PIPELINE OCCUPANCY APPLICATION (NCRR FORM 220)

This form is to be used when submitting a utility occupancy application for an underground pipeline. Use NCRR Form 210 for wire, conduit or cable occupancy applications.

Submit a cover letter, including a project description, and the completed application, application fee and one (1) copy of the project plans to:

HNTB North Carolina, P.C.
Attn: Manager, NCRR Pipes and Wires Occupancy Agreement Process
343 E. Six Forks Rd, Suite 200 Raleigh, North Carolina 27609

For NCRR / HNTB use only

123456
WEr123456

PROJECT OWNER/APPLICANT INFORMATION

Lorem ipsum dolor sit amet...

Lorem ipsum dolor sit amet...

APPLICANT's CHECKLIST

Lorem ipsum dolor sit amet...

PROJECT OWNER/APPLICANT INFORMATION

Test
Test
Test
Test
Test
Test
Test
Test
Test
123456

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Test
Test
Test
Test
Test
123456
test@test.com
1234567890
1234567890

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Yearly

Comments

Resolved by John Madigan

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Corporation
Test

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Test
Test
Test
Test
Test
Test
123456
test@text.com
1234567890
Test

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

PROJECT INFORMATION

Installation of a new facility
Yes

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Location of Installation:

Test
Test
Test
Test
Test
Test

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


284 MP
375 Feet
Longitudinal (parallel to tracks) only – fill in #15 below

Comments


For a transverse crossing under the tracks:

123
123
375 Feet

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


For a longitudinal occupancy only:

375 MP
375 Feet
375 MP
375 Feet
375 MP
375 Feet
375 MP
375 Feet

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


For a longitudinal and transverse crossing:

375 MP
375 Feet
375 MP
375 Feet
375 Feet
375 Feet
375 Feet

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Electric Power

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Distribution

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Conductors:

Test
Copper
Test
DC
440
8
240
Test

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


440
440

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


12
yes

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


no
Direction boring/Horizontal Direction drilling

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Facilities to be installed/utilized Type:

Manholes
10
7
Handholes
10
12
Pullboxes
10
12
Poles (New)
10
12
Poles (Existing)
10
12

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Proposed construction:

Test
Test
Test
Aenean in luctus risus. Praesent sodales eget felis placerat fringilla. Phasellus vel velit imperdiet, pulvinar nibh quis, imperdiet ex. Morbi ac diam nibh. Morbi laoreet vehicula ultricies. Phasellus non semper massa, porttitor elementum felis. Morbi at porta lectus.

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Underground Facilities

375 Feet
345
123
456
456
456
Test
Test
Test

Bury depth:

375 Feet
375 Feet
375 Feet

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Aerial Facilities

Test
Test
Test
Test
Test
375 Feet
375 Feet
375 Feet
375 Feet
375 Feet

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,


Fiber Optic Facilities

Test
Test

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Applicant’s Checklist

Test
Test

Please Type or Print

Test
Test
Test

Comments

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum sed sapien bibendum, rutrum velit ultrices,

Add Question / Files Requirement

Should not be empty

50 Minimum Character

100 Maximum Character

Add

Add Question / Files Requirement

Required

3 Minimum file sizw (MB)

5 Maximum file size (MB)

Add