11. Does project cross international boundary or affect international waterways? [ ] Yes [ ] No (if “yes” indicate on map)
12. Give statement of your technical and financial capability to construct, operate, maintain and terminate system for which authorization is being requested.
(Continued on reverse side) This form is authorized for local reproduction.
13a. Describe other reasonable alternative routes and modes considered.
b. Why were there alternatives not selected?
c. Give explanation as to why it is necessary to cross Federal Lands.
List authorizations and pending applications filed for similar projects which may provide information to the authorizing agency (Specify number, date
code or name)
Provide statement of need for project, including the economic feasibility and items such as: (a) cost of proposal (construction, operation and
maintenance); (b) estimated cost of next best alternative; and (c) expected public benefits.
16. Describe probable effects on the population in the area, including the social and economic aspects, and the rural lifestyles.
17. Describe likely environmental effects that the proposed project will have on: (a) air quality; (b) visual impact; (c) surface and ground water quality and
quantity; (d) the control or structural change on any stream or other body of water; (e) existing noise levels; and (f) the surface of the land, including
vegetation, permafrost, soil and soil stability.
Describe the probable effects that the proposed project will have on (a) populations of fish, plant life, wildlife and marine life, including threatened and
endangered species; and (b) marine mammals, including hunting, capturing, collecting or killing these animals.
State whether any hazardous material, as defined in this paragraph, will be used, produced, transported or stored on or within the right-of-way or any
of the right-of-way facilities, or used in the construction, operation, maintenance or termination of the right-of-way or any of its facilities. “Hazardous material” means any substance, pollutant or contaminant that is listed as hazardous under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as amended, 42 U.S.C. 9601 et seq., and its regulations. The definition of hazardous substances under CERCLA includes any “hazardous waste” as defined in the Resource Conservation and Recovery Act of 1976 (RCRA), as amended, 42 U.S. C. 6901 et seq., and its regulations. The term hazardous materials also includes any nuclear or byproduct material as defined by the Atomic Energy Act of 1954, as amended, 42 U.S.C. 2011 et seq. The term does not include petroleum, including crude oil or any fraction thereof that is not otherwise specifically listed or designated as a hazardous substance under CERCIA Section 101(14), 42 U.S.C. 9601(14), nor does the term include natural gas.
20. Name all the Department(s)/Agency(ies) where this application is being filed.
I HEREBY CERTIFY, that I am of legal age and authorized to do business in the State and that I have personally examined the information contained in the application and believe that the information is correct to the best of my knowledge.
Signature of Applicant Date
Title 18, U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction.