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

Plans for proposed installations are to be submitted to, and shall meet the approval of, North Carolina Railroad Company (NCR). Applicant shall enter into an occupancy agreement with NCRR before any construction activities commence on-site. Materials and installation are to be in strict accordance with specifications of the American Railway Engineering and Maintenance-of-Way Association (AREMA), North Carolina Railroad Company, and the Operating Railroads (Norfolk Southern Corporation and/or CSX Transportation as appropriate). The information submitted with this signed application and the required number of copies shall be per the Pipeline and Underground/Aerial Occupancy Application Instructions (NCRR Form 230). The engineering and application fees to be submitted with this application are as stated in the current engineering fee schedule (HN-02).

PROJECT OWNER/APPLICANT INFORMATION

Test
Test
Test
Test
Test
Test
Test
Test
Test
123456

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

Yearly

Corporation
Test

Name and address of the owner’s engineer or consultant (i.e. the party that will coordinate the project – leave blank if none or same as applicant)

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

PROJECT INFORMATION

Installation of a new facility
Yes

Location of Installation:

Test
Test
Test
Test
Test
Test

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

For a transverse crossing under the tracks:

1234
1234
1234 Feet

For a longitudinal occupancy only:

1234 MP
1234 Feet
1234 MP
1234 Feet
1234 Feet
1234 Feet

For a longitudinal and transverse crossing:

1234 MP
1234 Feet
1234 MP
1234 Feet
1234 Feet
1234 Feet
1234 MP

Yes
Yes (Test)

Tunneling (tunnel liner plate)

Yes
Yes
Yes
Yes

Yes

Yes

Yes
Test
Test
Test
12

Yes
Test
Test

No

Test
Test
Test

12/04/2021
12234hrs
Test
Test

Underground Facilities

Test
1234 Feet
1234 Feet
1234 Feet

Aerial Facilities

1234 Feet
1234
Test
1234 Feet
1234 Feet
1234 Feet

Pipe Data

Test
No
Test
123 (psi)
123 (psi)
123 Feet
Material
Test
Test
Process of Manufacture
Test
Test
Material Specifications
Test
Test
Nominal Diameter
Test
Test
Inside Diameter
Test
Test
Weight per Foot
Test
Test
Wall Thickness
Test
Test

Applicant’s Checklist

Application Package to Include:

  • One (1) copy of completed Pipeline Occupancy Application (Form NCRR 220)
  • One (1) copy (no larger than half-size, preferably 11”x17”) of the design and construction plans including plan view and profile view of the proposed facility
    • Plans clearly show the extent of proposed work affecting the NCRR Corridor
    • Plans sealed by a Professional Engineer licensed in the State of North Carolina (no crimped seals)
    • No aerial background shown on plans
  • Non-refundable Underground Facility Engineering Review Fee (including aerial pipeline) (see Utility Engineering Fee Schedule)
  • Soil borings in accordance with Form NCR 102 Section 3.1
  • One hundred (100) year storm drainage calculations for all pipes, ditches and other structures carrying surface drainage on NCRR Corridor and/or under NCRR track(s)
    • Hydraulic analysis of any existing ditch and/or structure impacted by the proposed improvements

Plan and Profile Submittal Requirements

  • All applicable requirements set forth in Form NCR 102 for all pipeline occupancy applications

General Plan View Requirements

  • All existing and proposed railroad tracks shown and labelled
  • North arrow
  • Scale
  • ‘To’ labels for the next town, city or station in either direction along the railroad
  • Name of the town and county in which the proposed facility is located
  • Angle of crossing relative to railroad track(s)
  • Show and label the NCRR Corridor boundary as “NCRR Corridor” and non-operating NCRR property lines as “NCRR Property” (Remove all other Right-of-Way or Property boundaries within the NCRR Corridor)
  • Show dimensions from the NCRR Corridor boundary to the centerline of the NCRR Corridor, centerline of the nearest track and the overall width of the NCRR Corridor
  • Dimension distance from the crossing to any turnouts
    • Indicate any facilities to be abandoned (Add note in accordance with NCR 102 Section 2.6)
  • Location of vents, if any, and height above ground
  • Size and material of the carrier pipe
  • Show launching and receiving pits that are within the NCRR Corridor. Dimension from the pits to the nearest centerline of track. Dimension the length, width and depth of the pits.
  • Details of any excavation or sheeting necessary to install the pipeline in accordance with NCR 102 Section 5.9.1.C
  • A cross section of the pipeline showing the carrier pipe, casing pipe and any supports
  • Note in accordance with NCR 102 Section 1.6.1.C.10 regarding NCRR Specifications

Additional Plan View Requirements for Aerial Transverse Crossings and Longitudinal Occupancies

  • Indicate the overall length of the occupancy on each page
  • Dimension the distance from centerline of closest track to centerline of pipeline

General Profile View Requirements

  • Scale
  • Profile above the centerline of the pipe showing the relationship of the pipeline and/or casing pipe to the ground levels, tracks and other facilities
  • Note in accordance with NCR 102 Section 1.6.1.C.10 regarding NCRR Specifications

Additional Profile View Requirements for Underground Transverse Crossings

  • Show theoretical embankment lines for all existing and proposed tracks per NCR 102 Section 4.3.1.F.5.
  • Show launching and receiving pits that are within the NCRR Corridor. Dimension from the pits to the nearest centerline of track. Dimension the length, width and depth of the pits.
  • Show depth of pipeline under existing ground where it enters and exits the NCRR Corridor

Additional Profile View Requirements for Underground Longitudinal Occupancies

  • Show the top of rail profile of the nearest track

12/04/2021
Test

Please Type or Print

Test
Test
1234567890