WM0801239_Application_20231128

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: November 22, 2023
4
County: Brunswick
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant:
The Chemours Company FC LLC
Applicant's Mailing Address: 22828 NC Highway 87W, Fayetteville, NC 28306
5.
H
7
A
a
Applicant's Email Address (if available): [e-mail]
Telephone: [phone]
Contact Person (if different than Applicant): Savannah Volkoff Telephone: [phone]
Contact Person's Mailing Address: 2501 Blue Ridge Rd, Suite 430, Raleigh, NC, 27607
Contact Person's Email Address (if available):
[e-mail]
Property Owner (if different than Applicant): NCDOT ROW Enroachment
Property Owner's Mailing Address: See attached
Property Owner's Email Address (if available): NA
Telephone: [phone]
Property Physical Address (Including PIN Number) Multiple locations - See attached figures & approved DOT permit
City See attached figures/DOT permit County See attached figures/DOT permit Zip Code See figs/permit
Reason for Well(s): Groundwater Monitoring Wells
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed: NA
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
10. Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
NA
11. Type of contaminants being monitored or recovered: PFAS
(ex: organics, nutrients, heavy metals, etc.)
12
13
Are there any existing wells associated with the proposed well(s)? If yes, how many? No
Existing Monitoring or Recovery Well Construction Permit No(s).: NA
Distance from proposed well(s) to nearest known waste or pollution source (in feet): None
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Possible private residence wells
If ves, give distance(s): N/A
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 D1g' signed 0y Sg, V2lvigi
DN. cn=$a,M1ya VaNigi, c=US, o=TM1e CM1emours Company, ou=Corporate
Remediation Group, email-Sa�M1ya [e-mail]
Da Signature of Applicant or *Agent
Sathya 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)

From:
Bass, Michael L
To:
Savannah Volkoff
Cc:
Cherilyn Mertes; Michael Schott; Hammers, Angela K
Subject:
Temporary Monitoring Well Installation within NCDOT Right of Way (Brunswick County) - Email Approval
Date:
Tuesday, November 7, 2023 11:25:45 AM
Attachments:
imaae001.pno
Geosyntec RequestforTemporaryWells BrunswickCountv.pdf
Encroachment Aareement Standard Conditions Updated July 2023.pdf
Importance:
High
CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you
recognize the sender and know the content is safe. If you have any suspicion, please confirm with the sender
verbally that this email is authentic. If you suspect fraud, click "Phish Alert Report."
Savannah,
This email serves as an approval for Temporary Monitoring Wells to be placed within NCDOT Right of
Way in Brunswick County. One Temporary Well will be placed on the following routes: SR 1553 (St.
Phillips Road SE), SR 1331 (Mill Branch Road NW), SR 1353 (Prospect Road NW). These Wells will be
abandoned within 4-6 weeks after installation. Please follow all attached Standard Conditions that
apply. If working within 5 ft of the edge of pavement, follow all MUTCD standards and traffic control
that apply. Please contact me at your convenience to set up a preconstruction meeting. Note that
the applicant is responsible for field verifying the placement of these Temporary Monitoring Wells
prior to holding a preconstruction meeting.
Thank you,
Michael L. Bass, Jr.
Assistant District Engineer
Division of Highways I Division 3 1 District 3
North Carolina Department of Transportation
910 398 9100 office
mlbassQncdot.gov
5911 Oleander Drive, Suite 101
Wilmington, NC 28403
R
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

Email correspondence to and from this sender is subject to the N.C. Public Records Law and may be disclosed to third parties.

Geosyntec '�'
consultants
Geosyntec Consultants of NC, PC
Mr. Benjamin Hughes, PE
District Engineer
NCDOT
5911 Oleander Drive, Suite 101
Wilmington, NC 28403
Geosyntec Consultants of NC, PC
2501 Blue Ridge Road, Suite 430
Raleigh, North Carolina 27607
PH 919.870.0576
FAX [phone]
www.geosyntec.com
November 3, 2023
Subject: Request for Installation of Monitoring Wells in Brunswick County Right of Way
Dear Mr. Hughes,
On behalf of our client, The Chemours Company FC, LLC, (Chemours), Geosyntec Consultants
of NC, P.C. (Geosyntec) has prepared this request to install temporary monitoring wells in the
Right of Way (ROW) at multiple locations in Brunswick County. Installation of temporary
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 to install temporary monitoring wells at the approximate
locations listed below and shown in Figures 1 a-c 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 1 a — 1 temporary well, St. Phillips Rd, Winnabow, NC 28479
• Figure lb — 1 temporary well, Corner of Big Neck Rd NW and Mill Branch Rd NW, Ash,
NC 28420
• Figure 1 c —I temporary well, Prospect Rd NW, Supply, NC 28462
The proposed temporary monitoring wells will be installed by a North Carolina -licensed well
contractor under the direction of Geosyntec. Wells will generally be constructed as shown in the
schematics and plans in Attachment 2 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, following
sampling and receipt of data. Wells are anticipated to be abandoned within 4-6 weeks of
installation.
Your cooperation in this matter is appreciated. Please contact me at [phone] or
mschott(&,geosyntec.com if you need any additional information or have any questions.
Sincerely,
Michael Schott, PE, PMP

Attachments
Attachment I Proposed Well Installation Locations (Figures I a through I c)
Attachment 2 Plans & Details

Attachment I
Proposed Well
Installation Locations
(Figures la through lc)

I=
-77.94883, 34.04129
-5 ft from edge of pavement
92 ft. to
Old King 6 ��SUMM,yoOM--
t ilita Ocean Terminal(SR1326) _ ry
Legend
-J� 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
8884 St. Phillips Rd SE (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. Brunswick County
200 100 0 200 Feet
Proposed 1-13-04 Sampling Location
Geosyntec'- Geosyntec, Consultants of NC, P.C. Figure
consultants NC License No.: C 3500 and C 295
1a
Raleigh, North Carolina October 2023

Mi//er
arch RaN� 4920 Mill Branch Rd NW
-78.4671, 34.0387
�6 ft from edge of pavement 210 ft. tc
Big Neck Rt
(SR 133,:
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. Brunswick County
200 100 0 200 Feet
Proposed B-06 Sampling Location
Geosyntec'- Geosyntec Consultants of NC, PC. Figure
consultants NC License No.: C 3500 and C 295
1b
Raleigh, North Carolina INovember 2023

10735054
10735036
-78.3308, 34.0369
-5 ft from edge of pavement
1,300 ft. to
Royal Oak Rd NW
(SR 1345)
10702098 1340 Prospect Rd NW
1340 Prospect Rd NW
2,500 ft. to
Makatoka Rd NW
10702102
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. Locations are in Brunswick County, North Carolina.
50 25 0 50 Feet
MINIM
Proposed B-07 Sampling Location
Geosyntec'- Geosyntec Consultants of NC, PC. Figure
consultants NC License No.: C 3500 and C 295
1c
Raleigh, North Carolina I November 2023

Attachment 2
Plans & Details

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

Figure 2: Typical Appearance of a Completed Well at Grade

„E STATED,
s
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER J.R. "JOEY” Homms
GOVERNOR SECRETARY
November 20, 2023
Sathya Yalvigi — Senior Remedial Project Manager
The Chemours Company, FC LLC — Fayetteville Works
22828 NC Highway 87 W
Fayetteville, NC 28306
SUBJECT: Encroachment Agreement (E033-010-23-00451) for Green Hill Rd, SR 1410, located in
Brunswick County
Dear Applicants,
Attached for your files is a copy of Right of Way Encroachment agreement properly executed. This
agreement covers the following:
Installation of environmental groundwater monitoring wells with soil and groundwater sampling as
directed by NCDEQ at locations within the NCDOT R/W of SR 1410, Green Hill Rd, across from
2963 Green Hill Rd (3 wells), in Brunswick County.
• Approval may be rescinded upon failure to follow any of the provisions in this agreement
and may be considered a violation of the encroachment agreement.
• Placement of wells to be as close as practicable to property lines.
• Adjacent property owners to be notified of well placement prior to installation by certified
mail.
• All material(s) taken from the wells shall be removed daily from and not stored within
NCDOT Right of Way.
• Prior to the preconstruction meeting, all utility locates must be completed and verified.
• Avoid the 1:1 slope from EOP throughout construction.
• All pre -cons are valid for 90 days.
• The Continuing Indemnity Bond posted with the NCDOT is hereby obligated to cover work
under this encroachment agreement. The Encroaching Party shall notify NCDOT at 910-
398-9100 upon completion of the work for a final inspection.
Mailing Address: Telephone: [phone] Location:
NC DEPARTMENT OF TRANSPORTATION Fax: [phone] BARBADOS BOULEVARD
DIVISION OF HIGHWAYS Customer Service: 1-877-368-4968 CASTLE HAYNE, NC 28429-5647
5505 BARBADOS BOULEVARD
CASTLE HAYNE, NC 28429-5647 Website: www.ncdot.gov

• Time Restriction — Peak Hours Restricted: No lane closures shall be allowed from 6:00am
to 9:00am and from 4:00pm to 7:00pm and NO weekend lane closures. (HOURS
SUBJECT TO CHANGE DUE TO TRAFFIC CONDITIONS — NIGHTTIME
OPERATIONS WILL BE REQUIRED WHEN WARRANTED)
• For the Pre -construction meeting, the Encroaching party or their contractor shall provide
Three (3) business days in advance notice prior to construction activity within the NCDOT
right of way, Contact the District office to schedule.
As per this approval it is subject to this work being done in accordance with the attached plan
sheets and special provisions.
Sincerely,
II
DocuSigned by:
l,�&'Att f?xss
E254FB0739E2460...
Michael L. Bass Jr., Assistant District Engineer
For Chad Kimes, PE, Division Engineer
DCK/mlb/akh
ec: Trey Moore, NCDOT Brunswick County Maintenance Engineer

ROUTE multiple (see attached) PROJECT
STATE OF NORTH CAROLINA
COUNTY OF Brunswick
DEPARTMENT OF TRANSPORTATION
-AND-
The Chemours Company, FC LLC- Fayetteville Works
22828 NC Highway 87 W
Fayetteville, NC 28306
RIGHT OF WAY ENCROACHMENT AGREEMENT
FOR NON -UTILITY ENCROACHMENTS ON
PRIMARY AND SECONDARY HIGHWAYS
THIS AGREEMENT, made and entered into this the 20th day of November, 20 23 , by and between the Department
of Transportation, party of the first part; and
The Chemours Company, FC LLC - Fayetteville Works
WITNESSETH
party of the second part,
THAT WHEREAS, the party of the second part desires to encroach on the righLQLw3u of the public road designated as
Route(s) multiple (see attached figures) , located in Brunswick County eNa-or, eaNlies
with the construction and/or erection of: environmental, groundwater monitoring wells
WHEREAS, it is to the material advantage of the party of the second part to effect this encroachment, and the
party of the first part in the exercise of authority conferred upon it by statute, is willing to permit the encroachment
within the limits of the right of way as indicated, subject to the conditions of this agreement;
NOW, THEREFORE, IT IS AGREED that the party of the first part hereby grants to the party of the second
part the right and privilege to make this encroachment as shown on attached plan sheet(s), specifications and
special provisions which are made a part hereof upon the following conditions, to wit:
That the said party of the second part binds and obligates himself to install and maintain the encroaching facility in such safe
and proper condition that it will not interfere with or endanger travel upon said highway, nor obstruct nor interfere with the proper
maintenance thereof, to reimburse the party of the first part for the cost incurred for any repairs or maintenance to its roadways
and structures necessary due to the installation and existence of the facilities of the party of the second part, and if at any time the
party of the first part shall require the removal of or changes in the location of the said facilities, that the said party of the second
part binds himself, his successors and assigns, to promptly remove or alter the said facilities, in order to conform to the said
requirement, without any cost to the party of the first part.
That the party of the second part agrees to provide during construction and any subsequent maintenance proper signs, signal
lights, flagmen and other warning devices for the protection of traffic in conformance with the latest Manual on Uniform Traffic
Control Devices for Streets and HighwaVs and Amendments or Supplements thereto. Information as to the above rules and
regulations may be obtained from the Division Engineer of the party of the first part.
That the party of the second part hereby agrees to indemnify and save harmless the party of the first part from all damages
and claims for damage that may arise by reason of the installation and maintenance of this encroachment.
It is clearly understood by the party of the second part that the party of the first part will assume no responsibility for any
damage that may be caused to such facilities, within the highway rights of way limits, in carrying out its construction and
maintenance operations.
That the party of the second part agrees to restore all areas disturbed during installation and maintenance to the satisfaction of
the Division Engineer of the party of the first part. The party of the second part agrees to exercise every reasonable precaution
during construction and maintenance to prevent eroding of soil; silting or pollution of rivers, streams, lakes, reservoirs, other water
impoundments, ground surfaces or other property; or pollution of the air. There shall be compliance with applicable rules and
regulations of the North Carolina Division of Environmental Management, North Carolina Sedimentation Control Commission, and
with ordinances and regulations of various counties, municipalities and other official agencies relating to pollution prevention and
control. When any installation or maintenance operation disturbs the ground surface and existing ground cover, the party of the
second part agrees to remove and replace the sod or otherwise reestablish the grass cover to meet the satisfaction of the Division
Engineer of the party of the first part.
That the party of the second part agrees to assume the actual cost of any inspection of the work considered to be necessary
by the Division Engineer of the party of the first part.
That the party of the second part agrees to have available at the encroaching site, at all times during construction, a copy of
this agreement showing evidence of approval by the party of the first part. The party of the first part reserves the right to stop all
work unless evidence of approval can be shown.
Provided the work contained in this agreement is being performed on a completed highway open to traffic; the party of the
second part agrees to give written notice to the Division Engineer of the party of the first part when all work contained herein has
been completed. Unless specifically requested by the party of the first part, written notice of completion of work on highway
projects under construction will not be required.
That in the case of noncompliance with the terms of this agreement by the party of the second part, the party of the first part
reserves the right to stop all work until the facility has been brought into compliance or removed from the right of way at no cost to
the party of the first part.
That it is agreed by both parties that this agreement shall become void if actual construction of the work contemplated herein
is not begun within one (1) year from the date of authorization by the party of the first part unless written waiver is secured by the
party of the second part from the party of the first part.
FORM R/W 16.1A (Revised February 2021)

R/W (161A) : Party of the Second Part certifies that this agreement is true and accurate copy of the form
R/W (161A) incorporating all revisions to date.
IN WITNESS WHEREOF, each of the parties to this agreement has caused the same to be executed the day and
year first above written.
ATTEST OR WITNESS
Cherilyn Digitally signed by
Cherilyn Mertes
Mertes late:2023.08.27
15:40:40-04'00'
Cherilyn Mertes, Sr Scientist
Geosyntec Consultants
DEPARTMENT OF TRANSPORTATION
oocusigned by: Michael L. Bass Jr., Assistant District Engineer
B : AAA 16(ti4(( 6ASS For Chad Kimes, PE, Division Engineer
tZZ14t-bUtOVtZ40U...pq
Sathya DN ally signed by Salhya Valvigi
DN: ,=.hya Valvigi, c=US, o=The
Chemours Company, o Corporate
Ya I vi q i Remedialion Group
ai =S 23 08 25 11i 54 1 -04'0 rs.com
Date: 2023.08.2511'.54.21-04'00'
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.

Encroachment Agreement Standard Conditions
District Office Contact Information:
5911 Oleander Drive, Suite 101
Wilmington, NC 28403
[phone]
The Standard Conditions in this document apply to this and all encroachment agreements issued by District 3.
SCl A Pre -Construction meeting must be held with the District Office within 90 days of approval. All locates Shall be completed prior
to the scheduling of meeting.
SC2 The Encroaching Party shall follow any and all revisions shown in RED on attached plan(s).
SC3 This permit along with all terms and agreements shall be incorporated into any lease or sales 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 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.
SC5 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.
SC6 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 by calling 910-398-9100 or email at [e-mail].
SC7 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.
SC8 All bonds will be held for a minimum of one year from the time of the Initial Construction Inspection acceptance date. At the
end of that time period, the bond may be released at the request of the applicant pending Final Inspection Acceptance.
SC9 All flagging operations within NCDOT right-of-way require qualified and trained Work Zone Flaggers. Qualified and trained
Work Zone Traffic Control Supervisors will be required on significant projects. Training for this certification is provided by
NCDOT approved training sources and by private entities that have been pre -approved. For more information, visit
https:llconnect.ncdot.gov/projectslWZTC/PagesITraining.aspx or contact Steve Kite, PE with the NCDOT Work Zone Traffic
Control Unit at [phone], or [e-mail].
SC10 No lane closures shall be allowed on State Holidays (day of, day before, and day after) or during Local events.
SC11 No lane closures or impediment to traffic shall be allowed on weekends without prior written approval from the District
Engineer. Work would be permitted on -site during these events, as long as, there are no lane closures or the impediment of
traffic.
SC12 One lane must always be open to traffic; only one lane closure will be allowed in each direction. Ingress and egress shall be
maintained to all businesses and dwellings affected by the project. Special attention shall be paid to Police and Fire Stations,
fire hydrants and Hospitals.
SC13 All roadway signs removed during project work shall be reinstalled immediately after completion of work. All
equipment and materials shall be removed from the NCDOT right-of-way when not in use.
SC14 Any work requiring personnel or equipment within 5' of a travel lane on an undivided roadway, or 10' of the travel lane, on a
divided roadway shall require a lane closure per the latest edition of the MUTCD and the NCDOT Standard Specifications.
The more stringent standards shall apply.
SC15 Approval is only for work within NCDOT right-of-way. Any construction planned or proposed outside NCDOT right- of -way
shall require the permittee to obtain concurrence and/or right-of-way from subject property owner and/or local government.
This approval excludes area(s) within Railroad right-of-way and/or Municipal right-of-way which will require separate
approval from the Railroad, City or Town. Approval is with the understanding that NCDOT does not guarantee the right-of-
way on any road.
Division 3, District 3
Updated 07/26/2023.

SC16 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: Manual on Uniform Traffic Control Devices, Policy on
Street and Driveway Access to North Carolina Highways, Policies and Procedures for Accommodating Utilities on Highway
Rights of Way, Subdivision Roads Minimum Construction Standards, NCDOT Standard Specifications for Roads and
Structures, NCDOT Roadway Standard Drawings, AASHTO Policy on Geometric Design of Highways and Streets, NCDOT
Asphalt Quality Management System manual, and the approved plans.
SC17 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.
SC18 NC 811 services DOES NOT provide locates of traffic signal cables. If the work is located within''/2 mile of a signalized
intersection, the Encroaching Party shall contact NCDOT Traffic Services at [phone] no less than one week prior to
beginning work, for the location of all traffic signal and detection cables. Location is required prior to excavation. Cost to
replace or repair NCDOT signs, signals or associated equipment shall be the responsibility of the Encroaching Party.
SC19 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].
SC20 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.
SC21 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.
SC22 Prior to beginning work, if the area of work is within a municipality limit, it is the responsibility of the Encroaching Party to
notify the municipal authorities.
SC23 The Encroaching Party shall comply with all applicable Federal, State, and local statutes, rules, regulations, and ordinances
that may be imposed by other governmental agencies. The Encroaching Party shall obtain all necessary Federal, State, and
local environmental permits, including but not limited to, those related to sediment control, storm water, wetlands, streams,
endangered species, and historical sites.
SC24 All wiring and related work shall conform to the latest edition of the National Electrical Safety Code.
SC25 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.
SC26 An executed paper copy of the Encroachment Agreement and approved plans shall be present at the work site at all times while
performing work. NCDOT reserves the right to stop all work unless evidence of approval can be shown. Additionally,
NCDOT reserves the right to further limit, restrict, or suspend operations within the right-of-way.
SC27 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.
SC28 All erosion control devices shall be placed as needed prior to disturbance and maintained throughout the project. All areas
disturbed (shoulders, ditches, removed accesses, etc.) shall be graded and seeded within 15 calendar days with an approved
NCDOT seed mixture. For disturbance of residential/commercial lawns, vegetation shall be replaced in like kind.
SC29 For disturbance of plants, vegetation, trees, or plant beds in the NCDOT right-of-way, they shall be replaced with plants,
vegetation or trees of like kind or similar shape. Contact the Division Roadside Environmental Engineer at 910-259-4919.
SC30 The placement of curb and gutter is not allowed within shoulder sections of roadway (from the Right of Way to the edge of
pavement).
SC31 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.
Division 3, District 3
Updated 07/26/2023.

SC32 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.
SC33 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).
SC34 The Encroaching Party shall comply with all OSHA requirements and provide a competent person on site to supervise
excavation at all times.
SC35 The Encroaching Party is responsible for any and all damages caused from project work within the right-of-way, including
damage to drainage structures, pavement, vegetation, etc.
SC36 Any pavement damaged including settlement of the pavement or damage by equipment used to perform the project work, shall
be re -surfaced to the satisfaction of the District Engineer or their representative. This may include the removal of pavement and
a 50' mechanical overlay. All temporary and final pavement markings are the responsibility of the Encroaching Party.
SC37 Centerline pavement markings shall be installed the same day resurfacing is accomplished. All other pavement markings
shall be completed within five days of resurfacing.
SC38 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.
SC39 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".
SC40 All removed curb, driveways, and shoulder areas shall be backfilled at a 6:1 slope or flatter at the end of the days'
production.
SC41 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.
SC42 Directional drilling methods have not been given statewide approval for use on NCDOT right-of-way. Under no condition
shall jetting alone or wet boring with water be used for the installation of utility pipelines.
• Directional boring is not allowed in embankment material. Directional boring is allowed beneath embankment material in
naturally occurring soil.
• Any changes shall be submitted to the District Engineer for approval prior to construction.
• Directional bores are not allowed beneath bridge footings, culvert wingwall footings or retaining walls.
• 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.
• Directional boring using jetting with a Bentonite (or equivalent material) slurry is approved with the following
conditions:
o Minimum depth of ten (10') feet below the pavement surface of roads with no control of access or fifteen
(15') feet below the surface of roads with partial or full control of access.
o Minimum depth of five (5') feet below any ditch line and/or creek bed.
o Minimum depth of (5') for parallel installation. Must be outside the theoretical 1:1 slope from the existing edge of
pavement except where the parallel installation crosses a paved roadway.
o Minimum horizontal distance of ten (10') feet from the nearest part of any structure, including but not limited to
bridges, footings, pipe culverts, and box culverts.
o Minimum vertical distance of ten (101) feet from the nearest part of pipe culverts or box culverts.
o Tip of the drill string shall have a cutter head and detection wire installed with non-ferrous material.
o All directional drilled piping for sewer force mains and waterlines shall be a minimum of SDR-9.
Division 3, District 3
Updated 07/26/2023.

Minimum horizontal separation of five (51) feet between each conduit which is part of a multiple conduit
installation (including perpendicular and parallel installations). Alternatively, install multiple conduits within
a single duct.
o Over bores for pipe or encasements shall not be more than 1.5 x O.D. for pipe 12 inches or less and
O.D. +6 inches for pipes larger than 12 inches.
An overbore exceeding the prescribed maximums for pipe or encasements will only be considered if the
encroachment agreement includes a statement signed and sealed by a North Carolina Registered Professional
Engineer indicating that the proposed overbore in excess of NCDOT guidelines of the diameter of the pipe or
encasement will arch and no damage will be done to the pavement or sub- grade.
SC43 All excavations inside the theoretical 1:1 slope from the existing edge of pavement to the bottom of the nearest trench wall
shall be done in accordance with the following conditions:
• Any excavation encroaching upon the theoretical 1:1 slope from the edge of pavement of any NCDOT
maintained road shall require temporary active shoring that must be reviewed and approved by NCDOT prior to
work.
• All trench excavation inside the limits of the theoretical 1:1 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.
• The length of parallel excavation shall be limited to the length necessary to install and backfill one (1) joint of pipe at a
time.
• Traffic shall be moved to a travel lane outside the limits of a theoretical 1:1 slope from the bottom of the nearest
trench wall to the pavement surface.
• Installation of trench shoring shall be accomplished with minimal over -excavation. Trench boxes shall not be used
as shoring.
• An NCDOT Inspector, the cost of which is to be borne by the Encroaching Party, shall be assigned to this project
if deemed necessary by the Division Engineer.
• The trench backfill material shall meet the Statewide Borrow Criteria. The trench shall be backfilled, in accordance
with Section 540-6 of the latest NCDOT Standard Specifications for Roads and Structures, which requires the backfill
material to be placed in thicknesses between 4" and 8" loose and compacted to at least 97% of the maximum density
obtained by compacting a sample in accordance with AASHTO T 180, as modified by the Department.
• At the first sign of trench failure, a trench shall be immediately backfilled with materials consisting of A-1, A- 3, A-2-4
soils or A-4 soils having a maximum of 45% passing a No. 200 sieve and a maximum P.I. of 6. All work shall cease,
and the Division Engineer shall be contacted. The Encroaching Party shall be required to repair any damage to the
pavement caused by the excavation.
• No part of any pit shall be within three (3) feet of edge of pavement or back of curb.
• Detection tape shall be buried in the trench approximately one foot above the utility or fiber optic cable, whenever
conduit is installed in right-of-way and is not of ferrous material.
SC44 The 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.
SC45 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:
o 11.0" B25.00 or B25.OB 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.
Division 3, District 3
Updated 07/26/2023.

o Overlay entire area(a minimum 50' length mechanical overlay) with 2.0" S9.5Cor S9.5B asphalt concrete surface
course for a total asphalt depth of 13". Butt joints are required with no feathering of joints.
o All open cuts shall be backfilled, paved and traversable prior to removing lane closure.
SC46 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".
SC47 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.
SC48 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.
SC49 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.3 og tube.com/watch?v=AOuYa5IW3dlz&feature=youtu.be
Division 3, District 3
Updated 07/26/2023.

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
November 3, 2023
Mr. Benjamin Hughes, PE
District Engineer
NCDOT
5911 Oleander Drive, Suite 101
Wilmington, NC 28403
Subject: Request for Right of Way Encroachments in Brunswick County
Dear Mr. Hughes,
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 for
multiple locations in Brunswick 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 a permanent monitoring well at the approximate location
listed below and shown in Attachment 1. Locations shown on the figure may be moved up to 10
feet during drilling to accommodate conflicts with existing utilities and/or access issues with the
drill rig.
• Figure 1 — 3 permanent wells, Green Hill Rd, Leland, NC 28451
A completed Standard Encroachment Plan Checklist, typical well plans and construction details,
a completed VCER-1, and a signed Encroachment Agreement Form are attached to this
application (Attachments 2-5). The proposed permanent monitoring wells will be installed by a
North Carolina -licensed driller under the direction of Geosyntec. Wells will generally be
constructed as shown in the schematics and plans in Attachment 3 and in accordance with
applicable well construction regulations. The final well locations depend on the presence of
existing utilities and other possible obstacles to the safety of drilling activities and field crew
members.
Your cooperation in this matter is appreciated. Please contact me at [phone] or
mschott&geosyntec.com if you need any additional information or have any questions.
Sincerely,
Michael Schott, PE, PMP

Attachments
Attachment I Proposed Well Installation Locations (Figure 1)
Attachment 2 NCDOT Standard Encroachment Plan Checklist
Attachment 3 Plans & Details
Attachment 4 VCER-I Form
Attachment 5 Encroachment Agreement Form

Bond No. 9422949
CONTINUING INDEMNITY BOND
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION — HIGHWAY ENCROACHMENT INSTALLATIONS
Amount of Bond: $100,000.00
PRINCIPAL (or second Party): The Chemours Company
SURETY (or Bonding company): Fidelity and Deposit Company of Maryland
KNOW ALL MEN BY THESE PRESENTS: that we, The Chemours Company , with principal office at 1007
Market Street Wilmington DE , 19898 , as PRINCIPAL and Fidelity and Deposit Company
of Maryland a corporation organized and existing under the laws of the State of Illinois
with its principal office in the City of Schaumburg , as SURETY, are held and firmly bound unto the
Department of Transportation, an agency of the State of North Carolina, in the sum of $100,000.00 , for
payment of which we bind ourselves, heirs, executors, administrators, successors and assigns, firmly by these presents.
Signed, sealed and dated this 20th day of October , 20 23
THE CONDITIONS OF THIS OBLIGATION IS SUCH, that whereas the said The Chemours Company , hereinafter
called the PRINCIPAL, agrees to reimburse the Department of Transportation for any repairs made necessary by
damage to any roads occasioned by the operations of the PRINCIPAL.
NOW, THEREFORE, the conditions of this obligation are such that if the PRINCIPAL shall well and truly perform and
comply with all the duties and obligations imposed on it, then this obligation shall be null and void; otherwise in full
force and effect.
This bond is executed by the SURETY upon the following express conditions:
That the SURETY may, if it shall so elect, cancel this bond by giving sixty (60) days notice in writing to the Department of
Transportation, Raleigh, North Carolina, and this bond shall be deemed cancelled at the expiration of said sixty (60)
days; the SURETY remaining liable, however, subject to all the terms, conditions and provisions of this bond, for any act
or acts covered by this bond which may have been committed by the PRINCIPAL up to the date of such caueIIAt16fv,,,'�
(Seal of Principal) The Chemours Company �'��
PRINCIPAL (Company Name)
ATTEST: ^ r OF��14
BY: • ....
I rk r Secretary ( f Princ pal) Signature of President (or Authorized Person)`'��,,� I fill %
-��erko��eer�t� (oSE+et} Fidelity and Deposit Company of Maryland
land
AD—
WitnSURETY (Bonding Company Name)
Bianca M. Phillips ; ?
(Seal of Surety) BY:
Signatur d o Atto ; ey-in-Fact for Bonding Company
Cori VIson, Attorney -in -Fact
COUNTERSIGNED
BY:
NCDOT State Utilities Manager
NOTE: Attach Power of Attorney and Certificate of Authority of Attorney -in -Fact.
R/W 166: Party of the Second Part (PRINCIPAL) certifies that this agreement is true and accurate copy of the form
R/W 166: incorporating all revisions to date. Revised April 2021 (Previously revised July 1978)

ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois. and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by
Robert D. Murray, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which
are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate,
constitute, and appoint Cori Wilson , its true and lawful
agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds
and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies,
as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the
ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL
AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of
the By -Laws of said Companies, and is now in force.
IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 27th day of September, A.D. 2023.
By: Robert D. Murray
Vice President
Bv: Dawn E. Brown
Secretary
State of Maryland
County of Baltimore
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
t
3xU myo=
^¢{vSEAL
, u. SEAL • s =
SEAL
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On this 27th day of September, A.D. 2023, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified,
Robert D. Murray, Vice President and Dawn E. Brown, Secretary of the Companies, to me personally known to be the individuals and officers described
in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith, that he/she is the
said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the
said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the
said Corporations.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written.
Genevieve AT Aloism?
;rVCA1
GENEVIEVE M. MAISON
WTARY PUBLIC
GALTIAIMECOUrfY NID
kyConmisscnE,aicsJANlARY27.70�

EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, Attorneys -in -Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attorneys -in -fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney -in -fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of
the By -Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney... Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the loth day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 20th day of October 2023
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Thomas 0. McClellan
Vice President
TO REPORT A CLAIM WITH REGARD TO A SURETY BOND, PLEASE SUBMIT A COMPLETE DESCRIPTION
OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND, THE BOND NUMBER, AND YOUR CONTACT
INFORMATION TO:
Zurich Surety Claims
1299 Zurich Way
Schaumburg, IL 60196-1056
www.reDortsfciaims(cD,zurichna.com
800-626-4577

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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
ID Email Address
® Applicant Project Name / Information / Number
IN County
❑ Proposed Schedule Not Applicable -
less than 1 acre
on 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 for work outside of
NCDOT right of way, including work on city and non-NCDOT maintained roadways from the submittal
Continued
Page 1 of 3 April 2021

Plan Title Sheet
( 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
Existing utilities will be
General Profile View located by NC 811
A profile view is required when crossing a roadway or other NCD locator.
Wells will public utility tybe 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

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
Brunswick +
Naw a -,,omit,`
5 ► -7 ` l-L/- l e Z-q
P.E. Seal
C A Ro ffr.
xx SFAL=
040356
ldd�

-78.1839, 34.169
-10 ft from edge of pavement
-78.1839, 34.169
-10 ft from edge of pavement
-78.1839, 34.1689
-10 ft from edge of pavement
2,685 ftya
Town Creel
(SR141/4
2963 Green Hill Rd NE
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. Brunswick County.
20 10 0 20 Feet
Proposed B-08 Sampling Location
Geosynte& Geosyntec Consultants of NC, P.C. Figure
consultants NC License No.: C-3500 and C-295
1
Raleigh, North Carolina IOctober 2023

Figure 2: Typical Appearance of a Completed Well at Grade

anana�e�urnr rnurecxian
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