, PE
District Engineer
NCDOT
295-A Wilmington Highway
Jacksonville, NC 28540
Subject: Request for Right of Way Encroachments in Pender County
Dear Ms. Spirakis,
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
multiple locations in Pender 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-b 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.
Figure la — 1 temporary well on Wallace Airport Rd, Pender County, NC 28478
Figure lb — 1 temporary well on N Sunset Rd, Pender County, NC 28421
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 temporary 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. Temporary monitoring wells will be abandoned in accordance with well abandonment
regulations.
Your cooperation in this matter is appreciated. Please contact me at [phone] or
mschottggeosyntec.com if you need any additional information or have any questions.
Sincerely,
Michael Schott, PE, PMP

Attachments
Attachment 1 Proposed Monitoring Well Installation Locations (Figures I a and lb)
Attachment 2 NCDOT Checklist
Attachment 3 Plans & Details
Attachment 4 VCER-1 Form
Attachment 5 Encroachment Agreement Form

Attachment I
Proposed Monitoring Well
Installation Locations
(Figures la and lb)
Request for Right of Way Encroachments in Pender County

2394-37-4899-0000
2394-36-4882-0000
-78.0227, 34.7005
—8 ft from edge of pavement
2394-37-6126-0000
2394-47-1692-0000
(5)
171 ft to
rd Rd
1001)
Willard Rd (SR1001)
2394-37-8195-0000
2394-47-1692-0000
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. Pender County.
50 25 0 50 Feet
Proposed B-14 Sampling Location
Geosyntec V Geosyntec Consultants of NC, PC. Figure
consultants NC License No.: C 3500 and C 295
1a
Raleigh, North Carolina August 2023

N
Legend
$ Proposed Well Location
Tax Parcel Boundary
3
Z
-78.1749, 34.5281
—5 ft from edge of pavement
s�
�cP
0
00
s�
163 fVto
Vl.\Henry St
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. Pender County.
100 50 0 100 Feet
Proposed B-15 Sampling Location
Ge o syn to ct'- Geosyntec Consuitants of NC, P.C. Figure
consultants F I U re
NC License No.: C 3500 and C 295 g
1b
Raleigh, North Carolina August 2023

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

xaUMM 5 BRE rn nF FR
ntxu�om�s srreana�o�e rnoaxAM
TYPICAL
FLUSH -MOUNT GROUNDWATER MONITORING WELL
CONSTRUCTION DIAGRAM
Nwoms¢�aa
ow u�u oe�
BOLTED MANHOLE COVER
CONCRETE PRO
MANHOLE SLEEVE
LOCKING WELL CAP
L' SCHEDULE 4U PVC PIPE
BENTON TE GROUT
BENTONITE SEAL
TYPE
SAND PACK
GRAIN SIZE
L' SLOTTED SCHEDULE
96 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 Pender 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.
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
Pender
5 ( I yZy - t4r,24
P.E. Seal
c AR 0 fi
a SEAL r•
040356
'�'l���iti ,wi�``.

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

ROUTE multiple (see attached) PROJECT
STATE OF NORTH CAROLINA
COUNTY OF Pender
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 Pender 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
Digitally signed
C h e ri I yn by Cheri lyn
Mertes
Mertes Date:2023.08.27
15:43:05-04'00'
Cherilyn Mertes, Sr. Scientist
Geosyntec Consultants
DEPARTMENT OF TRANSPORTATION
,01
DIVISION ENGINEER
S at h ya DN: lly signed by Salhya Y111ill
DN: cn=Salhya 11Y.1yg,S11, -US, ­Th.
Chemoura Company, ou=Corporate
emmediation Group,
Ya l v i d Datell 023 0825a11 511 22 ep4'00f'
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.