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�trc5ra7E, noRrk <br /> " NCDOT Traffic Impact Analysis Need Screening / Scoping Request <br /> i..--. TIA i i TIA i <br /> yo , _Scoping_i _Submittal_ OFTR. <br /> ❑ The proposed site access is located within 1,000 feet of an interchange. <br /> ❑ The Applicant requests for a new or modified control-of-access break. <br /> ❑ The Applicant requests for a new or modified median break. <br /> Frank Csapo <br /> Applicant's Signature Print Name Date <br /> Site PlanNicinity Map Requirement for TIA Need Screening: While the site plan may not be finalized <br /> during the TIA Scoping stage, the graphic representation of the proposed development shall provide <br /> adequate details on the development scope and context. More specifically, the site plan/map shall clearly <br /> show the location and type of each access point, spacing to adjacent and opposing driveways or <br /> intersections,internal street network,proposed buildings/parcels with their anticipated uses and sizes at full <br /> build-out and, if applicable,any nearby interstate,US,NC or Secondary Roads(SR). <br /> Project Name: Hillsborough Industrial Site Project Reference Number: <br /> ® A TIA is Required by the Local Government.In addition,the study area is expected to include <br /> NCDOT maintained transportation facilities. <br /> ® A TIA is Required by NCDOT,per the Policy on Street and Driveway Access to North Carolina Highway. <br /> If either or both of the boxes above are checked,the Applicant/TIA Consultant is hereby requested to <br /> fill out as much as possible of the following TIA Scoping checklist, and return it along with the <br /> supporting documents to NCDOT prior to the Scoping meeting. <br /> ❑ A TIA is NOT required. This decision is based on the development information presented above. <br /> Changes in the development plan will require re-evaluation of the TIA need,and may necessitate a TIA. <br /> The Applicant should inform the District Engineer of any significant changes in a timely fashion to avoid <br /> delays or rejections of the driveway permit/encroachment agreement applications. <br /> Effective Date: 10/01/2017 (Version 17-721) Page 2 of 2 <br />