Creekview North-CS061213FEDERAL EMERGENCY MANAGEMENT AGENCY O.MB. NO.3067-0147
COMMUNITY ACKNOWLEDGMENT FORM EYpinesSeptember30, 2006
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 sand your completed survey to the above addross.
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.
Commurnty 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. 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 induded 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.
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Community Official's Name and Title- (Please Prmt or Type} Telephone No
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Community Name. Community Official's Signature (required} Date.
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FEMA Form 8187 B, SEP 02 Community Acknowledgment Form MT-1 Form 3 Page 1 of 1
FEDERAL EM®tGENCY MANAGEMENT AGENCY cte! x No. 3BrS7~1J7
PROPERTY INFORMATION FORM ~~spa~aaes
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this fam 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, end completing, reviewing, and submitting the form. You are rid required
to respond [o this cdlec0on of information unless a valid OMB control number appears in the upper right corns of this fam. Send comments regerdng
the accuracy of the burden estimate and any suggestions for reducing this burden to' Information Cdledions Management. Federal Emergency
Management Agency, 500 C Street, SW, Washington ix 20472, Paperwork Reduction Project (3067-0147}. Sutxnission of the form is required to obtain
a retain benefits under the National Flood Insurance Program. Plsaae do not send your completed survey to the above address.
This form may be completed ~ the property owner, property owner's agent, licensed lend surveyor, or registered professiatel engineer to support a
request for a Letter of Map Amendment (COMA), Conditional Letter d Map Amendment (CLOMA), Letter of Map Revision Based on FiU (LOMR-F), or
Conditional Letter of Map Revison Based on Fill (CLOMR-F) for existing or proposed, singe or multiple IotsJstrudures. Please check the item below
that describes ur r uest:
COMA A letter from FF1~AA staging that en existing structure a parcel of land that has not been elevated tn/ fiN
natural rode would not be inundated the base flood.
^ CLOMA A letter from FEMA stating that a proposed structure that is not to be elevated by fill (natural grade)
_ wwld not be inundated the base flood if buiR as ro sad.
^ LOMR-F A letter from FEMA stating that an existing structure or parted of Land that has been elevated by All
would not be inundated the base flood.
^ A letter-from FEMA stating that a parcel of land a proposed structure that will be elevated byflll
CLOMR-F would not be inundated by the base food il fig i5 placed on the parcel es proposed or the structure is
built as osed
Fu is defined es material from any source placed to raise the ground to or above the Base Flood Elevation (BFE). The convnon constructon practice of
remrriing unsuitable existing mderial (topsoil} and bacl~lling with select structural material is not considered the placement of fdi il the practice does nu
alter the existing (natural gads) elevation, which is at or above the BFE FNI that is plead baton the date of the Arst Nstlansl Flood Insurance
Program (PFIP) map showing the area in a Special Flood Hazard Area (SFHA) is canatderod natural grade.
Has fill been placed ai your praperiy? ~ Yes ~lo If yes, when was fill placed?
monthtyear
tMll fill be placed on your properly? ^ Yes ^ No If yes, when will fiN be pared'? /
monthlyear
1. Street Address otthe Property {if request is for multiple structures, pease attach additional sheet):
G~9z. 7~'Wf.J'z G~ok.t7- Co~vP~'t.L. ~ '7S"ol 1
2.. Legal description of Property (Cat, Block, Subdvision) {A a street adders cannot be provided):
~ mT' ,t? ~S~f~-- !' ®F ~2~-,Eirc Y<E-w ~ ~Tfi ~F~r~p.~
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 properly (e certified metes end bounds desciiption end map of the arse to be removed,
certfiied by a licensed land surveyor or registered professional engineer, are required)?
^ StrucNres on the property? What are the dates of construction?
4 Is this request fora (check one}:
^ single structure
~smgle Id
^ multiple structures (How many structures ere involved in your request? List the number )
multiple lots {How many lots are involved in your request? List the number: }
FEMA Farm 81-87, SEP 02 Property Information Form MT•1 Form 1 Page 1, of 2
In addition to this'am (~[T-1 Form 1), ALL raqucsts must inc r:de [he fcaowrng.
• C:py of the PIS Map for the property ;tiwth recordrtion data znd stamp cf the Record~Y .Office)
UR ,
• Copy of the property Deed (with recordation data and stamp of the Racorder s Office), accompanied tN a tax essosso• ;map or ether ca [flied
reap srowiny the s;~rveyed locatror c` the properly rala[ivs to local streets and wa'er~ou;;o=:,
• Copy of ttie effec!ive FIRM panel andlcr Flmd Rarnda.~~ and Florxtway Map (FBFM) (rf applicable) on which the property Irx alien has been
accurately plotted (propery inadvertently located in the NFiP reglat~ry floodway wi!I require :-lec:lron E3 ~ MT-1 ~o°m 3)
• Farr 2 E:avelivn Fam. If an t7evation Cvrlificate has akeedy teen completed frx this property, it may tx3 subn~ted in additfort to Form 2.
Please include a map scale and No!2h arrow on alt mars submitted.
For LOMB-Fs and C:_OMR Fs, the following rrnrst hosl3bmittad in addition to the items liaexl above:
• Fam 3 -Community Aclmowlodgmont Form
Piocessinq Fes (see ;nstructions for appropriate mailing address; or, visit http:IAnn~wv.femagov7plarYpreventlthm/frm tees.shtm fa :he most currerd
fee schedule)
Revised fee schedules acs pub;ished pariodically, but no more than nice annually, as Hared in the Federr~LReQster. Please note: singloimul[ipfe
Ic[{s);'sttucture(s) LOMAs are tee sxem(rY. Tne curter[ review and processsng fees are fisted below:
Chock the fee :ha[ applies to your toques[
n $325 (single lotlstructure LOMR-F fdlowing a Ct_OMR-F)
^ $425 {single lotistructtxo LOMR-F)
^ $5C0 (single Ictlstructura CLOMA or CLOMR-F)
^ $700 {rwttipla Intlstn;rture I OMR-F h~lltrwrn:~ a CLtN~R-F, or rnoltpie btJstnicture CLOMA)
$800 (muRiple lotfstnxture LOMR-F or Gl-ONIR-F)
Please submit the Payrnert Iniormatior; Form `or rsmittan ee of appl`cable fees, Perr;e rnaka your chock or money ado' paya>~le to' Natio_.~al_Floacf
Insurance Fxgcar_am __~
A31 documents submitted in support of this request are correct to tte best of my la.owledge, I understand that arty fats statement may bo punishably by
fine a imprisonment under Title 18 of ttre United States Code, Section •1001.
Applicant's'vame ~-i4>r2 ~ rJ Com ~n 1C
Please Print or Type '~ f~ Y
MalinS Address: ! ~7 3 2 l G~ 7"a'~/ G j` . G~aime Telephone No.: Z~~! • 7 3 ~ ~ l 3 ~ g
r-Mail Adrtess: Fax No ~' 7 Z. Z' ~ 7 d ~' B
(optional)
Date Sic,~ature of Applic .(required) ~'~
If you have any questions concemirg FFMA policy, or the NFIP in gar, era', pease conta~ the FL~r1A Map Assistance Carter toll free at 1-877-FEMA
MAP (1-877-336.2627), or visit the Flood Hazard Mappir, g websita et httpaMNVw.fema.govlplan/preverd/fhm.
FEiYUI Form B1-Sl, SEP Ol Property Information Fomt
MT-1 Form 1 Pa,Qe 2 of 2
PLt?f?RAL EAALRI3ENCY MANAi3E14~EFIT AOI:NGY ~ 0~8. NOt ~I~i1-9117
ELEVATION FORM e~,r„a~~.~3g 199s
PAPERWORK 6tURD8F1 RISCL08URE HOT[CE
Pubic reporting burden forthls forth is esdtneted b averspe 1 hour per response. The burden estimate InUudes the tine fa reviewing inmrctions
,
searching existlng date sources, gettlaring end mahltainirg the needed date, and oomplatlng, roviswing, end subrrrittlrrg the tam. You ere hat required
to respond to this ooledon d irtorrftelon unless a veld OMB conttd number appears in the upper right comer of this farm. Send comments regarding
the ecwrscy of the twrden octtrr>eto and any rauggeedona fa redudmg tMs lwrden to tnfombtJon Collections Management, Federal Emergency
Menegelnvrrt Agency. 500 C Street, SW, Washington DC 2U4T1, P~apavrolkRsductlon Project {3067.0147}. 9ubmisttian of the forth is requ~ed to
obtain or rotaln benafis under the tVae4iomel Flood Insurance Pt m. Please da not Bend ur co fated sure to the above address.
This form must tNJ canpided for requeam Am d must be completed and signed by a rotlstorod professionol engineer or iconsed lend surveyor. A fEAIA
National Fbod hsurant:a ProQtan pVF~j Elevation GriJtlcata may be surbmltted in adrdtlon !o this form for stngte structuro regaeete.
For roquests ro remove a structure on netlursl grade OR on en9neered fll tram the Special Flood Heard Area (SFHAy, sutxat tqe lowest adacent
grtide (the larrast grot,nd touching iha structure}, including en ottachod deck a garage. For requests to roman an entire parcel of tang from the SFHA
,
provide the lowest lot elsvetlon; or, if the realest involves en area described by metes and boumds, provide the lowest elevation w3hin >.he metes rand
bounds descrrpaon.
1. NFIP Commurtly Number. SSG/JO Property Nen-e or Address: Gdl 7ifvPr `'fir-f
2. Are me elevelions listed below based on ®~ci~ or ^ used candlica~s9 (Cl-edc one)
3. What is ttre elsvadon datum? u any of the elevetlons lisi,ed iDekrw Trsre computed using a dNUm dlffarent than tine datum used for the
offocthre Flood lnsurence Rata Map (FIRM} (o.g., NGVU 29 ar NAVD $8). v-Aal was the mrrvorsforr fecror?
~~ Y~ ~ ~~~
Local Oswlbn ~!- R ^ FIRM Qstum
4. For the oxistlng or eposed stnrctures fisted below, wtrart era ilia es of canstrucdom (check e1 th84 apply}
^ r1aTN sparse ~ slab on
rade ^ ba9emenYendo
ut
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m
l
g
s
e
o
sr {exp
eim)
5, Has FEhAA identlied this area es subject m tend subsidlsrtce or uplift? (see tnstnxtions) ^ Yos ~ tVo
ft yes, whe; is fhe date of the current releveting9 t {monthfylesr)
lowest
La Number Brock
Nunlb~ Lowest t.a
Elevsfon Adjacent
Grads To base Food
devatfon
For FertA llse Ong
Structrms
z ! .~ 480
This c«rlicatlon is to be Signed and seated by a licensed land syuvoyor, rogistand proleasfonal engineer, or architect euthodzed by raw W certUy
etevdion inforrt>etion. NI dacumerrts submitted in support a this request are correct to the best of rrty I~owiedDe. I understand tl-at ery false
steMment may 8e punlsheWe by Hno ar Imprisorrrrorc under Tile 18 0l the Unied Slates Code, Section 1001.
ceAifiersNeme: Arr oaf/~ LicerweNO.: ¢,s"y~- ExWlr~uoncat.: !.~/3~~~~
GalraDamy Nalne:g4r ~ItW ,/ ~O. ~L C Telephone No.. 97~• ~,~ ~• Ss33 Fax Nor: 9?~ -~'}? - /,f 9I
Signature: Da<o: // l6~0~
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FEMA Form 81~8TA, SB-1)Q Bovatlon Forth hiT 1 Form 2 t'aue 1 ofd