The following is a checklist items that shell be completed when submitting this application for aporposed pipeline Occupancy of the NCRR Corridor .please place a check by all items listed below once they are included with the application package.For more detailed descriptions of the requirements below see Form NCR 102 "specification for pipeline Occupancy of North carolina Railroad Company Property

Application package to include

one(1) copy of completed Pipeline Occupancy Application(for NCRR)

one(1) copy (no larger thanhalf-size ,preferably 11"*17")of the design and construction plan includinf plan view and profile view of the proposed facility

plans clearly show the extent of proposed work affecting the NCRR corridor

plans drawn and printed to scale (ensure no unintented scaling occure during printing)

plans sealed by a professional engineer licenseded inthe state of North Carolina (no crimped seal)

No aerial background shown on plans

One (1) copy of all specifications and computations for purposed Occupancy

sealed by aprofessional Engineer licensed inthe state of North Carolina (no crimped seal)

Non-refundable UndergroundFacility Engineering review fees (including aerial pipeline)(see utility Engineering fees schedule)

Pipe Data Sheet in accordance with form NCR 102 Plate

Soil Boringin accodance with Form NCR 102 Section 3.1

Calculation for external and internal road on all pipes ,manholes and other facilties to be installed on NCRR corridor

Deflection calculation for flexible casing pipe

One hundred(100) year storm drainage calculation for all pipes ,ditches and other structures carriying surface drainage on NCRR corridor and/or under NCRR'tracks

Hydraulic analysis of any existing ditch and/or structure impacted by the imposed improvements

Design calculation for overhead pipes bridges and their foundations

sheetingdesign calculations

plan and profile submittal requirements

All applicable requirements set forth in form NCR 102 for all pipeline Occupancy

Additionally ,all applicable requirements set Forth in Form NCR 101 if any portion of the pipeline occupancy is aerial

General Plan View Requirements

All existing and proposed railroad tracks shown and labelled

Northh arrows

Scale

'To' labels for the next town ,city or station in either direction along the railroad

Name the town and country in which the propsed facility is located

Angle of crossing relative to railroad track

Distance (in feet) to lowest milepopost (see application)

Show and label the NCRR Corridor boundary as "Ncrr Corridor" and non operating NCRR properties lines as "NCRR Properties" (remove all other Right-of-Way or Properties boundary 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)

If occupany is within or adjacent to a roadway at grade crossing :

Show roadways edges of pavement,dimension width and roadway name

Show edges of pavement with dimension from edges of road to centerline of proposed pipeline

Additional Profile View Requirements For Underground Transeverse Crossing

Indicate the overall lenth of the occupancy on each page

Dimension the distance from centerline of closetest track to centerline of pipeline

General Profile View Requirements

Scale

Indicate which direction the section is looking

All existing and proposed railroad tracks shown

Show and Label NCRR Corridor boundary

Profile above the centreline of the pipe showing the relationship of the pipeline and/or casing pipe the ground lavel ,track and other facilities

Note in accordance with NCR 102 section 1.6.1.C.10 redarding NCRR Specifications

Additional Profile View Requirements For Underground Longitudinal Occupancy

Show theortical embankment lines for all existing and proposed track per NCR 102 section 4.3.1.F.5.

Show launchind and recieving pits that are within the NCRR Corridor.Dimensionfrom the pits to the nearest centerline of track.Dimension the length ,width and depthof the pits.

Show depth of pipeline under existing ground where it enters and exist the NCRR corridor

Additional Profile View Requirements For underground Longitudinal Occupancies

Show the top of rail profile of the nearest track

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If the application is approved ,applicant agrees to reimburse the North Carolina Railroad Company and the Operating Raillroad for any cost incurred by the North carolina Railroad company and the Operating Railroad incident to installation ,Maintances,and /or supervision necessitaed by the pipeline installation,and further agrees to asume all liability for accidents or injuries which arise as a result of this installation.

Date

Signature and Title of Officer Signing Application

Please Type and Print:

Name:

Title

Telephone Number