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Home My WebLink AboutFDP201700008 FEMA Overview and Concurrence Form 2019-04-12U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY OVERVIEW & CONCURRENCE FORM PAPERWORK BURDEN DISCLOSURE NOTICE O.M.B No. 1660-0016 Expires February 28, 2014 Public reporting burden for this form is estimated to average 1 hours per response. The burden estimate includes the lime 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 it displays a valid OMB control number. 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 20958-3005, Paperwork Reduction Project (1660-0016). 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. PRIVACY ACT STATEMENT AUTHORITY: The National Flood Insurance Act of 1968, Public Law 90-448, as amended by the Flood Disaster Protection Act of 1973, Public Law 93- 234. PRINCIPAL PURPOSE(S): This information is being collected for the purpose of determining an applicant's eligibility to request changes to National Flood Insurance Program (NFIP) Flood Insurance Rate Maps (FIRM). ROUTINE USE(S): The information on this form may be disclosed as generally permitted under 5 U.S.0 § 552a(b) of the Privacy Act of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/FEMAINFIP/LOMA-1 National Flood Insurance Program (NFIP); Letter of Map Amendment (LOMA) February 15, 2006, 71 FR 7990. DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent FEMA from processing a determination regarding a requested change to a (NFIP) Flood Insurance Rate Maps (FIRM). A. REQUESTED RESPONSE FROM DHS-FEMA This request is for a (check one): ❑ CLOMR: A letter from DHS-FEMA commenting on whether a proposed project, if built as proposed, would justify a map revision, or proposed hydrology changes (See 44 CFR Ch. 1, Parts 60, 65 & 72). ® LOMR: A letter from DHS-FEMA officially revising the current NFIP map to show the changes to floodplafns, regulatory floodway or flood elevations. (See 44 CFR Ch. 1, Parts 60, 65 & 72) B. OVERVIEW 1. The NFIP map panel(s) affected for all impacted communities is (are): Community No. Community Name State Map No. Panel No. Effective Date Example: 480301 City of Katy TX 48473C 0005D 02/08/83 480287 Harris County TX 48201C 022OG 09/28/90 510033 1510006 City of Charlottesville VA 51003C 0278D 02/04/05 510006 Albemarle Count VA 51003C 0278D 02/04/05 510033 City of Charlottesville VA 51003C 0286D 02/04/05 Albemarle County VA I 51003C 0286D 02/04/05 2. a. Flooding Source: Meadow Creek b. Types of Flooding: ® Riverine ❑ Coastal ❑ Alluvial fan ❑ Lakes 3. Project Name/ldentifier: Meadow Creek ❑ Shallow Flooding (e.g., Zones AO and AH) ❑ Other (Attach Description) 4. FEMA zone designations affected: A, AE (choices: A, AH, AO, Al-A30, A99, AE, AR, V, V1-V30, VE, 8, C, D. X) 5. Basis for Request and Type of Revision: a. The basis for this revision request is (check all that apply) ❑ Physical Change ❑ Coastal Analysis ❑ Weir -Dam Changes ❑ Improved Methodology/Data ® Regulatory F000dway Revision ® Hydraulic Analysis ❑ Hydrologic Analysis ❑ Levee Certification ❑ Alluvial Fan Analysis ® New Topographic Data ❑ Other (Attach Description) Note: A photograph and narrative description of the area o ❑ Base Map Changes ® Corrections ❑ Natural Changes FEMA Form 086-0-27, (02011) Previously FEMA Form 81-89 MT-2 Form 1 Page 1 of 3 b. The area of revision encompasses the following structures (check all that apply) Structures: ❑ Channelization ❑ LeveelFloodwall ® BridgelCufvert ❑ Dam ❑ Fill ❑ Other (Attach Description) 16. ❑ Documentation of ESA compliance is submitted (required to initiate CLOMR review). Please refer to the instructions for more information. C. REVIEW FEE Has the review fee for the appropriate request category been included? ® Yes Fee amount: $a ❑ No, Attach Explanation Please see the DHS-FEMA Web site at htt:I/www.fema. ov1 Ian/ reventlfhm/frm fees.shtm for Fee Amounts and Exemptions. D. SIGNATURE 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. Name: Carolyn A. Howard, PE Company: Draper Aden Associates Mailing Address: Daytime Telephone No.: 540-552-0444 Fax No.: 540-552-0291 2206 South Main Street E-Mail Address: choward@daa.com Blacksburg, Virginia 24060 Signature of Requester (required):.. f ^ �? 4 �4� Date: 02/1212019 As the community official responsible for floodplain management, I hereby acknowledge that we have received and reviewed this Letter of Map Revision (LOMR) or conditional LOMR 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 requirements for when fill is placed in the regulatory floodway, and that all necessary Federal, State, and local permits have been, or in the case of a conditional LOMR, will be obtained. For Conditional LOMR requests, the applicant has documented Endangered Species Act (ESA) compliance to FEMA prior to FEMA's review of the Conditional LOMR application. For LOMR requests, I acknowledge that compliance with Sections 9 and 10 of the ESA has been achieved independently of FEMA's process. 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 FEMA, all analyses and documentation used to make this determination. Community Official's Name and Title: Frank V. Pohl, PE, CFM, County Engineer Community Name: Albemarle County Mailing Address: Community Development Daytime Telephone No.: 434-296-5832 Fax No.: 401 McIntire Road Charlottesville, VA 22902 E-Mail Address: fpohl@albemarle.org Community Official's Signature (required): �' Date: 04/12/19 . a+i%.zmp.e.m,n..-y, kV P,hi Pr =1W. WVfttlow nan A04.1YMATLO-04W FEMA Form 086-0-27, (212011) Previously FEMA Form 81-89 MT-2 Form 1 Page 2 of 3 CERTIFICATION BY REGISTERED PROFESSIONAL ENGINEER AND/OR LAND SURVEYOR 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 data, hydrologic and hydraulic analysis, and any other supporting information as per NFIP regulations paragraph 65.2(b) and as described in the MT-2 Forms Instructions. 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: Carolyn A. Howard, PE License No.: 042775 Expiration Date: 11/3Q/2020 Company Name: Draper Aden Associates Telephone No.: 540.552.0444 Fax No.: 540.552.0291 Signature: F Date: 02/12/2019 E-Mail Address: choward@daa.com Ensure the forms that are appropriate to your revision request are included In your submittal. Form Name and (Number) Reauired If ... ® Riverine Hydrology and Hydraulics Form (Form 2) New or revised discharges or water -surface elevations ® Riverine Structures Form (Form 3) Channel is modified, addition/revision of bridgelculverts, additionlrevision of levee/fioodwall, addition/revision of dam ❑ Coastal Analysis Form (Form 4) New or revised coastal elevations ❑ Coastal Structures Form (Form 5) Additiordrevision of coastal structure Seal (Optional) ❑ Alluvial Fan Flooding Form (Form 6) Flood control measures on alluvial fans FEMA Form 086-0-27, (212011) Previously FEMA Form 81-89 MT-2 Form 1 Page 3 of 3