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Home My WebLink AboutApplication APPLICANT 7/7/2011 , , ) , ) . . City of Springfield Development Services Department 225 Fifth Street Springfield, OR 97477 Development Issues Meeting (DIM) "l " 4 " , ,,' ,r > ,,- I ""1 :l F'> t ~. -> 1Cy'~, ~"'''' '<t'~..~.;\ , ~"' t<~!~)t\ "'I, W;;;" ~,,' '""" I \ ' #' Reqttire"d :~ro~e<;t:<l:'lf9!~~a'tior,J~';;;:::~~,: :~ o~' ':: :~f1i~.:J,!,PP"lici!,'Jt:"complete this 'S~'ction) Prospective A Jicant Name: Phone: 1ft//-1'B4-/6G9 Com an : Address: 2173> L eJ L/:me Fax: '-~ 'r'"- ......,;:~:)". ..;.U.., ();e Prospective A .icant's Re .. Phone: Com an : Fax: Address: Owner: .[).4n Ii '- cJ, Ct)4;e r, ~ Phone: Com an Address: 2.. Z. DOll SrR ~e..r . P,:! ...<'j -:.., ASSESSOR'S MAP No:l1-t?3 -2. 7-/:../ Pro ert Address:Z32, Fax: 7 ~5'DO . '.; J,' Size of Pro ert : Acres 0 S uare Feet " .,',". 7"~ dujacre Prospective Applicant: , Date: Xl7e 0 Zt>I( Signature S111A-t..D L, C1L.1R. Tile. ';" Print Case No.: 7-7-1 Reviewed b : A Iication Fee: $ 5;), leD 5:;;) ~~ Technical Fee: $0 Posta e Fee: $0 TOTAL FEES: P ", P~SII-oroj3 <~-;'";; . ~ Y' ."'-": . _. ~'i't:';":'?"W"'''''''J"...;"irTh0itiV''-,~'''.t~;!.'i.''ifY'0k~0{S.;;;'r''''''9'''"I71.'7;;V:;,E;~- "x::~/ '/m; ''\',',''F.", JUL 0 7 2011 Revised 1/1/08 Molly Markarian 1 of 3 Original Submittal , (' . . Development Issues Meeting Process The purpose of a Development Issues Meeting is to give an applicant the opportunity to discuss his/her development proposal with the development review staff of the City, The discussion can be general or specific, depending on th~ details provided with the application. A Development Issues Meeting provides information to an applicant related to the current development conditions and standards of the City. The Development Issues Meeting is not a land use decision and does not confer any development rights, establish any conditions, or bind the applicant or the City to any course of action. The meeting conveys the status of known development opportunities and constraints. The status may change over time as development conditions or standards change. 1. Applicant Submits a Development Issues Meeting Application . The application must conform to the Development Issues Meeting Submittal Requirements Checklist on page 3 of this application packet. . Development issues meetings are conducted every Thursday. . We strive to conduct the development issues meetings within three to four weeks of receiving the application. . The applicant's proposal is circulated to the relevant staff in preparation for the meeting. 2. Applicant and the City Conduct the Development Issues Meeting . The applicant and any design team should attend the development issues meeting. . The meeting is scheduled for one hour. . Staff attending the meeting will be prepared to discuss the issues raised in the submittal by the applicant. Other issues raised during the meeting may also be discussed. . The meeting is informal and the City will issue no staff report. Revised 1/1/08 Molly Markarian 2 of 3 . . - ~ '"-"'I,. \: " Narrative and QuestiDns fDr 2327 DDn Street This property is currently is encumbered ,on its sDuth side by the 100 year flDDdplain ,of Channel 6. This spring I applied fDr a LOMA (see attached) tD remDve the prDperty from the flDDdplain. HDwever, the structure was nDt remDved. Apparently fill needs tD be placed tD remDve it from the flDDdplain. I now wDuld like tD add apprDximately 3 inches ,of fill 5,0 that the property can be remDved from the FIDDdplain. This requi~es a LOMA-F and I need the City tD sign ,off ,on the applicatiDn fDrm tD FEMA. My surveYDr, Marv Krush, has determined a BFE ,of 438.4 feet and the grade at the CDrners ,of the structure is at abDve this number (see attached tax map). I have the fDIIDwing questiDns: 1. DD I need tD raise the grade by 3" and if 5,0, I wDuld like tD discuss the DptiDns fDr dDing this. 2. If I need tD place fill tD raise the grade even by a small amDunt (3" deep, 2-3 feet around the perimeter ,of the fDundatiDn), wDuld this require a FIDDdplain Overlay applicatiDn and apprDval? WDuld it require an WAP? 3. DD YDU agree with the BFE provided by my surveYDr? Apparently he used the BFE set in the Clear Vue Estates plat as part ,of his determinatiDn. 4. Will the City sign ,off ,on the CDmmunity Official sectiDn ,of the LOMA-F applicatiDn? Date Received: JUL 0 7 2011 Original Submittal p,?~ //'>3 LANE COUi\lTY CITY-OF SPRINGFIELD 13381S N N --.;;: - - ) o .z ~ w ~ < IU Z o N -- w ::> z <( w > >< s: < ~ ..... U t A'VM31'V8 I ! ---- Date Received: JUL 0 7 2011 Original Submittal - ..i.'" o II-In()~ " w VlN83 f- > w - ~ w HJnO::> I z U w A3NOOl:! z 0 ~ 1 (fi3/:18NlfJdS :10 All: N38n:J :10 All:)-=: --- r-- LO AVM N30l::lV8 . · )it \ ELEVATION CERTIFICATE {,utfJ, IT' . u.s. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National FloocIlnsurance Program OMS No. 1660:0008 Expires March 31, 2012 Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION I~L ,CO Un..r-/VE' 1>2. Building Street Addre.. (including Apt.. Unit. Sune. and/or Bldg. No.) or P.O. Route and Box 2 s:-r. c City S-,c7/Zn-c/&, rtr.?t:..{:;. SlateO/ZE??'.....v A3. Property Description (lot and Block Numbers. Tax Parcel J'lJllTlbet'. legal Description. etc.) /7-O<;'-'Z7-?-/ .#" ZSCJCJ A4. Bullding Use (e.g.. Residential, Non-Re_ntial, Additlon. Accessmy. elc.) ;Ze 1'10,,,-,, T/;q L . AS. latitudellongnude: lot. 44" o4.Jt> "7?' long. /2. z," ~z..'4/~ Horizonlal Oatum:ftl NAD 1927 0 HAD 1983 A6. Attach at least 2 photographs of the building ti tho Certificate Is being used 10 obtain ftood Insurance. A7. Bullding Diagram Number.....2..... A6. For a building with a crawlspace orenclosure(s): /() ~ 1 A9. For a building with an attached garage: 4 r7 /l a) squarefoolageofcrawlspaceorendosure(s) II 1_ sqft a) squarefootegeofettachedgarage _~(./sqft b) No. of pennonent flood openings In tho aawtspaoo or ci4 b) No. of pennonent ftood openings In tho a~arage enctosuro(s) within 1.0 foot ebove adjacent grade / within 1.0 foot above adjacent grade c) Tolal net area of ftood openings In M.b ~ sq in c) Total net area of flood openings in A9.b ~~ z.. sq In d) Engineered flood openings? 0 Ves ~NO' d) Engineered flood openings? D Ves )&1.,,0 SECTION B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B 1. NFIP Community Name & Community Numbet' B2. Counly Name 1 L: P/l-fWiP F F ;4n./~ B4. Map/PaneI Number BS..suftix 86. FIRM Index B7. FIRM Panet / Date Effj!CtivelRovised Date ~...-,p:i!--'19 &~e::J?-'" Bl0. Indicate tho source of tho Base Flood Elevation (BFE) data or base ftood depth entered In Item B9. o FIS Profile )(1 FIRM Communily Determined D Other (Describe) Bll. Indicate elevation datum used forBFE in Item B9: 0 NGV01929 NNAV01986 DO_(Describe) B12. Is tho building Iocatad In e Coastal Barrlor Resources System (CBRS) area or Otherwise Protected Aree (OPA)? Designation Oate . D CBRS DOPA A 1. Buikting Owner's Name 21P Code 97477 '/2 ec'?'N B6. Flood s) B9. Base Flood Elevation(s) (Zone AO. use base flood depth) .3 DVes I!5tNo SECTION C. BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: D Construction Drawings' D Building Under Construction' ~ Fmished Construction 'A new Elevation certiftcate wilt be required when construction of tho ,building Is complete. C2. Elevations - Zones Al-A30, AE. AH. A (with BFE). VE. Vl-V30. V (with BFE). AR. ARIA. ARlAE, ARlAl-A30. ARlAH, ARlAO. Compiete Ilerns C2.a-h below according to tho buUdlng diagram specified In Item A7. Use tho ~me datum as tho BFE. Benchrnart< Utilizad ~ Pr J!. D . Co 5 '? 7 't-' Ver1Ical Oatum .v A i/ D 11f? ConversiatYComments Check the meaSUrement used. a) Top of bottom ftoor (Including bosernen~ crawlspace, or endosure ftoor) 4'3 7 .~ feet B meters (Puerto Rico only) b) Top of the next higher floor 4 ~9 . feet meters (Puerto Rloo only) c) Bottom of tho lowest horizonlol structural mornber (V Zones only) A.J .A feet D melers (Puorto Rico only) d} Attached garage (top of slab) ...,. ~ ~.~ feel D meters (Pyarto Rico only) . e} Lowesl elevation of machinery or equipment selViclng tho building 4 J. y...lJlI feet D meters (Pwate, ~cei ved: (Describe type of equipment and location In Comments) I) lowest adjacent (finlshad) grOOe next to bullding (LAG) 4 3R.lfeet 0 meters (puorto fiiW onnJ.. g) Hlghestadjacenl (nnlshad) grado next to building (HAG) -43V-: feet Dmelers(Puert~)/dOl1 h) Lowest adjacent grade at lowesl elevation of deck or stallS, Inctuding <l E p.4 feet D meters (Puerto Rloo only) structural suooort SECTION D, SURVEYOR, ENGINEER, OR ARCHITECT CERTlFICATIQI(lgmal ;;'UUlIllllcd Thls certlflcatJon is to be signed and sealad by a land surveyor, engineer. or a.c,,"eet authorized by law to cet1Ify elevation Information. I certify thaf fhe Infonnalion on this CartIticaI1t """"sent. my best efforts /0 Interpret tho data a..Hable. I understand thet any false statement may be punlshablo by fine or Imprisonment under 18 U.S. Code, Section 1001. 'R'I Chack here ti comments ore provided on bacl< of fonn. Were latitude end longitude ~octlon A .E!:ovided by a /'""' . . IIoensed land surveyor? ,RlJ Ves U No Licanse Num~ s..,.!l /~ _ ~ d' ~.f'c.c/Y.2/.6-'S .t=. 6 #>;-vIE Slate ~ ZIPCode. L 1_ f'-/D Telephone S-4/-c,I'4--~ZI REG I ST!I"IO PROFESSIONA LANlplleRvEY R A-:: FEMA Form 81.31. MarOQ See reverse side for oontinuation. Replaces all previous editions TIlle . . . . BUILDING SKETCH Date Received: JUL 0 7 2011 Original Submittal --. "--- - . . ,....., (0' Do/v S"r/Z.~E / -. ~ t4>."'~ 01 ~"E:.I · ~ U-:Sl"-~ o<J~~ o \o()'-.!Z ~ I\J :;0 ~ '~ tn '-N \~ C><:) )> ~.~ \1:'- G' );. ~ ~~~~ .>' ~ '(, --- ~ ~ /' 't:. '-.\ Z\~ ~ 0 \ ~ \) J> 0, w ,~ tl)\~ \ Q~-~~ f\I ~ ..Q\,\~ ~ t '" ~\ \ c:- \ '" 'j'1 rI1~ 1\ \. 0 ' ~ N I . ............ - r-a :s;:.. .:>-- .'-t:, ~- \~ ~ cF> '\ ~ . ~ ~;\ ~~ ' \~ - ~ ~ . ~\ )./0 ~ 6" Date R ceived: JUL 7 2011 S~Ub ittal ~ ~ 'T . . Federal Emergency Management Agency Washington, D.C. 20472 May 06, 2011 MR. DANIEL COURTNEY 2327 DON STREET SPRINGFIELD. OR 97477 CASE NO.: 11-IO-0545A COMMUNITY: ClTY OF SPRINGFIELD, LANE COUNTY, OREGON COMMUNITY NO.: 415592 DEAR MR. COURTNEY: . This is in rcference to a reqoest that the Federal Emergency Management Agency (FEMA) determine if the property described in the enclosed document is located within an identificd Special Flood Haz.1rd Area, the area that would be inundated by the flood having a I-percent chance of being equaled or c"eeeded in any given year (base flood), on the effective National Flood Insurance Program (NFlP) map. Using the inl"ormation submitted and the efli::etive NFIP map, our determination is shown. on the attached Lctter of Map Amendment (LaMA) Determination Document. This determination document providcs additional infOlmation regarding the cffectivc NFIP map, dlC lcgal dcseription of the propeny and our determination. Additional documents are encloscd which, provide information regarding the subject property and LOMAs. Please see the List of Enclosures below to detennine which documents are enclosed. Other attachments specifie to this request may be included as rel"crenced in dIe Determination/Comment document. II" you have any questions about this letter or any 01" the enclosures, please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter nddressed to the Federal Emergency Management Agency, LOMe Clearinghouse, 6730 Santa Barbara Coon, Elkridge. MD 21075, Sincerely, -~.t'::~~~~':=r~"-- ~'.') Luis Rodriguez, P.E., Chief Engineering Management Branch .Federal Insurance and Mitigation Administration LIST OF ENCLOSURES: LaMA-DEN DETERMINATION DOCUMENT (NON-REMOVAL) "ec~tatclCommonwcalth NFIP Coordinator Community Map Repository Region A>>r.Rfi/Jtl Date Received: JUL 0 7 2011 Original Submittal .. . . , / Page 1 of2 I Date: May 06, 2011 Icase No.: 11-10-0545A 1 LaMA-DEN ;t.1Jt.11!;\f~ ~.l Federal Emergency Management Agency ~... oU4r Washington. D.C. 20472 "-flo'n s1.C LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT lNON-REMOV ALl COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY OESCRIPTION CITY OFSPRINGFIELD, LANE Lot 5. Block 10. Second Addition to Beverly Park. as described in the COUNTY, OREGON Statutory Warranty Deed, recorded as Document No. 2010-065125, in the Office of the County Clerk. Lane County, Oregon COMMUNITY COMMUNITY NO.: 415592 NUMBER: 41039C1133F AFFECTED MAP PANEL DATE: 6/2/1999 FLOODING SOURCE: CHANNEL 6 APPROXIMATE LATmJDE & LONGITUDE OF PROPERTY: 44.068, .123.040 SOURCE OF LAT & LONG: STREETS AND TRIPS 2009 OA rUM: WGS B4 DETERMINATION OUTCOME 1% ANNUAL LOWEST LOWEST WHAT IS NOT CHANCE ADJACENT LOT LOT BLOCK! SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION SECTION THE SFHA ZONE ELEVATION ELEVATION (NGVD 29) (NGVD 29) (NGVD 29) 5 10 Second 2327 Don Streel Structure A 438.7 feet 438.4 feet - Addition to (Residence) Beverly Park Special Flood Hazard Area (SFHA) - Tho SFHA Is an area that would be inundated by the flood having a l~percent chance of being eaualed or exceeded In any C1iven vear (base ncodt ADDITIONAL CONSIDERATIONS (Please refer to the appropriate section on Attachment 1 for the additional considerations listed befow.) ZONE A STUDY UNDERWAY This document provides the Federal Emergency Management Agency's determinalion regarding a request for a Letter of Map Amendment fOf the property described above. Using the information submitted and the effective National Flood Insurance Program (NF1P) map. we haVG determined that the structure(s) on the property{ies) is/are located in the SFHA. an area Inundated by the flood havlng a 1-percent chance of being equaled or exceeded in any given year (base flood). Therefore. flood insumnce Is required' for the property described above. The lowest adjacent grade elevation to a structure must be al or above the Base Flood Elevation for a slructure to be outside of the SFHA. This determination is based on tho flood data presently available. The enclosed documents provide additional information regarding this determination and infonnalion regarding your options for obtaining a Letter of Map Amendment. If you have any questions about this document, please contacl the FEMA Map Assistance Center loll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency. LOMe Cleartnghouse, 5730 Santa Barbara Court, E1kridgo, MD 21075. Date Received: :...{ " .... -", . JUL 0 7 2011 7':_ , Luis Rodriguez. P.E.. Chief Engineerin9 Managemont 8nmeh Original Submittal FederalloslJrance and Mitigation Administration . . > Page2of2 I 11 (1~)~ ~ IOate: May 06, 2011 Icase No.: 11'10-tl545A I LOMA-OEN Federal Emergency Management Agency Washington, D,C20472 LETTER OF MAP AMENDMENT DETERMINA TION DOCUMENT (NON-REMOVAL) ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS) ZONE A (This Additional Consideration,applies to the preceding 1 Property.) The National Flood Insllrance Program map affecting this property depicts a Special Flood Hazard Area that was delermined using the best flood hazard data available to FEMA, but withou1 performing a detailed engineering analysis, The floed elevation used to make Ihis determination is based on approximate methods and has not been formalized Ihrough the standard process for establishing base flood elevations published in the Flood Insurance Study, This flood elevation Is subject to change, STUDY UNDERWAY (This Additional Consideration applies to ali properties in the LOMA-DEN DETERMINATION DOCUMENT (NON-REMOVAL)) This determinalion Is based on the flood data presently available. However, the Federal Emergency Management Agency is currently revising the National Flood Insurance Program (NFIP) map for the community, New flood data could be generated that may affect this property, When the new NFIP map is issued it will supersede this determination, The Federal requirement for the purchase of flood insurance will then be based on the newly revised NFIP map, Date Received: JUL 0 7 2011 Original Submittal Th)s aMchment provides addjtional information ~garding this request. If you have any questions about this attachment, please contact the FEM<\ Map Assistance Center toll free at (877) 336~2827 (877~FEMA MAP) or by latter addressed 10 Ihe Federal Emergency Management Agency, LOMe Clearinghouse, 6730 Santa Barbara Court, Elkridge. MD 21075, +,.~ ~ '., .. .."t'~ ~" Luis'Rodriguez.. P.E., Chief Engineering Management Brnnch Fademllnsurance and MiIIgation Admlrdsrration ,. . . ) Federal Emergency Management Agency Washington. D.C. 20472 ADDITIONAL INFORNIATTON REGARDING DENIALS OF REQUESTS FOR LETTERS OF MAP AMENDMENT AND LETTERS OF MAP REVISION BASED ON FiLL When making determinations on requests lor Letters of Map Amendment (LOMAs) and Letters of Map Revision based on the placement of fill (L01\-lR-Fs), the Department of Homeland Security's Federnl Emergency Management Agency (FEMA) bases its determination on the flood hazard information available al the time ofthc detemlination. Requesters should he aware nood conditions may change or new information may be generated that would supersede FEMA's determination. In such cases, the community will be informed by letler. . , . , Requesters also should be aware Ihat FEMA's denial of a request to remove a property (parcel of land or struclure) tium the Special Flood Hazard Area (SFHA) means FEMA has detennined the property is subject to inundation by the nood having a .1 "percent ehance of being equaled or exceeded in any given year (base flood). As mentioned earlier, this iklermination is based on the tlood hazard infonnatio~ available at the time. '11' more detailed property or flood hazard infonnation becomes available, and. the requester believes the infommtion will support removing the property from the SFHA. the requester may submit the inlormation to FEMA at any lime and request Ihat FEMA reconsider its deremlination. In areas where base flood eievations (BFEs) shown on the effective National Flood Insurance Program (NFl!') map were used for the '.original determinatimi, new BFEs counot be used uutil they hav.; been proposed and finalized through the community appeal process. The appeal process is described in detail in Part 67 of the NFIP regulations.' ,. If FEMA denies a request tor a LOMA because the elevation of the lowest adjacent grade (the lowest ground touching a..stmcture) is below the l3FE and that elevation is raised to or above the BFE by the placement of fill material, the requester mny submit the appropriate supporting datanlJd request a LOMR- F in accordance with Paragraph 65.5(a)(4) of the NFlI' regulations. In this circumstance. if both the' clevmion of the lowest ground touching the structure and the elevation of the lowest tloor (including basement!crawl space) are at or above the BFE. FEMA will issue a LOMR-F to remove the stmeture fro the SFHA. If IillmateriaI is used to elevate the lowest ground tonching the structure and the lowcstlloor (including basement/crawl space) to or above the HFE, the requester also must submit a complctcdcopy of Form 4, "Community Aeknowledgmcnt of Requests Involving Fill," from the MT-I application forms package that is to be used for all LOMR-F requests. The application forms package may be downloaded directly from our Web site at hl1p:!!www.fema.gov!plan!prevel1lin,m/dI mt-I.shtm, or copies may be obtained by calling our Map Assistance Center, toll free, at 1-877-FEMAMAP (1-877-336-2627).' EtTeetive October I, 1996, FEMA revised the Ice schedule for reviewing and processing requests Jor conditional and linnl modifications to published flood information and maps, thereby establishing nat review and processing fees lor most types of reque.i. Effective September I, 2002, FEMA modified that Ice schedule. All new requests will be processed under the current fee schedule. Date Received: JUL 0 7 2011 LOMAENC-2 Original Submittal ~' . n, . . j There is no review and processing fee for a LOMA request. The review and processing fees for requests for LOMR-Fs are shown below. Single-lotJsingle-structure LOMR-Fs $425 Multiple-Iot/multiple-structure LOl'vIR-Fs $800 Singlc-Iol/single-sttueture LOMR-Fs based on as-built in/ormation (CLOMR-F $325 previously issued by FEMA) Multiple-lot/IllUlliple-structure LOMR'Fs based 011 as-built infonnation $700 (CLOMR-F previously issued by FEMA) The review and processing fee must be received before FEMA can begin processing a request. Payment of this fee shall be made in the fonn of a check or money order. made payable in U.S. rrmds to the National Flood Insurance Prol!ram. or by credit card. The payment lIlust be forwarded to the following address; LOMe Clearinghouse Fee-Charge System Administrator 6730 Santa Barbara Court Elkridge, MD 21 075 Date Received: JUL 0 7 2011 Original submittal // ,I' . . , /I DEPARTMENT OF HOMELAND SECURITY - FEDERAL EMERGENCY MANAGEMENT AGENCY COMMUNITY ACKNOWLEDGMENT FORM a.M.B. NO. J66~OO15 Expires February 28, 2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing and submitting the form. This collection is required to obtain Dr retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0015). NOTE: Do not send your completed form to this address. This form must be completed for requests involving the existing or proposed placement of fill (complete Section A) OR to provide acknowledgment of this request to remove a property from the SFHA which was previously located within the regul'.ltory f100dway (complete Section B). This form must be completed and signed by the official responsible for floodplain management in the community. The six digit NFIP community number and the subject property address must appear in the spaces provided below. Incomplete submissions will result in processing delays. Please refer to the MT-l instructions for additional information about this form. Community Number: Property Name or Address: . A. REQUESTS INVOLVING THE PLACEMENT OF FILL As the community official responsible for floodplain management, I hereby acknowledge that we have received and reviewed this Letter of Map Revision Based on Fill (LOMR-F) or Conditional LOMR-F request. Based upon the community's review, we find the completed or proposed project meets or is designed to meet all of the community floodplain management requirements, including the requirement that no fill be placed in the regulatory floodway, and that all necessary Federal, State, and local permits have been, or in the case of a Conditional LOMR-F, will be obtained. For Conditional LOMR-F requests, the applicant has or will document Endangered Speci~s Act (ESA) compliance to FEMA prior to issuance of the Conditional LOMR-F determination. For LOMR-F requests, I acknowledge that compliance with Sections 9 and 10 ofthe ESA has been achieved independently of FED A's process. Section 9 of the ESA prohibits anyone from "taking" or harming an endangered species. If an action might harm an endangered species, a permit is required from U.S. Fish and Wildlife Service or National Marine Fisheries Service under Section 10 of the ESA. For actions authorized, funded, or being carried out by Federal or State agencies, documentation from the agency showing its compliance with Section 7{a)(2) of the ESA will be submitted. In addition, we have determined that the land and any existing or proposed structures to be removed from the SFHA are or will be reasonably safe from flooding as defined in 44CFR 65.2(c), and that we have available upon request by DHS-FEMA, all analyses and documentation used to make this determination. For LOMR-F requests, we understand that this request is being forwarded to DH5- FEMA for a possible map revision> Community Comments: 'Community Kfficial's E ame and ditle: (Please Print ar Type) Telephone No.: Community Name: Community K fficial's Signature: (reqUired) Date: - B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY - !V{>1 :> As the community official responsible for floodplain management, I hereby acknowledge that LOMA. We understand that this request is being forwarded to DHS-FEMA to determine if this regulatory floodway. We acknowledge that no fill on this property has be>en qr will be placed' that the completed or proposed project meets or is designed to meet all of the-community flo Community Comments: Date Received: Community K fficial's Eame and ditle: (Please Print or Type) JUL 0 7 2011 Community Name: Community Kfficial's Signature (reqUirE \ Original Submittal DUS ~ FEMA Fonn 086-0-268, FEB 11 Community Acknowledgment Fonn L Date Received: JUL 0 7 2011 APPLICATION FORMS FOR CONDITIONAL AND FINAL LETTERS OF MAP AMENDMENT AND LETTERS OF MAP REVISION B'Al~aJr$llbmittal OMB Control Number 1660-0015. Expires Feb 2.8, 2.014 General Background Information In 1968, the U.S. Congress passed the National Flood Insurance Act, which created the National Flood Insurance Program (NFIP). The NFIP was designed to reduce future flood losses through local floodplain management and to provide protection for property owners against potential losses through an insurance mechanism that allows a premium to be paid for the protection of those most in need. The creation of the NFIP represented a major shift in Federal strategy from previous structural flood~control and disaster relief programs. As part of the agreement for making flood insurance available to a community, the NFIP requires the community to adopt floodplain management ordinances that meet certain minimum requirements intended to reduce future flood losses. The community official or agency responsible for floodplain management in a community may be able to provide information that would be useful to a requester. This official or agency usually is responsible for engineering, public works, flood control, or planning in the community as well. Use of Application Forms The Department of Homeland Security's Federal Emergency Management Agency (FEMA) implemented the use of application forms for requesting revisions or amendments to NFIP maps for two reasons, First, because the forms provide a step-by-step process for requesters to follow and are comprehensive, requesters are assured of providing all of the necessary information to support their requests without having to go through an iterative process of providing additional information in a piecemeal fashion, which can result in a time-consuming and cost-intensive process. Second, use of the forms ensures that the requesters' submissions are complete and more logically structured, and generally allows DHS-FEMA to complete its review in a shorter timeframe. The application forms included in this package were designed to assist requesters (community officials, individual property owners, and'others) in gathering the information DHS-FEMA needs to determine whether property (parcels of land or structures) is likely to be flooded during the flood event that has a I-percent-annual-chance of being equaled or exceeded in any given year (base flood). lands that are at risk of being inundated by the base flood are called Special Flood Hazard Areas (SFHAs). The forms in this package shall be used to request letters of Map Amendment (LOMAs), Conditional Letters of Map Amendment (CLOMAs), Letters of Map Revision Based on Fill (LOMR-Fs), and Conditional Letters of Map Revision Based on Fill (CLOMR-Fs), as defined below. Pi ease note that not all of the forms apply to every request. Only those forms that apply to the request should be submitted. LOMA A letter from DHS-FEMA stating that an existing structure or parcel of land that has not been elevated by fill (natural grade) would not be inundated by the base flood. CLOMA A letter from DHS-FEMA stating that a proposed structure that is not to be elevated by fill (natural grade) would not be inundated by the base flood if built as proposed. LOMR-F A letter from DHS-FEMA stating that an existing structure or parcel of land that has been elevated by fill would not be inundated by the base flood. CLOMR-F A letter from DHS-FEMA stating that a parcel of land or proposed structure that will be elevated by fill would not be inundated by the base flood if fill is placed on the parcel as proposed or the structure is built as proposed. If the request is being made for a LOMA to be issued on a single residential property, the MT-EZ form, entitled "Application Form for Single lot or Structure, Amendments to National Flood Insurance Program Maps," may be used instead ofthe forms in this package. Forms for this purpose may be downloaded from our website at http://www.fema.gov/olan/orevent/fhm/dlmt-ez.shtm.This form is available in both an English and Spanish version. Instructions MT-l Forms (086-0-26, 086-0-26A. 086-0-26B) FEB 11 1 A fast alternative to using the MT-l application is eLOMA. eLOMA is a web-based application that provides licensed land surveyors and professional engineers a system to submit simple LOMA requests to FEMA. Many LOMA requests can be submitted to FEMA using eLOMA. You can find additional information about eLOMA, including the types of LOMA requests that qualify for the eLOMA process, at http://hazards.fema.gov. The forms in this package and the form entitled "Application Form for Single Lot or Structure, Amendments to National Flood Insurance Program Maps," shall not be used in the following instances: . Requests involving changes in Base Flood Elevations (BFEs); . Requests involving changes in regulatory floodway boundary delineations; . Requests for properties in alluvial fan areas; . Requests involving property and/or structures that have been elevated by fill placed within the regulatory floodway, channelization projects, bridge/culvert replacement projects, or other flood control improvements; or . Requests involving changes in coastal high hazard areas (V zones). For such requests, the community must submit the request to DHS-FEMA in accordance with Title 44, Chapter I, Code of Federal Regulations (CFR), Part 65 of the NFIP regulations, which is available online at http://www.access.gpo.gov/nara/cfr/waisidx02/44cfrvl02.html.using the separately published MT-2 application forms package entitled "Application Forms and Instructions for Conditional Letters of Map Revision and Letters of Map Revision." Forms for this purpose may be downloaded from our website at http://www.fema.gov/plan/prevent/fhm/dl mt-2.shtm. Please note that the forms in this package may be used for property that has been inadvertently included in a V zone or the regulatory floodway. However, if the property is to be removed from a V zone, it must not be located seaward of the landward toe of the primary frontal dune. For additional assistance in completing these forms, you may consult the LOMA Tutorial, available on DHS-FEMA's Internet site at: http://www.fema.gov/plan/prevent/fhm/ot ImreQ.shtm. Data Submission Requirements In accordance with the NFIP regulations, DHS-FEMA will use the information provided by these application forms to make a determination on whether a property (parcel(s) of land or a structure(s)) is located within a designated SFHA. In certain instances, additional data that are not referenced on these forms may be required. A DHS-FEMA representative will notify the requester of any additional requirements. DHS-FEMA encourages the submission of the required data in digitafformat (e.g. scanned documents on a CD). This may help expedite the processing of your request. Applicable Regulations The regulations pertaining to LOMAs, CLOMAs, LOMR-Fs, and CLOMR-Fs are presented in Title 44, Chapter I, CFR, Parts 65 and 70, which is available online at http://www.access.gpo.gov/nara/cfr/waisidx02/44cfrvl02.html. The purpose of Part 70 is to provide an administrative procedure whereby DHS-FEMA will review information submitted by an owner or lessee of property who believes that their property has been inadvertently included in a designated 5FHA. Part 70 provides information about the technical difficulty of accurately delineating the 5FHA boundaries on a NFIP map for a community. Part 70 procedures shall not apply if the topography has been altered to raise the original ground to or above the BFE since the effective dale of the first NFIP map [i.e., a Flood Insurance Rate Map (FIRM) or Flood Hazard Boundary Map) showing the property to be within the SFHA. Requests involving changes in topography (such as the placement of fill) are handled under the procedures described in Part 65. Date Received: JUL 0 7 2011 Instructions MT-l Forms (086-0-26, 086-0-26A, 086-0-26BJ FEB 11 Original submittal 2 Fee Requirements Title 44, Chapter I, CFR, Part 72 of the NFIP regulations, which is available online at http://www.access.gpo.gov/narajcfr/waisidxOZ/44cfrvl02.html. presents information regarding the reimbursement procedure initiated by DHS-FEMA to allow for the recovery of costs associated with the review of requests for (LOMAs, ClOMR-Fs, and lOMR-Fs via a review and processing fee. There is no review and processing fee for requests for single/multiple, lot/structure LOMAs. Revised fee schedules are published periodically, but no more than once annually, as a notice in the Federal Register. For the most up-to-date fee schedule, please contact the DHS-FEMA Map Information eXchange (FMIX) toll free at 1-877-FEMA MAP (1-877-336-2627) or consult the DHS-FEMA Internet site at http://www.fema.gov/plan/prevent/fhm/frm fees.shtm. Payment must be submitted in the form of a check or money order, made payable in U.S. funds to the National Flood Insurance Program, or by credit card payment. In addition, the requester must complete the Payment Information Form. The payment should be mailed together with the application and supporting data to the address listed in the Address for Submitting Requests section of these instructions. Basis of Determination If no fill has been placed, DHS-FEMA's determination as to whether the SFHA designation may be removed from the structure(s) on a property will be based on a comparison of the BFE with the elevation of the Lowest Adjacent Grade to the structure (lowest ground touching the structure) including any attached decks or garage. If fill has been placed, DHS-FEMA's determination will be based on a comparison of the BFE with the elevation of the lowest adjacent grade to the structure (lowest ground touching the structure) including any attached decks or garage and a completed Community Acknowledgment Form (see instructions for the Community Acknowledgment Form [Form 3] for more information). For DHS-FEMA to remove the SFHA designation from a legally defined property or portion of property that does not have a structure on it, the elevation of the lowest ground on the property must be at or above the BFE. Please note the following special considerations that may affect DHS-FEMA's determination: . In areas of shallow/sheet flooding (Zone AD), the elevation of the Lowest Adjacent Grade (including deck posts) ofthe structure(s) must be above the surrounding grade by an amount equal to or greater than the depth shown on the NFIP map. In addition, adequate drainage paths are required to gUide floodwaters around and away from the structure(s); the structure(s) should be on an elevated pad within the Zone AD area. With your application package, in addition to elevation information regarding the structure(s), provide a map showing the topographic data of the property and the immediate surrounding area, and the location of any structure(s) existing on the property (certified by a registered professional engineer or licensed land surveyor) to demonstrate that the above criteria have been met. . If the lowest floor of a building has been elevated on posts, piers, or pilings above the BFE and any portion of the structure (Le., posts, pilings, or piers) is still below the BFE, the building will not be removed from the SFHA. Response Timeframe In accordance with the procedures of Title 44, Chapter I, CFR, Part 72, which is available online at http://www.access.gpo.gov/nara/cfr/waisidx02/44cfrv102.html. DHS-FEMA will notify the requester of the determination in writing within 60 days of the date of receipt of all required data. Information about the status of active Letter of Map Change (LOMe) requests is available from DHS-FEMA's Mapping Information Platform (MIP) at https://hazards.fema.gov. The MIP allows requesters to search Open LOMCs by entering their Project (Case) Number and Project Type to find out the status of their request. From the MIP Home Page requesters should click on Tools & Links, Public Reports and select Public Reports from the Report Category dropdown. Date Received: JUL 0 7 2011 Instructions MT-l Forms (086-0-26, 086-0-26A, 086-0-26B) FEB 11 Original Submitt~ Effect on Insurance Purchase Requirements Although DHS-FEMA may issue a LOMA or LOMR-F removing a structure(s) from the SFHA, it is the lending institution's prerogative to require flood insurance, as a condition of a loan, if it deems such action appropriate. Historically, about 25% of all flood claims occur in areas outside of the SFHA. Property owners are strongly encouraged to convert their existing policy, using the premiums already paid for that policy, to a lower-cost Preferred Risk Policy (PRP), which is available for structures located outside the SFHA. For more information about the PRP, contact your agent or broker or visit http://fl oodsma rt.gov I prp. If the lending institution agrees to waive the flood insurance purchase requirement for a structure, the property owner is eligible for a full refund of the premium paid for the current policy year, provided that no claim Is pending or has been paid on the policy in question during the same policy year. If the property owner has been required to renew his or her policy during a period when a revised NFIP map was being printed, the premium will be refunded for an additional year. To initiate processing of the refund, the property owner should provide the LOMA or LOMR-F and evidence of the waiver of the flood insurance requirement from the lending institution to the insurance agent or broker who sold the policy. Conditional Determinations To qualify for a CLOMA or ClOMR-F, the proposed project must meet the same criteria as those required for a LOMA or LOMR-F. After construction is completed or fill is placed, certified as-built information must be submitted to DHS-FEMA for a LOMA or LOMR-F to be issued. The NFIP regulations do not require that a CLOMA or CLOMR-F be requested and issued for a proposed project. Check with local community officials to see if they are required. Property owners and developers should note that a CLOMA or CLOMR-F does not remove the mandatory purchase of flood insurance requirements, it merely provides comment on the proposed plan and does not revise or amend the NFIP map. Once the project has been completed another application wi)) have to be submitted with the as built conditions to receive a LOMA or a LOMR-F which in turn removes the federal requirements for mandatory purchase of flood insurance. It also does not relieve Federal agencies of the need to comply in carrying out their responsibilities for providing federally undertaken, financed, or assisted construction and improvements or in their regulating and licensing activities, in accordance with the provisions of Executive Order 11988 (http://www.fema.gov/plan/ehp/ehplaws/eo11988.shtm). Endangered Species Act Compliance CLOMR-F applicants are responsible for documenting to FEMA that Endangered Species Act (ESA) compliance has been achieved prior to FEMA's review of a CLOMR-F application. ESA compliance may be documented by submitting to FEMA a copy of an Incidental Take Permit, an Incidental Take Statement, a "not likely to adversely affect" determination from the National Marine Fisheries Service (NMFS) or the U.s. Fish and Wildlife Service (USFWS), or an official letter from NMFS or USFWS concurring that the project has "No Effect" on proposed or listed species or designated critical habitat. The applicant may begin by contacting a NMFS or USFWS office, State wildlife agency office, or independent biologist to identify whether threatened or endangered species exist on the subject property and whether the project associated with the CLOMR-F request would adversely affect species or designated critical habitat. These entities are also available to discuss questions pertaining to listed species and ESA compliance. If potential adverse impacts could occur, then NMFS or USFWS may require changes to the proposed activity and/or mitigation. For CLOMA, LOMA, and LOMR-F requests involving floodplain activities that have occurred already, private individuals and local and state jurisdictions are required to comply with the ESA independently of FEMA's process. These requests do not provide the same opportunity as CLOMR-Fs for FEMA to comment on the project because CLOMAs and LOMAs do not involve a physical modification to the floodplain and because lOMR.Fs are issued only after the phYSical action has been undertaken in the floodplain. Additional information about the ESA and these requirements is available on http://www.fema.gov/librarv/viewRecord.do?id=4312 or by requesting a copy from the DHS-FEMA Map Information eXchange (FMIX) toll free at 1-877-FEMA MAP (1-877-336-2627). Although FEMA's staff is not available to assist with this process, NMFS and the USFWS both have staff available around the country to answer questions about threatened and endangered species and ESA compliance. Date Received: Instructions MT-l Forms (086-0-26, 086-0-26A, 086-0-26B) FEB 11 JUL l\. 7 2011 Original Submittal Address for Submitting Requests Please submit all application forms and data to support a request for a flood lOne determination, including any applicable fees to the address listed below. Incomplete submissions will result in processing delays. DHS-FEMA encourages the submission of all required data in digital format (e.g. scanned documents on a CD). Mail your request to... LOMC Clearinghouse 7390 Coca Cola Drive, Suite 204 Hanover, MD 21076 Attn.: LOMA Manager FEMA REGIONS ,a Date Received: JUL 0 7 2011 Original Submittal Instructions MT-l Forms (086-0-26, 086-0-26A, 086-0-26B) FEB 11 1 INSTRUCTIONS FOR COMPLETING THE PROPERTY INFORMATION FORM (FORM 1) General Instructions The Property Information Form (Form 1) may be completed by the property owner, or on behalf of the property owner by authorized persons including but not limited to; the property owner's agent, licensed land surveyor, or registered professional engineer to support a request for a letter of Map Amendment (LOMA), Conditional Letter of Map Amendment (CLOMA), Letter of Map Revision Based on Fill (LOMR-Fl, or Conditional Letter of Map Revision Based on Fill (ClOMR~F) for existing or proposed, single or multiple lots/structures. Before completing this form, the requester must obtain the following documents from the County/Parish Clerk, Recorder, or Register of Deeds for the community: . A copy of the Deed for the property, showing the recordation information (e.g., BookjVolume and Page numbers or Document/Instrument number) containing the recorder's seal and recordation date, accompanied by a tax assessor's or other suitable map showing the surveyed location of the property. OR . A copy of the Plat Map for the property, showing the recordation information (e.g., BookjVolume and Page numbers or Document/Instrument number) and containing the recorder's seal and recordation date. The requester also must obtain a photocopy of the effective FIRM panel (including the Title Block) that shows the area in which the property is located. The FIRM should be available at the community map repository or from the community official or agency responsible for floodplain management. However, digital copies of the FIRM Index and FIRM panels may be ordered from the Map Service Center (MSC), for a nominal fee. To place orders from the MSC, go to their Internet site: http://www.msc.fema.gov.A FIRMette, which can be printed free of charge from the MSC website, may be submitted in lieu of a photocopy of the FiRM. This site allows requesters to search the MSC for maps and other technical data historically available from the MSC online. Requesters can search by the three following criteria: Catalog, Map Search, and Quick Order. Catalog allows requesters to search through the DHS-FEMA's Map Service Center for available data. Map Search allows requesters to search for data available for an individually specified map area. Quick Order allows requesters to search and order available data by specific FIRM panel or Community number. Payment must be in the form of a credit card. Visa, MasterCard, Discover and American Express, are accepted. Requesters without Internet access should contact the DHS-FEMA Map Information eXchange by caliing 1-877-336-2627. They may fax their map order requests to the MSC at 1-800-358-9620. Requesters should note that for multiple property (structure or lot) requests, this form should only be completed once to describe the entire project. One form for each lot is not necessary. Specific Instructions Basis of Request Select the type of MT-1 Letter of Map Change (LOMC) being requested, by checking only one box. Next to each type of LOMC a brief definition has been provided to assist the requester in making an informed selection. Fill Placement Fill is defined as material from any source (including the subject property) placed that raises the ground (natural grade) to or above the Base (1%-annual-chance) Flood Elevation (BFE). The common construction practice of removing unsuitable existing material (topsoil) and backfilling with select structural material is not considered the placement of fill if the practice does not alter the existing (natural grade) elevation, which is at or above the BFE. Fill that is placed before the date of the first National Flood Insurance Program (NFIP) map showing the area in a Special Flood Hazard Area is considered natural grade. The Special Flood Hazard Area (SFHA) is the area that would be inundated by the base flood. Assistance to ascertain if fiii has been placed on your property may be Date Received: Instructions MT-l Forms (086-0-26, 086-0-26A, 086-0-26B) FEB 11 JUL 0 7 2OJ1 Original submittal available from the community official or agency responsible for floodplain management. You may consult with the community map repository to obtain previous editions of the NFIP map, archived topographic data, or permit drawings related to construction on the site. 'fthe structure footprint is located on ground higher than the surrounding area, fill may have been placed. Additional sources for assistance would include the developer or engineer/designer of the subdivision, previous owners of the site, persons who have owned or resided on adjacent parcels, and large scale aerial photographs (check the tax assessor's office). In addition, digital copies of historic NFIP maps may be available on DHS-FEMA's Map Service Center (MSq, for a nominal fee. To place orders from the MSC, interested parties may visit the MSC website at httpJ/www.msc.fema.guv.. For additional information regarding historic maps, interested parties may contact the DHS-FEMA Map Information eXchange toll free, at 1- 877-FEMA MAP (1-877-336-2627). Regardless of the type of LOMC being requested, DHS-FEMA must require the requester to clearly state, to the best of his or her knowledge, whether fill was or was not placed on his or her property. The requester must select either "yes" or "no." If fill was placed on the property, the requester must provide the month and year fill was placed. In addition, for proposed projects, DHS-FEMA requires the requester to clearly state whether fill will be placed on his or her property. If fill will be placed, the requester must provide the month and year fill will be placed. In addition, the applicant must then provide documentation to show that ESA compliance has been achieved. Additional information about these requirements is available on Page 4 of this instruction packet. Number 1 - Street Address Enter the street address (911 type) for the structure or property being reviewed (subject property). For requests involving multiple lots, structures, or units, attach a separate piece of paper including all street addresses when space is insufficient. Number 2 - Legal Description Describe the property by referring to the Deed or Plat Map. The description may consist of a lot number and subdivision name, a parcel number, a tract number, or any other information provided in the Deed or Plat to identify the property (e.g. Lot 2, Block 1, Floodville Estates). It is not necessary to reproduce a lengthy description of the property as it appears in the Deed. Number 3 - Subject of Determination DHS-FEMA makes determinations on parcels of land or structures. The requester should select structure, portion of a parcel, or a parcel of land. If the request is for a structure on a property, the date of construction must be provided in this section. Date of construction information may usually be obtained from real estate settlement documents, the property developer, or the local government office where real estate and/or land development transactions are recorded. If there is more than one structure on a property, attach a separate piece of paper with the dates of construction. If the request is for a portion of a parcel, a certified metes and bounds description and map of the area to be removed, certified by a licensed land surveyor or registered professional engineer, are required. The metes and bounds description must cover the specific area to be removed, and it must be tied to an identifiable starting point. If the description is for a legally recorded lot or parcel, the metes and bounds description should commence or begin at the lot or parcel corner. Metes and bounds descriptions must not intersect or coincide with the footprint of an existing structure. Please see the example below for the preferred format of metes and bounds descriptions. BEGINNING at the northeast lot corner; thence S16042'22"E, 100.00 feet; thence 533014'40"W, 145.92 feet; thence S89013'29"W, 156.01 feet; thence N16042'22"W, 223.14 feet; thence 210.49 feet along a curve to the left having a radius of 542.00 feet to the POINT OF BEGINNING DHS - FEMA encourages the submission of metes and bounds descriptions in digital format on CD. This may help expedite the processing of your request. Date Received: Instructions MT-1 Forms (086-0-26, 086-0-26A, 086-0-26B) FEB 11 JUL 0 7 fOll Original submittaL. Number 4 - Number of Structures Or Properties DHS-FEMA makes determinations on single or multiple, lots (parcels of land) or structures. Select the choice that best describes your request. Required Data All requests must include the following data: . Property description documentation must be enclosed for every request and will consist of either the Plat Map or Deed (containing the recorder's stamp and recordation date) accompanied by a tax assessor's map or other suitable map showing the surveyed location of the property. The recordation data (e.g., Book, Volume, Page, Reel, Document Number, and Date) must be evident on the copies of these documents so that DH$- FEMA may use the legal description of the property. In addition, DHS-FEMA must be able to identify the property exactly. If the property is not recorded on a Plat Map, a copy of a tax assessor's map or other suitable map must be submitted to aid DHS-FEMA in locating the property. The map should include at least one street intersection that is shown on the FIRM panel. . A photocopy ofthe effective FIRM panel, annotated to show where the property is located, must be submitted for every request. if your community has a separate Flood Boundary and Floodway Map (FBFM), please include a copy. The panel number and effective date of the FIRM must appear on the copy submitted. The actual map or a photographic copy must be used. . The Elevation Form (Form 2) must be included for all requests, except requests for determinations in which the FiRM already shows the property to be CLEARLY outside the SFHA. For cases in which the determination for the property or structure is uncertain, elevation data must be submitted to provide a definitive determina- tion. This form must be completed by a licensed land surveyor or registered professional engineer. If an NFIP Elevation Certificate has been completed for a structure, it may be submitted in lieu of this form. The Elevation Certificate must be certified by a licensed land surveyor or registered professional engineer. . The Community Acknowledgment Form (Form 3) must be included for all LOMR-F or CLOMR-F, or for LOMA requests in which the property has been inadvertently included within the NFIP regulatory floodway. For LOMR-F and CLOMR~F requests only Section A needs to be completed. For LOMA requests in which the property has been inadvertently included within the regulatory floodway, only Section B needs to be completed (see INSTRUCTIONS FOR COMPLETING OPTIONAL FORMS of these instructions for additional information on the certification requirements of this form). . Documented ESA compliance must be submitted for CLOMR-Fs only. Appropriate documentation includes a copy of an Incidental Take Permit, an Incidental Take Statement, a "not likely to adversely affect" determination from NMFS or U5FWS, or an officiaf letter from NMFS or USFWS concurring that the project has "No Effect" on proposed or listed species or deSignated critical habitat. Additional information about these requirements is available on Page 4 of this instruction packet. Review and Processing Fee The appropriate review and processing fee must be submitted for requests involving proposed projects and for requests involving the placement of fill (e.g., CLOMA, LOMR-F, or CLOMR-F). The Payment Information Form should be included with the processing fee. No fee is required to obtain a determination based on existing conditions (i.e. LOMA) as long as no fill has been placed. For the current fee schedule visits DHS-FEMA's Flood Map-Related Fees Internet site: http://www.fema.gov/plan/prevent/fhm/frm fees.shtm. Signatu re The requester must provide his or her name, mailing address, and telephone number. The requester must also sign and date, where indicated, to certify the accuracy of the inforrflation provided. A Licensed land Surveyor, Registered Professional Engineer, or other designated agent may Sign this form for the requester if they are submitting on their behalf. Providing an email address is optional, however, providing one will make it easier for DHS-FEMA to contact you if necessary and may facilitate the processing of your request. Date Received; Instructions MT-l Forms (086-0-26, 086-0-26A, 086-0-26B) FEB 11 JUL ~ 7 2011 Original Submittal ~, -- INSTRUCTIONS FOR COMPLETING THE ELEVATION FORM (FORM 2) General Instructions The Elevation Form (Form 2) must be completed by a licensed land surveyor or registered professional engineer (authorized by law to certify the information requested). If the request is to make a determination on the structure, and an NFIP Elevation Certificate has already been completed for this property, it may be submitted in lieu of this form. If the request is to make a determination on the entire legally recorded property, or a portion thereof, the lowest lot elevation must be provided on Form 2. If the request is to have the 5FHA designation determined forthe entire legally recorded property, but the only elevation provided is the lowest Adjacent Grade to Structure, the determination will be issued for the structure. For a licensed land surveyor or registered professional engineer to complete this form, it will be necessary to obtain the effective Flood Insurance Rate Map (FIRM) panel, effective Flood Boundary and Floodway Map (FBFM) panel (if printed), and Flood Insurance 5tudy (FIS) report that cover the area in which the property is located. These can be obtained from the community map repository or ordered from the Map Service Center (MSCL for a nominal fee. To place orders from the MSC, go to their Internet site: httpJlwww.msc.fema.gov. The DHS-FEMA Map Service Center allows users, including homeowners, surveyors, and engineers, to search the MSC for maps and other technical data. Searches can be conducted under the three following criteria: Catalog, Map Search, and Quick Order. Catalog allows surveyors and engineers to search through the Map Service Center for available data. Map Search allows surveyors and engineers to search for data available for an individually specified map area. Quick Order allows surveyors and engineers to search available data by a specific FIRM panel or Community number. All search criteria will allow surveyors and engineers to search desired data and add that data to a "shopping cart" for later payment options. Payment must be in the form of a credit card. Visa, MasterCard, Discover and American Express are accepted. Surveyors and engineers that do not have Internet access should contact the DHS-FEMA Map Information eXchange by calling 1-877-FEMA MAP (1-877-336-2627). They may fax their map order requests to the M5C at 1- 800-358-9620. Number 1- Community Number Provide the six digit NFIP community number as it appears in the Title Block of the FIRM panel. In addition, include the name of the property (i.e. legal description) and/or the property's address. c."",,,,..,, ""m'" COmmwtltyN.11OO 1:lllIalJU'I'.fI.IIfLIlIIlllD 'M<<IIIOOW """"''''' JUCIlST11,1H11 Pal\et or Map Number I~~......,~~ EftodlnOllltl Figure 1. samptaF1RM Paoel (Single Community) Figure . Sample FIRM Panel (Countywide) Date Received: Instructions MT-1 Forms (086-0-26, 086-0-26A, 086-0-26B) FE8 11 JUL 0 7 2011 5 Original Submittal For additional information on reading FIRM panels you may consult the tutorial "How to Read a FIRM" on DHS- FEMA's Internet site: http:(/www.fema.gov/media/fhm/firmlotfirm.htm. *Please note that, in some communities, the only NFIP maps available may be Flood Hazard Boundary Maps, instead of FIRMs. Number 2 - Conditionals Identify whether the elevations being provided are based on existing or proposed conditions. Number 3 - Tvpe of Construction If the request involves or will involve a structure, provide the type of construction. Crawl Space - The bottom floor is below the first floor, is enclosed by solid and partial perimeter walls, and may be above ground level (grade) on one or more sides. Spaces below ground level on all sides must meet the requirements of FEMA Technical Bulletin 11-01. Spaces with a bottom floor elevation more than 2.0 feet below the Lowest Adjacent Exterior Grade (LAG) elevation will be classified as a basement. Slab an Grade - The bottom floor is at or above ground level (grade) on at least one side. Basement/Enclosure - The bottom floor (basement or underground garage) is below ground level (grade) on all sides. See Crawl Space above. Other - All other structure types not listed above including, but not limited to split levels, structures on piers, mobile homes, etc. Please be as detailed as possible. Number 4 - Elevation Datum Provide the elevation datum (e.g., NGVD 29, NAVD 88, or other specified) for which the property elevations shown on the form are referenced. If the datum being referenced is different than the datum used to produce the effective FIS, please provide the datum conversion. Please note that mean sea level datum (MSL) is used within the Commonwealth of Puerto Rico and local tidal datum (LTD) is used within the U.s. Virgin Islands. Number 5 - Geographic Coordinate Data The surveyor or engineer must provide the latitude and longitude of the property in decimal degrees to the 5th decimal place (00.00000). and indicate the appropriate horizontal datum, WGS84, NAD83, or NAD27. Number 6 - Subsidence or Uplift land subsidence is the lowering of the ground as a result of water, oil, gas extraction, as well as other phenomena such as soil compaction, decomposition of organic material, and tectonic movement. Periodically, the National Geodetic Survey re-levels some benchmarks to determine new elevations above the National Geodetic Vertical Datum of 1929 (NGVD 29) or above the North American Vertical Datum of 1988 (NAVD 88); however, not all benchmarks are re-Ieveled each time. Check "yes" if the area of the property is in an area of subsidence or uplift, and provide the date of the current re- leveling; check "no" if the area of the property is not in an area of subsidence or uplift. In areas experiencing ground subsidence (e.g" Harris County, Texas, and Incorporated Areas); the most recently adjusted Elevation Reference Mark (ERM) must be used for accurate ground and structure elevations. Please consult the effective Flood Insurance Study (FIS) for your community or local floodplain administrator for the most current ERM data. In general, the effects of subsidence can be accounted for by determining grade and structure elevations using benchmark elevations with the same re.level date as the benchmarks used to develop the Base (l%-annual- chance) Flood Elevations (BFEs) on the FIRM. Please be aware that benchmark re-Ievel dates can be different for different flooding sources. No adjustment is necessary to the BFEs on the FIRM. Date Received: Instructions MT-1 Forms [086-0-26, 086-0-26A, 086-0-268) FE8 11 JUL 0 76201f Original Submittal _ Elevation Table A row in the elevation table must be completed for each property (parcels of land or structures) involved in this request (subject property). Address - Provide the street address (911 type) for subject property. Lot/Block Number- Provide the property's lot and/or block number if available. In the absence of a lot or block number, the registered professional engineer or licensed land surveyor must include an identifier that clearly states for what the elevations are being referenced (e.g. residential structure, commercial building, unit 1, etc.). Lowest Lot Elevation - For requests involving property, or a portion thereof, provide the lowest lot elevation to the nearest tenth (0.1) of a foot or meter. If the FIRM shows BFEs in meters, the accuracy of the lowest lot elevation must be to the nearest tenth of a meter. If the BFE varies across the property, please provide a certified site plan showing the range of elevations across the property. lowest Adjacent Grade (LAG) to the Structure - For requests involving a structure, provide the LAG elevation (the elevation of the lowest ground touching the structure including attached patios, stairs, deck supports or garages), to the nearest tenth (0.1) of a foot or meter. If the FIRM shows BFEs in meters, the accuracy of the LAG elevation must be to the nearest tenth of a meter. Base Flood Elevation - Provide the BFE affecting the property. FEMA will verify the BFE during the review process. BFEs can be obtained by locating the property on the effective FIRM for the community in which the property is located. Upon locating the property on the FIRM, the engineer or surveyor should determine the type of flooding and in which flood zone the property is located. The summary below will provide direction for how to determine the BFE as a result of the flooding type and flood zone determination. Base Flood Elevation Source - Provide the source used in determining the BFE (e.g. FIRM, profile, floodway data table, Community Determined, or other source). When submitting a BFE that is either community determined or from an alternate source, please include in the request, sufficient data that supports the BFE. . Riverine Flooding Systems (Zones AE or AI-A30) - Consult the FIS report for the community in which the property is located. Next, locate the flood profile for the flooding source by name. Estimate the property's location along the flood profile and interpolate the BFE using the 100-yr. flood profile line. . Lacustrine (Stillwater) Flooding Systems - Consult the FIS report for the community in which the property is located. Next, locate the Summary of StiJJwater Elevations table. Locate the flooding source, by name, and use the BFE listed in the table. The flooding source's BFE is normally shown to the nearest one-tenth of a foot. If the flooding source is not listed in the "Summary of Stillwater Elevations" table, use the BFE as shown on the FIRM. . Coastal Flooding Systems (Zones AE or AI-A30 and VE or VI-V30) - First, obtain the BFE from the FIRM panel. Next, consult the FIS report for the community in which the property is located. locate the Summary of Stillwater Elevations table in the FIS report. Identify the flooding source, by name, and use the BFE listed In the table. Compare the BFE listed in this table to the BFE obtained from the FIRM. If the stillwater elevation listed in this table is less than or equal to the whole-foot BFE shown on the map minus 0.5 foot, a wave height, wave runup, and/or wave setup component exists. In this case, the whole-foot BFE shown on the map should be used for rating, construction, and floodplain management purposes. If the stillwater elevation listed in the "Summary of Stillwater Elevations" table is greater than the whole- foot BFE shown on the map minus 0.4 foot, the stillwater elevation shown in the table shall be used as the BFE. (Any property/structure located seaward of the landward toe of the primary frontal dune may not be removed from a Zone VE or VI-V30). . Zone A flooding -If the property is located in a Zone A, an area of approximate flooding with no BFEs determined, a BFE will need to be determined by the engineer or surveyor. First, the engineer or surveyor should determine if a Federal, State, or local government agency has developed a BFE. Such agencies include the U.S. Army Corps of Engineers, the U.s. Geological Survey, the State's Department of Natural Date Received: Instructions MT-l Forms (086-0-26, 086-0-26A, 086-0-26B) FEB 11 7 JUL 0 7 2011 Resources, Department of Environmental Quality, or Department of Transportation; or the local Planning and Zoning Department. If one has been developed, all supporting data and calculations used to develop the BFE must be submitted, or a letter directly from the government agency must be submitted. If a BFE has not previously been developed, the engineer or surveyor should consult DHS-FEMA 265, Managing Floodplain Development in Approximate Zone A Areas: A Guide far Obtaining and Developing 8ase (100- year) Flood Eievations, available online at http://www.fema.gov/library/viewRecord.do?id=221S.This publication is an excellent resource, which details the appropriate methods for determining BFEs in SFHAs designated flood zone A. To obtain additional information about developing BFEs, contact the OHS.FEMA Map Information eXchange at 1-877-FEMA MAP (1-877-336-2627). If the property is greater than SO lots or 5 acres, whichever is the lesser, the engineer or surveyor must determine a BFE as a provision of Part 60.3(b)(3), which is available online at http://www.access.gpo.gov/nara/cfr/waisidx03/44cfr6003.htm!. . Shallow Flooding (Zone AH) -If the property is located in flood zone AH, locate the Summary of Stillwater Elevations table in the FIS report. Identify the flooding source, by name, and use the BFE listed in the table. If no Summary of Stillwater Elevations table exists, use the BFE shown on the FIRM If different elevations appear within the same SFHA, the BFE is obtained by linear interpolation between two adjacent BFE lines. . Shallow/Sheet Flooding (Zone AO) - For a property located in 20ne AO, the characteristics of the Zone AD area shown on the NFIP map will determine the appropriate methodology to be used to develop the BFE for the property. If the flooding is conveyed by the street, provide the highest top of curb or crown of street elevation (whichever is higher) along the property line and add this to the depth of flooding. The lowest adjacent grade elevation must be above the curb or street elevation by an amount equal to or greater than the depth of flooding shown on the NFIP map. If the entire property is inundated by the SFHA and the flow is not conveyed by the street, add the depth of flooding to the average surrounding grade. If the property is partially inundated by the SFHA and the street does not convey the flow, add the depth of flooding to the lowest lot elevation. Along with the information required for one of the above- mentioned methods, provide sufficient certified topographic information, including flow paths, to show that the structure is located on high ground relative to the depth indicated on the NFIP map. If the request involves multiple properties (parcels of land or structures), elevations must be provided for each property. If the number of properties for which DHS-FEMA is to make a determination exceeds the number of rows on the Elevation Table, additional photocopies of the table may be attached to the back of the Elevation Form. Certification (by a licensed land surveyor, registered professional engineer, or architect) The certifier must provide his or her name, license number and expiration date, his or her company name, telephone number and, if applicable, his or her fax number and email address. The certifier's seal, jf available, may be provided here. The certifier must sign and date the Elevation Form, where indicated, to certify the accuracy of the information provided. Not all states authorize architects and engineers to certify elevation information. Consult the state board of registration for more information. Date Received: JUL 0 7 2011 Original Submittal Instructions MT-1 Forms (086-0-26, 086-0-26A, 086-0-268) FE8 11 8 INSTRUCTIONS FOR COMPLETING OPTIONAL FORMS General While Forms 1 and 2 must be completed for all requests, Form 3 must only be completed when applicable. Instructions for completing this form are provided below. Community Acknowledgment Form (Form 3) The Community Acknowledgment Form (Form 3) must be completed for all requests involving the placement of fill, existing or proposed, or requests for land or structures that are inadvertently included in the NfJP regulatory floodway. The form must be completed and signed by the community official responsible for floodplain management in the community. The community name and the subject property address shown in Items 1 and 2 of the Property Information Form must appear in the spaces provided. Space has been provided within each section for the community official to provide comments on the project (e.g. Section A - The project is reasonably safe from flooding and satisfies Parts 60.3 and 65.5 of the NFIP regulations. Section B - Removal of the project from the regulatory floodway will not result in an increase in Base Flood Elevations.). If additional space;s required by the community official to provide the community's comments on a project, additional sheets may be attached to the back of this form. Section A - Requests Involving the Placement of Fill Instructions for Communities: As a participant in the NFIP under 44 CFR 60.3(a)(2), you are required to ensure, prior to issuing a floodplain development permit, that an applicant is in compliance with local and NFIP regulations and has obtained all necessary Federal and State permits related to development. For ClOMR-F requests, applicants must document ESA compliance to FEMA prior to issuance of the CLOMR-F determination. For lOMR~F requests, ESA compliance is required independently of FEMA's process. The community must ensure that appropriate ESA permits are obtained per requirement under Section 60.3(a)(2) of FEMA's regulations. Additional information about these requirements is available on Page 4 of this instruction packet. Another common Federal permit requirement may include wetland permits under Section 404 of the Clean Water Act of 1972. If you need a wetlands permit or are not sure if one is required, contact your local U.S. Army Corps of Engineers District Office. Necessary State permits vary depending on the State. Instructions for Applicants: You are responsible for obtaining all necessary Federal, State, and local permits as a condition of obtaining a LOMR-F or CLOMR-F. Your community is required to verify that you have obtained these necessary permits prior to issuing a floodplain development permit or signing the Community Acknowledgment Form (MT-1 Form 3). In addition, for CLOMR-F requests, you must document to FEMA that ESA compliance has been achieved prior to issuance of the CLOMR-F determination. For LOMR-F requests, ESA compliance is required independently of FEMA's process. Your community must ensure that appropriate ESA permits are obtained per requirement under Section 60.3(a){2) of FEMA's regulations. Additional information about these requirements is available on Page 40f this instruction packet. Another common Federal permit requirement may include wetland permits under Section 404 of the Clean Water Act of 1972. If you need a wetlands permit or are not sure if one is required, contact your local U.S. Army Corps of Engineers District Office. Necessary State permits vary depending on the State. To assist communities in determining if a property or structure, existing or proposed, is reasonably safe from flooding, DHS-FEMA has published Technical Bulletin 10-01. This bulletin outlines safe building practices, which when followed, may reduce the risk of flood damage to a property or structure. Community Officials interested in obtaining copies of this bulletin should visit our Internet site at http://www.fema.gov/pdf/fima/tb1001.pdf. Community Officials that do not have Internet access should contact the FMIX toll free at 1-877-FEMA MAP (1-877- 336-2627). Date Received: Instructions MT-1 Forms [086-0-26, 086-0-26A, 086-0-26B) FEB 11 JUL 07 ZOi11 Original Submittal_ All inquires regarding these, or other NFIP regulations, should contact the FMIX for assistance. Section B - Property Located within the Regulatory F100dway Required for all requests that are inadvertently included in the regulatory floodway. The regulatory floodway is the area of the Special Flood Hazard Area that must remain unobstructed in order to prevent unacceptable increases in Base Flood Elevations. This form must be signed by a community official, responsible for floodplain management, to acknowledge the community's acceptance of a revision to the regulatory floodway within the community. Date Received: JUl 0 7 2011 Original Submittal Instructions MT-1 Forms (086-0-26, 086-0-26A, 086-0-26B) FEB 11 10 DEPARTMENT OF HOMELAND SECURITY - FEDERAL EMERGENCY MANAGEMENT AGENCY PROPERTY INFORMATION FORM O.M.B. NO. 1660-0015 Expires February 28, 2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reparting burden for this data collection is estimated to average 1.63 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data SOurces, gathering and maintaining the needed data, and completing and submitting the form. This collection is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0015). NOTE: Do not send your completed form to this address. This form may be completed by the property owner, property owner's agent, licensed land surveyor, or registered professional engineer to support a request for a letter of Map Amendment (LOMA), Conditional letter of Map Amendment (CLOMA), letter of Map Revision Based on Fill (LOMR-F), Or Conditional Letter of Map Revision Based on Fill (ClOMR-F) for existing or proposed, single or multiple lots/structures. In order to process your request, all information on this form must be completed in its entirety, unless stated as OPtional. Incomplete submissions will result in processing delays. Please check the item below that describes your request: 0 LOMA A letter from DHS-FEMA stating that an existing structure or parcel of land that has not been elevated by fill (natural grade) would not be inundated by the base flood. 0 CLOMA A letter from DHS-FEMA stating that a proposed structure that is not to be elevated by fill (natural grade) would not be inundated by the base flood if built as proposed. 0 LOMR-F A letter from DHS-FEMA stating that an existing structure or parcel of land that has been elevated by fill would not be inundated by the base flood. o CLOMR-F A letter from DHS-FEMA stating that a parcel of land or proposed structure that will be elevated by fill would not be inundated by the base flood if fill is placed on the parcel as proposed or the structure is built as proposed. Fill is defined as material from any source (induding the subject property) placed that raises the ground to or above the Base Flood Elevation (BFE). The common construction practice of removing unsuitable existing material (topsoil) and backfilling with select structural material is not considered the placement of fill if the practice does not alter the existing (natural grade) elevation, which is at or above the BFE. Fill that is placed before the date of the first National Flood Insurance Program (NFIPI map showing the area in a Special Flood Hazard Area (SFHAI is considered natural grade. Has fill been placed on your property to raise ground that was previously below the BFE? DYes 0 No If yes, when was fill placed? I monthfyear Will fill be placed on your property to raise ground that is below the BFE? DYes' 0 No If yes, when will fill be placed? I monthfyear * If yes, Endangered Species Act (ESA) compliance must be documented to FEMA prior to issuance of the ClOMR-F determination (please refer page 4 to the MT-l instructions). 1. Street Address of the Property (if request is for multiple structures or units, please attach additional sheet referencing each address and enter street names below): 2. legal description of Property (lot, Block, Subdivision or abbreviated description from the Deed): - 3. Are you requesting that a flood zone determination be completed for (check one): 0 Structures on the property? What are the dates of construction? _ Date Received: 0 A portion of land within the bounds of the property? (A certified mei removed, certified by a licensed land surveyor or registered professi JUL 07 I metes and bounds descriptions, please refer to the MT-l Form Ilnsj 2011 I 0 The entire legally recorded property? I 4. Is this request for a (check one)' Original Submittal 0 Smgle structure I ! 0 Smgle Jot of to ~ 0 Multiple structures {How many structures are Involved In your reque 0 Multiple lots (How many lots are Involved In your request? list the ~ I DHS - FEMA Form 086-0-26, FEB 11 Property Information Form MT -1 Form 1 Page 1 of 2 In addition to this form (MT-l Form 1), please complete the checklist below. ALL requests must include one copy of the following: D Copy of the effective FIRM panel on which the structure and/or property location has been accurately plotted (property inadvertently located in the NFtP regulatory floodway will require Section B of MT-1 Form 3) D Copy of the Subdivision Plat Map for the property (with recordation data and stamp of the Recorder's Office) OR o Copy of the Property Deed (with recordation data and stamp of the Recorder's Office), accompanied by a tax assessor's map or other certified map showing the surveyed location of the property relative to local streets and watercourses. The map should include at least one street intersection that is shown on the FIRM panel. o Form 2 - Elevation Form. If the request is to remove the structure, and an Elevation Certificate has already been completed for this property, it may be submitted in lieu of Form 2. If the request is to remove the entire legally recorded property, or a portion thereof, the lowest lot elevation must be provided on Form 2. o Please include a map scale and North arrow on all maps submitted. For LOMR-Fs and CLOMR-Fs, the following must be submitted in addition to the items listed above: o Form 3 - Community Acknowledgment Form For CLOMR-Fs, the following must be submitted in addition to the items listed above: D Documented ESA compliance, which may include a copy of an Incidental Take Permit, an Incidental Take Statement, a "not likely to adversely affect" determination from the National Marine Fisheries Service (NMFS) or the U.s. Fish and Wildlife Service (USFWS), or an official letter from NMFS or USFWS concurring that the project has "No Effect" on proposed or listed species or designated critical habitat. Please refer to the MT-1 instructions for additional information. Please do not submit original documents. Please retain a copy of all submitted documents for your records. DH5-FEMA encourages the submission of all required data in a digital format (e.g. scanned documents and images on Compact Disc {CDJ}. Digital submissions help to further DHS.FEMA's Digital Vision and also may facilitate the processing of your request. Incomplete submissions will result in processing delays. For additional Information regarding this form, Including where to obtain the supporting documents listed above, please refer to the MT.l Form Instructions located at httPJlwww.fema.gov/plan/prevent/fhm/dl mt-l.shtm. Processing Fee (see instructions for appropriate mailing address; or visit htto://www.fema.gov/fhm/frm fees.shtm for the most current fee schedule) Revised fee schedules are published periodically, but no more than once annually, as noted in the Federal Register. Please note: Single/multiple lot(s)/structure(s) LOMAs are fee exempt. The current review and processing fees are listed below: Check the fee that applies to your request: D $325 (single lot/structure LOMR-F following a CLOMR-F) 0$425 (single lot/structure LOMR-f) D $500 (single lot/structure CLOMA or CLOMR-F) D $700 (multiple lot/structure LOMR-F following a CLOMR-F, or multiple lot/structure CLOMA) D $800 (multiple lot/structure LOMR-F or CLOMR-F) Please submit the Payment Information Form for remittance of applicable fees. Please make your check or money order payable to: National Flood Insurance Program_ All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable by fine or imprisonment under Title 18 of the United States Code, Section 1001. Applicant's Name (required): Mailing Address (required): Company (if applicable): Daytime Telephone No. (required): E-Mail Address (optional): 0 By checking here you may receive correspondence electronically at the email address provided): Fax No. (optional): Date (required) Signature of Applicant (required) DHS - FEMA Form 086-0-26, FEB 11 Property Information Form MT-1 Form 1 Page 2 of 2 DEPARTMENT OF HOMELAND SECURITY - FEDERAL EMERGENCY MANAGEMENT AGENCY ELEVATION FORM a.M.B. NO. 1660-0015 Expires February 28, 2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing and submitting the form. This collection is required to obtain or retain benefjts. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA 20S98-3005, Paperwork Reduction Project (1660-0015). NOTE: Do not send your completed form to this address. This form must be completed for requests and must be completed and signed by a registered professional engineer or licensed land surveyor. A DHS - FEMA National Flood Insurance Program INFIPI Elevation Certificate may be submitted in lieu of this form for single structure requests. For requests to remove a structure on natural grade OR on engineered filt from the Special Flood Hazard Area (SFHA), submit the lowest adjacent grade (the lowest ground touching the structure), including on attached deck or garage. For requests to remove an entire parcel of land from the SFHA, provide the lowest lot elevation; or, if the request involves an area described by metes and bounds, provide the lowest elevation within the metes and bounds description. All measurements are to be rounded to nearest tenth of a foot. In order to process your request, all information on this form must be completed in its entirety. Incomplete submissions will result in processing delays. 1. NFIP Community Number: Property Name or Address: 2. Are the elevations listed below based on 0 existing or 0 proposed conditions? (Check one) 3. For the existing or proposed structures listed below, what are the types of construction? (check all that apply) o crawl space 0 slab on grade 0 basement/enclosure 0 other (explain) 4. Has DHS - FEMA identified this area as subject to land subsidence or uplift? (see instructions) o Yes ONO If yes, what is the date of the current re-Ieveling? I (month/year) S. What is the elevation datum? 0 NGVD 29 o NAVD 88 o Other (explain) If any of the elevations listed below were computed using a datum different than the datum used for the effective Flood Insurance Rate Map (FIRM) (e.g., NGVD 29 or NAVD 88), what was the conversion factor? local Elevation +/- ft. = FIRM Datum 6. Please provide the latitude and longitude of the most upstream edge of the structure (in decimal degrees to the nearest fifth decimal place): Indicate Datum: 0 WGS84 o NAD83 o NAD27 lat. long. Please provide the latitude and longitude of the most upstream edge of the property (in decimal degrees to the nearest fifth decimal place): Indicate Datum: 0 WGS84 o NAD83 o NAD27 lat. long. lowest Address lot Number Block lowest lot Adjacent Base Flood Number Elevation. Grade To Elevation BFE Source Structure This certification is to be signed and sealed by a licensed land surveyor, registered professional engineer, or architect authorized by law to certify elevation information. All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable by fine or imprisonment under Title 18 of the United States Code, Section 1001. Certifier's Name: license No.: Expiration Date: Company Name: Telephone No.: Email: Fax No. Signature: Date: . For requests involving a portion of property, include the lowest ground elevation within the metes and bounds description. Seal (optional) Please note: If the Lowest Adjacent Grade to Structure is the only elevation provided, a determination will be issued for the structure only. DHS - FEMA Fonn 086-Q-26A, FED 11 Elevation Form MT-l Fonn 2 Page t ofZ Continued from Page 1. Lowest Lot Lowest Adjacent Base Flood Address Lot Number Block Number Elevation. Grade To Efevation BFESource Structure This certification is to be signed and sealed by a licensed land surveyor, registered professional engineer, or architect authorized by law to certify elevation information. All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable by fine or imprisonment under Titre 18 of the United States Code, Section 1001. Certifier's Name: License No.: Expiration Date: Company Name: Telephone No.: Email: Fax No. Signature: Date: * For requests involving a portion of property, include the lowest ground elevation within Seal (optional) the metes and bounds description. Please note: If the Lowest Adjacent Grade to Structure is the only elevation provided, a determination will be issued for the structure only. DHS - FEMA Form 086-0-Z6A, FED 11 Elevation Form MT.l Form Z Page Z ofZ DEPARTMENT OF HOMELAND SECURITY. FEDERAL EMERGENCY MANAGEMENT AGENCY COMMUNITY ACKNOWLEDGMENT FORM O.M.B. NO. 1660-0015 Expires February 28, 2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing and submitting the form. This collection is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0015). NOTE: Do not send your completed form to this address. This form must be completed for requests involving the existing or proposed placement offill (complete Section A) OR to provide acknowledgment of this request to remove a property from the SFHA which was previously located within the regulatory floodway (complete Section B). This form must be completed and signed by the official responsible for floodplain management in the community. The six digit NFIP community number and the subject property address must appear in the spaces provided below. Incomplete submissions will result in processing delays. Please refer to the MT.1 instructions for additional information about this form. Community Number: Property Name or Address: A. REQUESTS INVOLVING THE PLACEMENT OF FILL As the community official responsible for floodplain management, I hereby acknowledge that we have received and reviewed this letter of Map Revision Based on Fill (lOMR~F) or ConditionallOMR.F request. Based upon the community's review, we find the completed or proposed project meets or is designed to meet all of the community floodplain management requirements, including the requirement that no fill be placed in the regulatory f1oodway, and that all necessary Federal, State, and local permits have been, or in the case of a ConditionallOMR.F, will be obtained. For ConditionallOMR-F requests, the applicant has or will document Endangered Species Act (ESA) compliance to FEMA prior to issuance of the ConditionallOMR-F determination. For lOMR~F requests, I acknowledge that compliance with Sections 9 and 10 of the ESA has been achieved independently of FEMA's process. Section 9 of the ESA prohibits anyone from "taking" or harming an endangered species. If an action might harm an endangered species, a permit is required from U.S. Fish and Wildlife Service or National Marine Fisheries Service under Section 10 of the ESA. For actions authorized, funded, or being carried out by Federal or State agencies, documentation from the agency showing its compliance with Section 7(a)(2) of the ESA will be submitted. In addition, we have determined that the land and any existing or proposed structures to be removed from the SFHA are or will be reasonably safe from flooding as defined in 44CFR 65.2(c), and that we have available upon request by DHS-FEMA, all analyses and documentation used to make this determination. For lOMR.F requests, we understand that this request is being forwarded to DHS- FEMA for a possible map revision. Community Comments: Community Official's Name and Title: (Please Print or Type) Telephone No.: Community Name: Community Official's Signature: (required) Date: B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY As the community official responsible for floodplain management, I hereby acknowledge that we have received and reviewed this request for a lOMA. We understand that this request is being forwarded to DHS-FEMA to determine if this property has been inadvertently included in the regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatory floadway. We find that the completed or proposed project meets or is designed to meet all ofthe community floodplain management requirements. Community Comments: Community Official's Name and Title: (Please Print or Type) Telephone No.: Community Name: Community Official's Signature (required): Date: DHS - FEMA Form 086-0-26B, FEB 11 Community Acknowledgment Fonn MT-t Form 3 Page t ort FEDERAL EMERGENCY MANAGEMENT AGENCY PAYMENT INFORMATION FORM Community Name: Project Identifier: THIS FORM MUST BE MAILED, ALONG WITH THE APPROPRIATE FEE, TO THE ADDRESS BELOW OR FAXED TO THE FAX NUMBER BELOW. Type of Request: o MT-l apPlicatiOn} o MT-2 application LOMC Clearinghouse 7390 Coca Cola Drive Suite 204 Hanover, MD 21076 Attn.: LaMA Manager o EDR application } FEMA Project Library 847 South Pickett St. Alexandria, VA 22304 FAX (703) 212-4090 Request No.: (if known) Amount: o INITIAL FEE' 0 FINAL FEE 0 FEE BALANCE*' 0 MASTER CARD 0 VISA 0 CHECK 0 MONEY ORDER *Note: Check only for EDR and/or Alluvial Fan requests (as appropriate). **Note: Check only if submitting a corrected fee for an ongoing request. COMPLETE THIS SECTION ONLY IF PAYING BY CREDIT CARD CARD NUMBER EXP. DATE ITJJJ - ITJJJ - ITJJJ - ITJJJ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 CD-CD Month Year Date Signature NAME (AS IT APPEARS ON CAROl: (please print or type) ADDRESS: (for your credit card receipt-please print or type) DAYTIME PHONE: DHS. FEMA Form 086-0-26B, FED 11 Community Acknowledgment Form MT.l Form 3 Page 10ft