PROJECT INFORMATION

Please include with the application copy of the existing agreement between applicant and north Carolina Railroad and/or Norfolk southern Railway(or Predecesores).

11.Location of installation

Nearest Street

Nearest town

Country

State

Latitude:

Longitude:

* Use the next lowest whole milepost adjecent to the project location + feet in the direction of increasing milepost to the project location.Applies to all milepost references in the application.

14.For a transverse crossing under the tracks

Number of tracks to be crossed:

Angle of crossing:

Total length on crossing on the NCRR Corridor:

Feet

15.For a Longitudinal occupency only:

Begain at Raiload Milepost: MP End at at Raiload Milepost: MP

Total length on crossing on the NCRR Corridor:

Feet

MIn.distance from centerline of nearset track of Longitudel porotion:

Feet

16.For a longitudel and transverse crossing :

Begain at Raiload Milepost: MP

+

Feet

End at at Raiload Milepost: MP

+

Feet

length parallel

Feet

+

Feet

MIn.distance from centerline of nearset track of Longitudel porotion:

+

Feet

17.Will pipline be located entirely within the confies of a public street ?

Yes

No

18.Will the Insttalation connect to an existing facility within the NCCR Corridor ?

Yes

No

If yes,identify owner:

19. Method of proposed Insttalation

Bore and Jack

Jacking

Tunneling(tunnel liner plate)

Direction boring/Horizontal Direction drilling

Open cut

Other(please specify)

20. Are there any wires,poles or obstructions to be relocated ?

Yes

No

If yes,identify owner:

owner

To be Relocated

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

Yes

No

If,Yes Provide

22.Shut off values?

Yes

No

If Yes,Provide details

23.Vents ?

Yes

No

If,Yes Location

Number

Size

Height have ground

24.Seals ?

Yes

No

If yes,both ends

One end

25.Any existing faciliies to be abonded or removed ?

Yes

No

If yes,Explain

26.Character of suburface matrial

27.Approximate ground water level

28.Source of information on subserface information

29.Proposed construction

Start date

Duration

Name of conttactor

Define any special specifications of installation

Underground faciliies

30.Toatal buried length on the NCCR corridor:

Feet

31.Buy depth

From the base of rale to top of casing:

Feet

Minimum depth on NCRR Corridor but not beneath track:

Feet

Below dicths :

Feet

Aerial faciliies

32.Total length on the NCCR corridor:

Feet

33.Number of pole lines crossed:

34.Type of pipe supports:

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

Feet

36.Minimum height of pipe above wirelines:

Feet

37.Horizontal distance of pipe supports from centerline of nearset track:

Feet

Pipe data

38.matrial to be conveyed:

Flammable

Yes

No

Temprature

Type of test:

40.Pipe data ( still include from NCR 102 plate i):