WM0501309_Application_20181219

TERRA uest
ENVIRONMENTAL CONSULTANTS,P.C.
December 14, 2018
Eric Rice
NCDEQ DWR
1628 Mail Service Center Quality
NC Dept of Environmental Q Y
Raleigh, NC 27699-1628
DEC
Re: Submittal of Well Construction Permit Application Regional-Ra Office
Quick Stop, 611 N. Bickett Blvd., Louisburg, NCleigh
NCDWM-UST Incident No. 39923
Terraquest Project No. 01716
Dear Mr. Rice,
Terraquest is in the process of completing a Comprehensive Site Assessment for the Quick Stop
facility in Louisburg, NC. The enclosed permit application is part of that. Note that a delegation
of signature has been obtained and is enclosed. (This is a re-submittal of the application that was
lacking that document previously).
Sincerely,
TERRAQUEST ENVIRONMETNAL CONSULTANTS, P.C.
Ryan D. Kerins
Project Manager
Enclosure
100 E. Ruffin Street• Mebane, North Carolina 27302
Telephone [phone] • Facsimile [phone]
www.terraquestpc.com

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: 8/14/18 FOR OFFICE USE ONLY
2. County: Franklin PERMIT NO. VAA050110q ISSUED DATE
3. What type of well are you applying for?(monitoring or recovery): monitoring
4. Applicant: Said Sarraa Telephone: [phone]
Applicant's Mailing Address: 35 Pond Ridge Rd. Louisburg. NC 27549
Applicant's Email Address(if available): saidsarr(a)-yahoo.com
5. Contact Person (if different than Applicant): Ryan Kerins Telephone: [phone]
Contact Person's Mailing Address: 100 E Ruffin St Mebane NC 27302
2� ,tiU
Contact Person's Email Address(if available): [e-mail] F
o ` �
6. Property Owner(if different than Applicant): NCDOT Telephone:
Property Owner's Mailing Address: 1501 Mail Service Center Raleigh, NC 27699-1501
„4 Q
Property Owner's Email Address(if available): �q
7. Property Physical Address(Including PIN Number) adjacent to 2805-88-9071 0 N BICKETT BLVD-;
City Louisburg County Franklin Zip Code 54
8. Reason for Well(s): UST release assessment
(ex: non-discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility or site for which the well(s) is(are)needed: UST
(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).
NCDWM-UST Incident No. 39923
11. Type of contaminants being monitored or recovered: petroleum
(ex: organics, nutrients, heavy metals,etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? 10
Existing Monitoring or Recovery Well Construction Permit No(s).: none
13. Distance from proposed well(s)to nearest known waste or pollution source(in feet): <100
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? no
If yes,give distance(s):
15. Well Contractor: Terraguest Environmental—Wesley Sorrells Certification No.: 3577
Well Contractor Address: 100 E Ruffin St, Mebane, NC 27302
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C.0105(f)(7),attach a well construction diagram of each well showing the following:
a. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth f. Grout horizons
C. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Metal manhole
material: 2
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 9/2018
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 9/2018
(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. 143-215.1013(5), landfills, or other waste disposal areas)within 500 feet
of the proposed well or well system.
SIGNATURES
The AP
lica t hereby agre that the proposed well(s)will be constructed in accordance with approved specifications and conditions of
this Well C nstruction Pe as regulated under the Well Construction Standards(Title 15A of the North Carolina Administrative Code,
Subchapter 2C)and accepts full responsibility for compliance with these rules
Terraguest Environmental—Project Manager
Sig natu o Applic nt or , gent Title of Applicant or*Agent 5��Ie
Ryan D. Kerins *If signing as Agent, attach authorization agreement
stating Printed name of Applicant or*Agent that you have the authority to act as the Agent.
If the property is owned by someone other than the applicant,the property owner hereby consents to allow the applicant to construct
wells as outlined in this Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the
well(s) conform to the Well Construction Standards(Title 15A of the North Carolina Administrative Code, Subchapter 2C).
Signature of Property Owner(if different than Applicant) Printed name of Pf4erty 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, INC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
Fayetteville Regional Office Washington Regional Office Winston-Salem Regional Office
225 Green Street, Suite 714 943 Washington Square Mall 450 W. Hanes Mill Road
Fayetteville, NC 28301-5094 Washington, NC 27889 Suite 300
Phone: [phone] Phone: [phone] Winston-Salem, NC 27105
Fax: [phone] Fax: [phone] Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, INC 28115
Phone: [phone]
Fax: [phone]
le r le
t �
ill ngton
t GW-22MR Rev.3-1-2016

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PROPERTY OWNERS TABLE AR: AGRICULTURAL & RESIDENTIAL
B3: BUSINESS 0' 200' 400' 800'
01: OFFICE & INSTITUTIONAL 1" = 400'
LI: LIGHT INDUSTRIAL
ye mm SITE VICINITY MAP
QUICK STOP
611 N. BICKETT BLVD.
A LOUISBURG, FRANKLIN COUNTY, NC
SAID SARRM
LOUISBURC, NC
ENViRONMENTAI CONSULTANTS, P.C. PROJECT NO. 01716 DRAWN BY: JTL DATE: 8/14/18
SCALE: 1" = 400' CHECKED BY: JRG FIGURE NO. i

LEGEND
It
-
•• �- - TYPE II MONITORING WELL
m d N
�' � TYPE III MONITORING WELL � �
Z a '0
SOIL BORING/SAMPLE LOCATION O J
_ F—
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=n,. _. PROPOSED MONITORING WELL A IS O z aCD
r UOC4T01D AND F220.5EET RFOEETCEROM THE NTERLINE OF
STREET J z
a
INTERSECTION OF US-401 AND JUSTICE
O
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! PROPOSED MONITORING WELL B IS O mz
LOCATED 56 FEET FROM CENTERLINE OF - J
MWS MW6' US-401 AND 124.1 FEET FROM THE Z �Y 0
of
INTERSECTION OF US-401 AND JUSTICE to Yz
T STREET. O U�
Beyond the subject UST release incident, Z z as m
Terroquest knows of no known sources of O � o Z
groundwater contamination or water = �
GASOLINE' +� supply wells as listed under NCAC 02C im =
'A" Cn
� UST_S_ M 24. 1 .0105(f)(5) within a 500 foot radius. 0 —
} / MOD Monitoring wells and soil borings O
/ MW� associated with the UST release incident
at the Quick Stop facility are shown. a- CO
Groundwater contamination from the UST O II
release is also depicted 0
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a
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PROPOSED
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0 WELL
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PROPOSED GRAPHIC SCALE
b § e o MONITORING z
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b aaoi e� ...°.m,......:..... 0' 15' 30' 60 >
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FIGURE 3 - TYPICAL TYPE II MONITORING WELL DETAIL
8" MANHOLE COVER
0'
LOCKING CAP
GENERAL INFORMATION
CEMENT GROUT Groundwater monitoring wells are simple 2"
diameter wells used to monitor groundwater
quality. They ore constructed using Schedule 40
PVC piping and screen as shown in the diagram
to the left. Upon completion, on 8" round
3' manhole cover is installed over the well for
protection. In the event that the well is
4' BENTONITE SEAL installed in an area where there exists the
5' possibility that it could be damaged such as an
TOP OF SCREEN agricultural field, an aboveground or stickup
manhole will be used. After the manhole is set,
a small concrete pod is poured around the
manhole. Both the manhole and pad are flush
with the ground surface, except as noted, and
will not interfere with driving, mowing, foot
traffic, etc. Type II monitoring wells are used
for sampling groundwater from shallow,
unconfined aquifers. They are used to
determine the horizontal extent of contamination.
Well Driller:
Terraquest Environmental Consultants, P.C. —
Wesley J. Sorrells #3577
GRAVEL PACK
20' -
BOTTOM OF SCREEN
BOTTOM OF BORING
-� 6" �-
TE ue
st
'��a�� ��--gow
ENVIRONMENTAL CONSULTANTS, P.C.

Subject: Delegation of Signature Authority
Quick Stop
Incident No. 39923
To Whom It May Concern:
I, Said Sarraa, hereby designate Terraquest Environmental Consultants, P.C. as an
authorized representative with the power to sign in my place in matters pertaining to
environmental assessment and remediation associated with the Quick Stop (#39923)
release incident.
If you have any questions regarding this letter, please contact Ryan D. Kerins at 919-563-
9091.
, 'aid Sarra Date
V`Ponsib?e P4
Te quest Env nmental Consultants, P.C.
RyA D. Keri s Date
Project Manager

STATE OF NORTH CAROLR1 -A
DEP .TTNUN T of TRANSPORTATION
RO Y COOPER JAIMES H.TRI OGD0-,\,,M
CflVIMITOR —aCRETARY
5/18/2018
Terraquest
100 E.Ruffin Street
Mebane,NC 27302
COUNTY: Franklin
SUBJECT: Encroachment Contract- E053-035-18-00014
ROUTE(S): US 401
Gentlemen:
Attached for your file is a copy of the Right of Way Encroachment Agreement which has been properly
executed. This contract covers the following:
2 permanent type H groundwater monitoring wells
This encroachment is approved subject to the applicable Special Provisions which are attached to and made a
part of the Encroachment Contract.
Please refer to Encroachment Contrac E053-035-18-00014 on future correspondence with this office about
this project.
Sincerely,
R Digitally slgned I,I.8.Elmore
T. . E I m o re DN:cn=T.RElmore,otles,o=NCD T, Vance/
Wanen/Franklln Counties,ou=NCDOT,
email=[e-mail],c=U5
Data.2018.05.2313:42:00-04'00'
For J.R.Hopkins,P. E.
Division Engineer
cc: District Engineer
County Maintenance Engineer
State of North Carolina I Department of Transportation I Division Five—District 3
321 Gillburg Road I CS#07-15-01 1 Henderson,North Carolina 27537
252-598-5100 Telephone [phone] Fax
E053-035-18-00014

Encroachment Special Provisions
1 Failure to comply with the provisions of this Encroachment will be grounds for
revocation.
2 Lane closures shall be restricted between 9:00 AM and 4:00 PM. NCDOT reserves the
right to further limit,restrict, or suspend operations within the right of way if, in the
opinion of NCDOT,safety or traffic conditions warrant such action.
3 It shall be the responsibility of the Encroacher to determine the location of utilities
within the encroachment area. The encroacher shall be responsible for notifying other
utility owners and providing protection and safeguards to prevent damage or
interruption to existing facilities and maintain accessibility to existing utilities.
4 The encroaching party is to give notice to the municipality within which they are
working prior to beginning work.
5 A$1,000.00 Performance and Indemnity Bond shall be executed and posted with the
Division of Highways. A copy of this bond will be present at the construction site at all
times during construction. The Division of Highways reserves the right to stop all work
unless evidence of approval can be shown.After the completion of this work the
NCDOT has the right to hold the BOND required for the life of the monitoring wells to
insure the work is done to NCDOT specifications and the right of way is returned to
premonitoring well conditions.
6 Tony Newton,Engineering Technician at(252)598-5100,shall be notified prior to
beginning work.
7 Excavated areas adjacent to pavement having more than a 2"drop shall be safed up at a
6:1 or flatter slope and designated by appropriate delineation during periods of
inactivity, including,but not limited to,night and weekend hours.
8 Excavated material shall not be placed on the roadway at anytime.Where excavated
material must be placed on the roadway with approval of the District Engineer,
screenings shall be placed on the roadway prior to the excavated material being placed
on the road.
9 The contractor shall not begin the construction until after the traffic control and erosion
control devices have been installed to the satisfaction of the District Engineer.
10 Proper temporary and permanent measures shall be used to control erosion and
sedimentation in accordance with all local, State and Federal regulations.
11 All driveways altered during construction shall be returned to a state comparable with
the condition of the driveways prior to construction.
12 Right of Way monuments disturbed during construction shall be referenced by a
registered Land Surveyor and reset after construction.
E053-035-18-00014 Page 2 of 8

13 It is the responsibility of the owner/agent to secure any construction easements
(temporary or permanent)from property owners affected by the construction limits.
14 Well cap shall be flush mounted with the ground/pavement surface in areas within the
clear recovery area and the routine mowing boundaries with the frame and cover
designed for HS 20 loading.
15 Any contaminated soils encountered in construction as spoil from the bore holes shall be
removed from the right of way prior to completion of the wells.
16 After the monitoring well(s)has served its intended purpose,the encroaching party shall
fill the well(s)in a manner approved by the Division of Environmental Management.
Any above ground obstructions shall also be removed from the right of way.
17 At the discretion of the District Engineer,a highway inspector shall be assigned to any
work covered under the approved Encroachment Agreement on highways open to traffic
or completed highway project if,in his opinion,inspection is necessary.The cost of
such inspections will be borne by the applicant. Any inspector assigned to the
installations operations will have full authority to act in behalf of the Department and to
stop all work adversely affecting highways;provided the work is not being performed in
accordance with the Agreement executed between the Department and the applicant
based on Department standards.
18 Two way traffic shall be maintained at all times with no lane closures unless permitted
by the District Engineer.
19 If encroacher is within 5'of the travel lane(s)of an undivided highway and within 10'of
a divided highway with any part of his operation including but not limited to vehicles,
equipment, etc.,encroacher shall install a lane closure for each lane in accordance with
the latest Manual on Uniform Traffic Control Devices(MUTCD).
20 Access shall be maintained to driveways at all times.
21 Trenching,bore pits and/or other excavations shall not be left open or unsafe overnight.
The contractor shall comply with all OSHA requirements and provide a competent
person on site to supervise excavation at all times.All trench excavations shall be
completely backfilled and compacted at the end of each construction day.No portion of
the trench shall be left open overnight.
22 All fill areas/backfill shall be compacted to 95%density in accordance with AASHTO
T99 as modified by the North Carolina Department of Transportation.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.
E053-035-18-00014 Page 3 of 8

23 Special care shall be taken to protect the traveling public during all aspects of the
operation, including but not limited to bore pits, shoulder drop offs,etc.
24 All vehicles, equipment and supplies shall be stored outside of the clear recovery zone.
25 All NCDOT roadway signs that are removed due to construction shall be reinstalled as
soon as possible to the original condition and location.
26 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.
27 No access,parking or storage of materials shall be allowed along state maintained
roadways.
28 The party of the second part agrees to provide traffic control devices, lane closures,road
closures,positive protection and/or any other warning or positive protection devices
necessary for the safety of road users during construction and any subsequent
maintenance.This shall be performed in accordance with the latest NCDOT Roadway
Standard Drawings and Standard Specifications for Roads and Structures and
amendments or supplements thereto.When there is no guidance provided in the
Roadway Standard Drawings or Specifications,comply with the Manual on Uniform
Traffic Control Devices for Streets and Highways and amendment or supplement
thereto.Information as to the above regulations may be obtained from the Division
Engineer of the party of the first part.
29 Work Zone Traffic Control Qualifications and Training Program: All personnel
perfonning 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 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.
For questions and/or additional information regarding this training program please refer
to our website at https:Hconnect.nedot.gov/projects/WZTC/Pages/Training.aspx or call
J.S.(Steve)Kite,PE at(919)622-4339 or [e-mail] or Roger Garrett at(919)
663-4383 or [e-mail],both with the NCDOT Work Zone Traffic Control
Section.
30 Encroacher shall utilize the latest edition of NCDOT's Roadway Standard Drawings or
MUTCD for traffic control.
E053-035-18-00014 Page 4 of 8

31 Existing drainage patterns shall be maintained at all times throughout the proposed
construction.The encroacher shall keep the roadway clean of dirt and debris at all times
throughout the duration of the project.
32 Encroacher shall be responsible for positive flow of the ditchline and/or curb and gutter.
33 All excavations inside the theoretical 1:1 slope from the existing edge of pavement to
the bottom of the nearest excavation wall should be made in accordance with the
following conditions:
A)Active excavation shoring,such as sheet piling,shall be installed. The design of the
shoring shall include the effects of traffic loads.The shoring system shall be designed
and sealed by an engineer licensed in North Carolina. Shoring plans and design
calculations shall be submitted to the Division Engineer for review prior to construction.
Trench boxes shall not be accepted as shoring.
B)The trench backfill material should meet the Statewide Borrow Criteria.The trench
should be backfilled in accordance with Section 300-7 of the 2006 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 NCDOT.
C)A qualified NCDOT inspector should be on the site at all times during construction.
The encroaching party should be required to 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 Professional Engineer registered in North Carolina,on the
site at all times.The Professional Engineer will be required to certify that the utility was
installed in accordance with the encroachment agreement and that the backfill material
meets Statewide Borrow Criteria.
D) All trench excavations inside the limits of the theoretical one to one slope,as
defined by the policy,should be completely backfilled and compacted at the end of each
construction day.No portion of the trench should be left open overnight.
E) An appropriate performance bond shall be posted for a period of five(5)years to
cover any long term repairs which may be required as a result of the installation.
34 Encroacher shall contact Tony Newton at(252)598-5100 for a final inspection upon
completion of the Encroachment. Once the final inspection has been completed and the
project meets our specs,Built to Standards will be granted.
35 If any drainage structure(pipe)is damaged it will be at the cost of the encroachee to
replace.
36 This encroachment agreement only covers work within NCDOT Right-of-Way as shown
on the attached plans received in District Office on May 18th 2018.
E053-035-18-00014 Page 5 of 8

Encroachment Standard Provisions
1 The Department of Transportation does not guarantee the right of way on this road,nor
will it be responsible for any claim for damages brought by any property owner by
reason of the installation.
2 An executed copy of this encroachment agreement shall be present at the construction
site at ALL times during construction. If safety or traffic conditions warrant such
action,NCDOT reserves the right to further limit,restrict or suspend ALL operations
within the right of way.
3 If there are any existing traffic signals,signal equipment, or NCDOT signs in the area of
proposed work,you shall contact Division Traffic Engineer at 919-220-4600,in
Durham,prior to beginning any work on State Right of Way.Cost to repair,relocate,or
any damage to NCDOT signs,signals,or associated equipment shall be the
responsibility of the Encroacher.
4 The traveling public will be warned of the construction with signing that is in
accordance with the latest manual on Uniform Traffic Control Devices. Further,for
construction involving lane closures,either Part VI of the MUTCD or an approved
traffic control plan must accompany this agreement.
5 Two-way traffic shall be maintained at all times.
6 All materials and construction shall meet NCDOT Standards and Specifications.
7 At the end of each working day,equipment,materials and supplies shall be parked
outside of the clear recovery zone.
8 Any drainage structure disturbed or damaged shall be replaced to its original condition
at the discretion of the District Engineer.
9 All erosion control devices and measures shall be constructed,installed,maintained,and
removed by the Encroacher in accordance with all applicable Federal, State, and Local
laws,regulations,ordinances, and policies. All earth areas shall be regraded and seeded
in accordance with NCDOT Standards and Specifications.
10 When surface area in excess of one acre will be disturbed,the Encroacher shall submit a
Sediment and Erosion Control Plan which has been approved by the appropriate
regulatory agency or authority prior to beginning any work on the right of way. Failure
to provide this information shall be grounds for suspension of operations.
E053-035-18-00014 Page 6 of 8

11 All earth areas disturbed shall be regraded and reseeded in accordance with Division of
Highways Standards and Specifications.These rates shall apply.Year round mixture of
50#Pensacola Bahia grass,50#KY Tall Fescue,5#Centipede,500# 10-20-20
Fertilizer,4000#Limestone.(2:1 Slopes Standard mix-Use year round mixture but
delete centipede and add 25#Sericea Lespedeza. If using Crown Vetch-Use year round
mixture but delete Centipede and Bahia.Add 15 lbs./Ac Crown vetch-Use this mix
September-May.)
12 Trenching,bore pits and/or other excavations shall not be left open or unsafe overnight.
The contractor shall comply with all OSHA requirements and provide a competent
person on site to supervise excavation at all times.
13 The applicant is responsible for identifying project impacts to waters of the United
States(wetland,intermittent streams,perennial streams and ponds)located within the
NCDOT right-of-way. The discharge of dredged or fill material into waters of the
United States requires authorization from the United States Army Corps of Engineers
(USACE)and certification from the North Carolina Division of Water Quality
(NCDWQ). The applicant is required to obtain pertinent permits or certification from
these regulatory agencies if construction of the project impacts waters of the United
States within the NCDOT right-of-way. Additional information can be obtained by
contacting the USACE or NCDWQ.
14 The applicant is responsible for avoiding impacts to federally protected species during
project construction. Bald Eagle,Michaux's Sumac,smooth coneflower,dwarf
wedgemussel,harperella,red-cockaded woodpecker and tar spinymussel are federally
funded species that have been identified within NCDOT right of way in Durham,
Person,Granville,Wake,Franklin,Vance and Warren counties.Additional information
can be obtained by contacting the North Carolina Natural Heritage Program or the
United States Fish and Wildlife Service.
15 The applicant is responsible for complying with the Neuse and Tar-Pamlico Riparian
Buffer Rule as regulated by the NCDWQ. The rule regulates activity within a 50-foot
buffer along perennial streams,intermittent streams and ponds.Additional information
can be obtained by contacting the NCDWQ.
16 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, archaeological and historical sites.
17 Excavation within 1000 feet of a signalized intersection will require notification by the
party of the second part to the Division Traffic Engineer at(919)220-4600.All traffic
signal or detection cables must be located prior to excavation.
E053-035-18-00014 Page 7 of 8

18 HOLIDAY AND HOLIDAY WEEKEND LANE CLOSURE RESTRICTIONS
1.For unexpected occurrence that creates unusually high traffic volumes, as directed by
the Engineer.
2.For New Year's Day,between the hours of 6:00 a.m.December 31 st and 7:00 p.m.
January 2nd. If New Year's Day is on a Friday, Saturday, Sunday or Monday,then until
7:00 p.m.the following Tuesday.
3.For Easter,between the hours of 6:00 a.m.Thursday and 7:00 p.m.Monday.
4.For Memorial Day,between the hours of 6:00 a.m.Friday and 7:00 p.m.Tuesday.
5.For Independence Day,between the hours of 6:00 a.m.the day before Independence
Day and 7:00 p.m.the day after Independence Day.If Independence Day is on a Friday,
Saturday, Sunday or Monday,then between the hours of 6:00 a.m. the Thursday before
Independence Day and 7:00 p.m.the Tuesday after Independence Day.
6.For Labor Day,between the hours of 6:00 a.m.Friday and 7:00 p.m. Tuesday.
7.For Thanksgiving Day,between the hours of 6:00 a.m. Tuesday and 7:00 p.m.
Monday.
8.For Christmas,between the hours of 6:00 a.m. the Friday before the week of
Christmas Day and 7:00 p.m.the following Tuesday after the week of Christmas Day.
Holidays and holiday weekends shall include New Year's,Easter,Memorial Day,
Independence Day,Labor Day,Thanksgiving,and Christmas.The Contractor shall
schedule his work so that lane closures are not required during these periods,unless
otherwise directed by the Engineer.
E053-035-18-00014 Page 8 of 8

STATE OF NORTH CAROLINA
ROUTE US-401 PROJECT COUNTY OF Franklin
DEPARTMENT OF TRANSPORTATION RIGHT OF WAY ENCROACHMENT AGREEMENT
FOR NON-UTILITY ENCROAGHMENTS ON
-AND- PRIMARY AND SECONDAkiH{G`1-1INA`fS
Said Sarraa
35 Pond Ridge Rd., Louisburg, NC
18th _
THIS AGREEMENT,made and entered into this the day of 20 1� _ ,by and lieweeh t)te Department
of Transportation,party-if the firs(Art:and Said Sarraa
----- party of the second part,
W I T N E S S E T H
THAT WHEREAS,the party of the second part desires to encroach on the right of way of the public road designated as
Route(s) US-401 (N. Bickett Blvd.) located (A)-44 feet from centerline of US-401 and 220.5
feet from intersection of US-401 and Justice St.
(B)-56 feet from centerline of US-401 and 124.1
feet from intersection of US-401 and Justice Street.
-------------- ------ ---_---------- _._.-_ —_..__....._._.__......--
with the construction and/or erection of: Two perinanent type-II grou ater monitoringwells_—-- _
WHEREAS,it is to the material advantage of the party of the second�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 Hichways and Amendments or Supplements thereto. Information as to the above riles 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 par:.
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 RM 16.1A (January, 1981)

R/W(161A):Party of the Second Part certifies that this agreement is true and accurate copy of the form
R1W(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
T. R. Elmore
For Asst. Manager of Right of Way
ATTEST OR WITNESS:
(Signature) j rt �f1_.J� rr (Signature) L?%
(Printed Narne) C V1 ��U CJ�f�.r V 1 tom- (Printed Na1' 'Said Sarraa
(Address ofsignee) (Address ofSignee)35 Pond Ridge Road, Louisburg,
AC _��� llri'Y NC 27549
�.."s'utS l�rn r)C /-4 C Second Party
J 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
Manager of Right of Way. 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:
i. All roadways and ramps.
2. Right of way lines and where applicable,the control of access lines.
3. Location of the proposed encroachment.
4. Lenoth 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 andlor 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.

Bond Number:W150321354
PERFORMANCE AND INDEMNITY BOND
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION -HIGHWAY ENCROACHMENT INSTALLATION
i
Terraquest Environmental Consultants,PC
PRINCIPAL (Contractor for second party to encroachment agreement)
SURETY Old Republic Surety Company
i
DESCRIPTION OF ENCROACHMENT AGREEMENT:
Route or Highway No. US 401 N Brickett Boulevard
$1,000.00 County Franklin i
AMOUNT OF BOND Date of Encroachment Agreement _ nwjS/217118
Specific Location of Encroachment: i
Between Justice Street & US 401 N Brckett Blvd
Type of Encroachment Right of Way
07/26/2018 (Water, sewer, gas, etc.) I
DATE OF BOND i
i
Second party to Encroachment Agreement
KNOW ALL MEN BY THESE PRESENTS, That we the PRINCIPAL and SURETY above named, are held and firmly
bound unto the Department of Transportation, an agency of the State of North Carolina, hereinafter call the I
DEPARTMENT, in the amount stated above for the payment for which sum we bind ourselves, our heirs,executors,
administrators, and successors,Jointly and severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the above indicated second party to an
Encroachment Agreement named above entered into an Encroachment Agreement with the DEPARTMENT, and
the PRINCIPAL(contractor)entered into a contract with the said second party to an Encroachment Agreement
named above to perform certain work, including the installation or relocation of certain encroachments described in
a certain Encroachment Agreement with the DEPARTMENT hereinabove described and incorporated herein by
reference;
NOW,THEREFORE, if the PRINCIPAL shall well and truly install the said encroaching facilities on and along the
highway in accordance with the"Policies and Procedures for Accommodating Utilities on Highway Rights of Way"
and any supplements thereto and in accordance with the other provisions of the said Encroachment Agreement, and
shall indemnify the DEPARTMENT for the failure to install the encroachments in accordance with the foregoing
manual and provisions of the said Encroachment Agreement, then, this obligation to be void; otherwise to remain in
full force and effect.
IN WITNESS WHEREOF, the above-bounden parties have executed this instrument under their several seals on
the date indicated above, the name and corporate seal of each corporate party being hereto affixed and these
presents duly signed by its undersigned representative pursuant to authority of its governing body.
(Seal of Principal)
Terra quest Environmental Consultants, PC
ATTEST: /' PRINCIPAL (Type Na of ' ' al)
,!4u z d wa, BY: I
Clerk r Secretary ��;e„t Vice President
(Delete Inappropriate Title)
Old Republic Surety Company
(Name of SURETY) 3
(Seai.of Surety) BY. Aj-<Z X,
Atto -in-Fact Jo .Suggs
NOTE:Attach Power of Attorney and Certificate of Authority of Attorney-in-Fac I
FORM R/W 16A (This form to be used only by Contractor for second party to encroachment agreement.)
RIW(16A):Party of the Second Part certilles that this agreement is true and accurate copy of the form
R/W(16A)incorporating all revisions to date.
l
1
Revised July 1978