HomeMy WebLinkAboutFEMA documents FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.3067-0147
PROPERTY INFORMATION FORM Expires.September 30,2005
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form 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, reviewing, and submitting the form. You are not required
to respond to this collection of information unless a valid OMB control number appears in the upper right comer of this form. Send comments regarding
the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Federal Emergency
Management Agency, 500 C Street,SW,Washington DC 20472, Paperwork Reduction Project(3067-0147). Submission of the form is required to obtain
or retain benefits under the National Flood Insurance Program. Please do not send your completed survey to the above 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. Please check the item below
that describes your request:
ILOMA A letter from 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.
I-1 CLOMA A letter from 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 FEMA stating that an existing structure or parcel of land that has been elevated by fill
would not be inundated by the base flood.
A letter from FEMA stating that a parcel of land or proposed structure that will be elevated by fill
CLOMR-F 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 placed to raise 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(NFIP)map showing the area in a Special Flood Hazard Area(SFHA)is considered natural grade.
Has fill been placed on your property? [] Yes I I No If yes,when was fill placed? 6/2000
month/year
Will fill be placed on your property? I 1 Yes No If yes,when will fill be placed? /
month/year
1. Street Address of the Property(if request is for multiple structures,please attach additional sheet):
1005 Earl Rudder Freeway South,College Station,Texas
2. Legal description of Property(Lot,Block,Subdivision)(if a street address cannot be provided):
Greensworld Subdivision,PH 1 (Vol. 1292, Pg.209)
3. Are you requesting that the SFHA designation be removed from(check one):
the entire legally recorded property?
a portion of land within the bounds of the property(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)?
Istructures on the property? What are the dates of construction?
4. Is this request for a(check one):
Isingle structure
single lot
II multiple structures(How many structures are involved in your request?List the number:
[X multiple lots(How many lots are involved in your request?List the number: 3)
FEMA Form 81-87,SEP 02 Property Information Form MT-1 Form 1 Page 1 of 2
In addition to this form(MT-1 Form 1),ALL requests must include the following:
• Copy of the Plat Map for the property(with recordation data and stamp of the Recorder's Office)
OR
• 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
• Copy of the effective FIRM panel and/or Flood Boundary and Floodway Map(FBFM)(if applicable)on which the property location has been
accurately plotted(property inadvertently located in the NFIP regulatory floodway will require Section B of MT-1 Form 3)
• Form 2—Elevation Form. If an Elevation Certificate has already been completed for this property, it may be submitted in addition to Form 2.
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:
• Form 3—Community Acknowledgment Form
Processing Fee(see instructions for appropriate mailing address;or,visit http://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:
n $325(single lot/structure LOMR-F following a CLOMR-F)
$425(single lot/structure LOMR-F)
F1 $500(single lot/structure CLOMA or CLOMR-F)
n $700(multiple lot/structure LOMR-F following a CLOMR-F, or multiple lot/structure CLOMA)
® $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: Rabon A.Metcafl,P.E. Company: Rabon Metcalf Engineering
Please Print or Type
Mailing Address: P.O.Box 9253 Daytime Telephone No.: (979)690-0329
College Station,TX 77842
E-Mail Address: rmengineer@verizon.net Fax No.: (979 ••I-1329
(optional)
-41111 .
/`
December 30,2005
Date Signature of Applicant(required)
If you have any questions concerning FEMA policy,or the NFIP in general,please contact the FEMA Map Assist- ce Center toll free at 1-877-FEMA
MAP(1-877-336-2627),or visit the Flood Hazard Mapping website at http://www.fema.gov/fhm/.
FEMA Form 81-87,SEP 02 Property Information Form MT-1 Form 1 Page 2 of 2
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.3067-0147
ELEVATION FORM Expires September 30,2005
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1 hour per response. The burden estimate includes the time for reviewing instructions,
searching existing data sources,gathering and maintaining the needed data,and completing, reviewing,and submitting the form. You are not required
to respond to this collection of information unless a valid OMB control number appears in the upper right comer of this form. Send comments regarding
the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Federal Emergency
Management Agency, 500 C Street,SW,Washington DC 20472, Paperwork Reduction Project(3067-0147). Submission of the form is required to
obtain or retain benefits under the National Flood Insurance Program. Please do not send your completed survey to the above address.
This form must be completed for requests and must be completed and signed by a registered professional engineer or licensed land surveyor. A FEMA
National Flood Insurance Program(NFIP)Elevation Certificate may be submitted in addition to this form for single structure requests.
For requests to remove a structure on natural grade OR on engineered fill from the Special Flood Hazard Area(SFHA),submit the lowest adjacent
grade(the lowest ground touching the structure), including an 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.
1. NFIP Community Number: 480083 Property Name or Address: 1005 Earl Rudder Freeway,College Station,Texas
2. Are the elevations listed below based on Fl existing or I I proposed conditions? (Check one)
3. What is the elevation datum? NGYD 29 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
4. For the existing or proposed structures listed below,what are the types of construction? (check all that apply)
[1 crawl space I I slab on grade basement/enclosure other(explain)
5. Has FEMA identified this area as subject to land subsidence or uplift?(see instructions) [1 Yes ® No
If yes,what is the date of the current releveling? / (month/year)
Lowest
Block Lowest Lot Adjacent Base Flood
Lot Number Number Elevation Grade To For FEMA Use Only
Structure Elevation
1 1 258.54 258.29
2 1 258.98 258.73
3 1 258.95 258.73
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.
Certifiees Name: Rabon A.Metcalf, P.E. License No.: 88583 Expiration Date: 6/30/06
Company Name: Ra... .etcatf Engineeri . Telephone No.: 979-690-0329 Fax No.: 979-690-0329
Signa . -�_ Date: la,/D/cry"
Asil"It.OF TEj,:kli®
• "�•
RABON A. METCALF E1
A 88583
� c`9SION At 04.1--
/2/- 1/C!
FEMA Form 81-87A,SEP 02 Elevation Form MT-1 Form 2 Page 1 of 2
Continued from Page 1.
Block Lowest Lot Lowest Base Flood
Lot Number Number Elevation Adjacent Grade Elevation For FEMA Use Only
To 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.: Fax No.:
Signature: Date:
Sea optional)
/24.,/�—
FEMA Form 81-87A,SEP 02 Elevation Form MT-1 Form 2 Page 2 of 2
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.3067-0147
COMMUNITY ACKNOWLEDGMENT FORM ExpiresSeptember 30,2005
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 0.88 hour per response. The burden estimate includes the time for reviewing instructions,
searching existing data sources,gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required
to respond to this collection of information unless a valid OMB control number appears in the upper right comer of this form. Send comments regarding
the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Federal Emergency
Management Agency, 500 C Street, SW, Washington DC 20472, Paperwork Reduction Project (3067-0147). Submission of the form is required to
obtain or retain benefits under the National Flood Insurance Program. Please do not send your completed survey to the above 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 regulatory floodway(complete Section B).
This form must be completed and signed by the official responsible for floodplain management in the community. The community number and the
subject property address must appear in the spaces provided below.
Community Number: 480083 Property Name or Address: 1005 Earl Rudder Freeway,College Station,Texas
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. 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 FEMA,all analyses and documentation used to make this determination. For LOMR-F
requests,we understand that this request is being forwarded to 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 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 floodway. We find that the completed or
proposed project meets or is designed to meet all of the 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:
FEMA Form 81-87B,SEP 02 Community Acknowledgment Form MT-1 Form 3 Page 1 of 1
FEDERAL EMERGENCY MANAGEMENT AGENCY
PAYMENT INFORMATION FORM
Community Name: 480083
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:
FEMA
® MT-1 application 1 Fee Charge System Administrator
n MT-2 application - P.O.Box 22787
Alexandria,VA 22304
FAX(703)317-3076
FEMA Project Library
EDR application 3601 Eisenhower Avenue
Alexandria,VA 22304
FAX(703)751-7391
Request No.: (if known) Amount: 800.00
® INITIAL FEE* n FINAL FEE FEE BALANCE** n MASTER CARD I I VISA n CHECK I I 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
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Month Year
Date Signature
NAME(AS IT APPEARS ON CARD):
(please print or type)
ADDRESS:
(for your
credit card
receipt-please
print or type)
DAYTIME PHONE:
FEMA Form 81-107 Payment Information Form