+

+

+

Begin at Railroad milepost:

+

End at Railroad milepost:

+

MIN distance from the centerline of nearest track of longitudinal portion:

21. Will temporary track support or rip rapping be required?

yes

No

if yes,Provide details

22. Shut off valves?

yes

No

if yes,Location

23. Vents??

yes

No

if yes,Location

Number

size

Height above ground

24. Seals?

yes

No

if yes,both ends

one end

25. Any existing facilities to be abandoned or removed:

yes

No

if yes,explain

26.Character of subsurface materials:

27.Approximate ground wate level:

28.Source of information:

29. proposed construction

Start Date

Duration

Name of contractor

Define any special specifications of installation:

under ground facility

30. Total buried length on the NCRR Corridor :

Feet

31.Bury Depth:

From base of rail to top of casing

Feet

Minimum Depth on the NCRR Corridor but not beneath tracks:

Feet

Below ditches:

Feet

Aerials Facilities

32. Total aerial length on the NCRR Corridor :

Feet

33. Number of pole lines crossed :

34. types of pipe supports :

35. Minimum height of pipe and support above top of rail:

Feet

36. Minimum height of pipe above wirelines:

Feet

37. Horizontal distance of pipe supports from centerlines of nearest track:

Feet

pipe data

38.Material to be conveyed:

Flameable:

yes

No

Temprature:

39.Maximum working pressure:

psi

Field test pressure:

psi

Type of test:

40.Pipe data (Still Include Form NCR 102 Plate):

CARRIER PIPE

CASING PIPE

Material

Process of Manufacture

Material Specification

Material Grade

Minimum yield strength(psi) of material

Mill Test Pressure

Nominal Diameter

Inside diameter

Outside diameter

Weight per Foot

Wall Thickness

Type of seam

Laying Length

Type of joint

Type of Coatings

Cathodic Protection Detail

Protective Coating Details