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Lot 16, Spring Ridge LORM-F Application 02/20/2013DEPARTMENT OF HOMELAND SECURITY - FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. N0.1660 -0015 PROPERTY INFORMATION FORM Expires Februar 2s,zola PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting 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: ❑ 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 inun 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. A letter from DHS -FEMA stating that a parcel of land or proposed structure that will be elevated by ❑ CLOMR F fill would not be inundated by the base flood if fill is placed on the parcel as proposed or the struct is built as proposed. Fill is defined as material from any source (including 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 lithe 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 to raise ground that was previously below the BFE? ® Yes ❑ No If yes, when was fill placed? /2006 month /year Will fill be placed on your property to raise ground that is below the BFE? ❑ Yes* ❑ No If yes, when will fill be placed? / month /year * 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 -1 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): 13745 Spring Ridge Loop, Blair, NE 68008 2 Legal description of Property (Lot, Block, Subdivision or abbreviated description from the Deed); Lot 16, Spring Ridge, Washington County, Nebraska 3. Are you requesting that a flood zone determination be completed for (check one): ❑ Structures on the property? What are the dates of construction? (MM /YYYY) ® 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. For the preferred format of metes and bounds descriptions, please refer to the MT -1 Form 1 Instructions.) ❑ The entire legally recorded property? 4. Is this request for a (check one): ❑ Single structure ® Single lot ❑ Multiple structures (How many structures are involved in your request? List the number: ❑ Multiple lots (How many lots are involved in your request? List the number: ) 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 -1 Form 1), please complete the checklist below. ALL requests must include one copy of the following: ® Copy of the effective FIRM panel on which the structure and /or property location has been accurately plotted (property inadvertently located in the NFIP regulatory floodway will require Section B of MT -1 Form 3) ® Copy of the Subdivision 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. The map should include at least one street intersection that is shown on the FIRM panel. ® 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. ® 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 For CLOMR -Fs, the following must be submitted in addition to the items fisted above: ❑ 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. DHS -FEMA encourages the submission of all required data in a digital format (e.g. scanned documents and images on Compact Disc (CD]). 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 -1 Form Instructions located at htto : / /www.fema,gov /plan /orevent /fhm /dl mt- l.shtm. Processing Fee (see instructions for appropriate mailing address; or visit htto: / /www.fema.Rov /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: $325 (single lot /structure LOMR -F following a CLOMR -F) ® $425 (single lot /structure LOMR -F) ❑ $500 (single lot /structure CLOMA or CLOMR-F) ❑ $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 (required): Richard M Broyles Mailing Address (required): 10836 Old Mill Road Omaha, NE 68154 Company (if applicable): Thompson, Dreessen & Comer, Inc Daytime Telephone No. (required): 402 - 330 -8860 Fax No. (optional): 402 -330 -5866 E -Mail Address (optional): ® By checking here you may receive correspondence electronically at the email address provided): RBROYLES @TD2CO COM Sit;Iaalu��uf Applicant (required) Date b ki (iuirfA ll 02 - 19 - 2013 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 O.M.B. NO. 1660-0015 ELEVATION FORM Expires February 18, 1014 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, s 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 and must be completed and signed by a registered professional engineer or licensed land surveyor. A DHS - FEMA National Flood Insurance Program (NFIP) 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 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. All measurements are to be I 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: Lot 16, Spring Ridge 2, Are the elevations listed below based on ® existing or ® proposed conditions? (Check one) 3, For the existing or proposed structures listed below, what are the types of construction? (check all that apply) ❑ crawl space ® slab on grade ❑ basement /enclosure ❑ other (explain) 4 Has DHS - FEMA identified this area as subject to land subsidence or uplift? (see instructions) ❑ Yes ® No If yes, what is the date of the current re- leveling? / (month /year) 5 What is the elevation datum? ❑ NGVD 29 ® NAVD 88 ❑ 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: ❑ WGS84 ❑ NAD83 ❑ 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: ❑ WGS84 ® NAD83 ❑ NAD27 Lat. 41. 48792 Long. - 96.16938 Address 13745 Spring Ridge Loop Lowest Block Lowest Lot Adjacent Lot Number Number Elevation' Grade To Structure _,._.. 16 _. .., 1180.2 117$.2 Base Flood BFE Source Elevation 1178.0 NE NRD 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 f ine or impr iwoment under Title 18 of the United States tardy , Section 1001. Certifier's Name: Richard M Broyles License No.: NE RLS # 477 Expiration Date: April 1, 2015 Company Name: Thompson, Dreessen & Dorner, Inc. Telephone No.: 402 - 330 -8860 Email: RBROYLES @TD2CO.COM Fax No. 402 - 330 -5866 Sign ,r ' Date: February 19, 2013 ` For requests involving a portion of property, include the lowest ground elevation within 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. - . P -8 a f a= a DHS - FEMA Form 086- 0.26A, FEB 11 Elevation Form MT -1 Form 2 Page 1 of 2 uo DEPARTMENT or HOMELAND SECURITY ELEVATION � CERTIFICATE »m^"�/nom/��*»�v,�nmn Important: d instructions ---~ ---� '-^^-� ^ ~ ---9. S ECTION A - 'PROPERTY INFORMAT - 4T ~ Ov/W.ngOwn��nanll �������AND����OR�1[ - ulfding Street Address (including Apt., and/or -' wm' Pnnovm --- m�sm�u�m Bldg. No and Box No city ��o�'--- -' - - - ------ 'Stam NE ZIP Code '600uu -------- ~' --'-- OMB No. 1GG0{008 Expiration Date: July 81.2O16 -__-. *x and Block Nu mbers, - >- -- - --'--'- --�- LOT 15, SPRING RIDGE, A SUBDIVISION IN � WASH N E BRA SKA A4 Building Use (ag. Residential, mvn-Rnamwnno.*uuitivn.Accessvry.etc)neo|oswTIAL «a Latitude/Longitude: Lot 41.4025 Long -96J6953 Horizontal Datum: O NAD 1927 [0 NAD 1983 A6 Attach at least u photographs of the building n the Certificate is being used m obtain flood insurance pn Building Diagram Number I AV For o building with oxrawlupnceorenvkmure<o* Ao For a building with pu attached garage: x) Square footage vfnmnlspvcov,ano|oovm<W 1792 oqM a> Square footage o, attached garage 758 vqM W Number of permanent flood openings (n the rraw|vpoma W Number v[ permanent flood openings |n the attached garage oreno|nuu,*(o) within 1n foot above adjacent grade U within 10 foot above adjacent grade O c) Total net area of flood openings |nAVu 0 oqm c) Total net area vr flood openings ioxau oqin 0 Engineered flood openings? [] Yes [] No d) Engineered flood openings? [] Yes [] No SGCT|ONB - PLOODINSURANCERATE MAP (F|RM)INFORMATION ___ ' _ B1 NqPCommunn Name moommvuywumuo 82 83 State | CITY Vre�unETJ 310228 \ VN^SH|NGT0N | ms � o* Bs �� H6 � '�17�O285 D '(��� -Do ���--- - ''—'- --^~- Ba Flood ~ i 01**-202 `, / B10 Indicate the source of the Base Flood Elevation(BFE) data or base flood depth entered in Item B9L O moprofilv O FIRM O Community Determined [9 omer/Source:wEBRAoKA DNRoETsmw|wATIOw B11 Indicate elevation datum used for opsm Item s9: O Nmm1o29 0 wAVo1mm O Other/Source:__ e12 m the building o Coastal Barrier Resources System (CoRa) area o, Otherwise Protected Area ()P*)Y O *a DD No Designation Date: _--_ O oeno [] opA SECTION C-BU|LD|M� ELEVAT INFORMAT (SURVEYREQUIRED) C1 Building elevations meuauudnn: [] Construct Drawings* [] Building Under Construction* UD Finished Construction *A new Elevation Certificate will be required when construction of the building is complete .z Elevations - Zones A1_Aoo AE, ay.A (with gFs).ve vI-voo.V (with oFs). AR, ARIA, Anms.*R/Al_x3o.*R/A*.AR/AO Complete Items czw-h below according m the building diagram spncifioomItem A7 |n Puerto Rico only, enter meters Benchmark Utilized: Vertical Datum: w*Vo18Ok Indicate eleva datum used for the eleva in items ) through Woomw 13 wGVo1$29 0 N*VD1988 OOthe*8owrce:___ Datum used for building elevations must bn the same ev that used for the opE. Check the measurement used a) Top vf bottom floor (including basement, nraw|npoce.nr enclosure floor) 11 QDfeet []meters u) Top m the next higher floor 0fem El meters n> Bottom vf the lowest horizontal structural member (v Zones only) NA NA []feet El meters u) Attached garage (top vrslab) 11890 IS feet []meters a) Lowest elevation nr machinery u, equipment servicing the building 1180I Z feet El meters (Describe type vr equipment and location inComments) 0 Lowest adjacent (nnishon) grade next m building <LAG> 11802 feet []meters g} Highest adjacent (anisxeu) grade next m building (uAG) 11890 23 feet Omwwrs h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 1180.4 N feet Omwmm SECTION -_--__- AR CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false sta tement may be punishable by fine or imprisonment under 16 U S Code, Section 100 1 0 Check here if comments are provided on back of form Were latitude and longitude in Section A provided by a N Check here if attachments licensed land surveyor? 0 Yes No Certifier's Name RICHARD M BROYLES License Number NE RLS 477 Title REG LAND SURVEYOR Company Name THOMPSON, DREESSEN & DORNER INC Address 10836 OLD MILL ROAD City OMAHA State NE ZIP Code 68154 1� Date 01-18-2013 Telephone 402-330-8860 FEMA Form 00� -1 ,, (7112) e reverse side for continuation Replaces all previous editions 4.b`vr���v�■ vi., �, �vr��` rxu�v .c. IMPORTANT: in these spaces, copy the corresponding inform from Section A. d'Citi tNSU�,IC #: +f7�t' @CSC ?F Building Street Address (including Apt, Unit, Suite, and /or Bldg. No.) or P.0 Route and Box No Pollc -v Ntr;3i 'f, 13745 SPRING RIDGE LOOP City BLAIR State NE ZIP Code 68008 r rw rsf A :ii f1C t ;; iGitata�t r, SECTI D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Co both sides of this Elevation Certificate for community Copy 1 {) official, (2) insurance agent/company, and (3) building owner Comments THE BASE FLOOD ELEVATION OF 1178.0 WAS ESTABLISHED BY THE NEBRASKA DEPARTMENT OF NATURAL RESOURCES THE DETERMINATION IS EFFECTIVE JANUARY 28, 2013, SEE ATTACHED DOCUMENT r Signature date 01 -18 -2013 SECTION E - BUILDING ELEVATION W LL ...- MATI ., .,S.._. INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO andA (without BFE), complete Items E1 —E5. if the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, 8, and C For Items E1 —E4, use natural grade, if available Check the measurement used In Puerto Rico only, enter meters. E1 Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG) a) Top of bottom floor (including basement, crawispace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG E- For Building Diagrams 6--9 with permanent flood openings provided In Section A Items 8 and /or 9 (see pages 8 -9 of Instructions), the next higher floor (elevation C2 b in the diagrams) of the building is D feet ❑ meters ❑ above or ❑ below the HAG E3 Attached garage to of slab is g g (top ) ___, _, - [] feet C] meters E] above or [] below the HAG. E4 Top of platform of machinery and /or equipment servicing the building is -- ❑ feet ❑ meters ❑ above or ❑ below the HAG E5 Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordin ance? ❑ Yes ❑ No ❑ Unknown The local official must certify this information in Section G. SECTION F — PROPERTY OWNER OR OWNERS REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA - issued or community- issued BFE) or Zone AO must sign h ere The statements in Sections A, B, and E are correct to the best of my knowledge Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments [] Check here if attachments SECTION G -- COMMUNITY INFORMATION (OPTIONAL) The local official who is j tI =• "srr;f n f ,r ?;s r; of o(dinonco to administer the commoody's floodplait3 management < riir, ` can complete Sections A, P, C (or E) ind G of this Elevation Certificate Complete the applicable item(s) and sign below. Cheri; the measurement used in Items G8-610 In Puerto Rico only, enter meters 01 ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized bylaw to certify elevation information (Indicate the source and date of the elevation data in the Comments area below) G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued 8FE) or Zone AO G3 ❑ The following information (Items G4 —G10) is provided for community floodplain management purposes. G4 Permit Number 65 Date Permit Issued G6 Date Certificate Of Compliance/Occupancy Issued G7 This permit has been issued for: ❑New Construction [I Substantial Improvement G8 Elevation of as -built lowest floor (including basement) of the building: ® feet ❑ meters Datum G9 BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10 Community's design flood elevation ❑ feet ❑ meters Datum Local Official's Name Community Name Signature Comments Title - __.... Telephone Date Check here if attachments. ------ ......._ . --- _..._ -.... _ ,..,.... FEMA Form 086 -0.33 (7/12) Replaces all previous editions DEPARTMENT OF HOMELAND SECURITY - FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. NO, 1660 -0015 COMMUNITY ACKNOWLEDGMENT FORM I 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 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 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: 310228 Property Name or Address: Lot 16, Spring Ridge, Washington County, Nebraska 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 Species 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 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) Phil Green, Assistant City Administrator Telephone No. 402- 426 -6691 Community Name: Community fficial's Signature: (required) Date: City of Blair, NE 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 I 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: DHS - FEMA Form 086 -0 -268, FEB 11 Community Acknowledgment Form MT -1 Form 3 Page 1 of 1 2/20 /2013 9 :44 AM BOB ROWING H: \1400 \1437 -154 J,W"n CoNt, Lt 15 Spring RWq* Wwhington Cnty NE\Dnw1n9. \1437154L0MRdvg 110 j j ✓ LEGAL. A portion of Lot 16, Spring Ridge, as shown on the \ 1178. Plat recorded as Instrument No. 200602214, in Plat Book 2, Pages 1262 through 1271, in the Office of the Register of Deeds, Washington County, Nebraska. A 4 The portion of property is more particularly described by the following metes and bounds: BEGINNING at the Northwest corner of Lot 16; thence S66'11'53 "E, 310.00 feet; thence S2348'07"W, 238.00 feet; thence N64'35'21 "W, 310.82 feet; thence N23'48'07 "E, 229.00 feet to the POINT OF BEGINNING. ® 00 0 A Aj ' M -477 SURVO �t M FEBRUARY 12, 2013 RICHARD M. BROYLES NEBRASKA RLS 477 1 d'a LEGEND 1178.0 EXISTING GROUND ELEVATION (NAVD 1988) FLOOD ZONE DELINEATION LINE Job Number: 1437154 LOMR Date: 02112=19 thompson, dreessen & dorner, Inc. LETTER OF MAP REVISION BASED ON FILL 10836 Old Mill Rd Drawn By: MRS • e • • e Omaha, NE 68154 Reviewed By: RMB NIELSEN CONSTRUCTION sage: 13107 9 p.402.330.8860 f,402.330.5866 Revision Date: Page: 21 td2co.com Base Flood Elevation Determination Section 34-18-11E, Washington County, Nebraska ° fi c " , ? y � .#fir!• `t t 2818.11E1 Arq 1 1 - N dd4 yp a r. .,.. .. t1 1 �r r t o ` 999f^Si O �d f,. , i : �tq- 1711E i Use and Limitations The Base Flood Elevation (BFE) is defined as the calculated water surface elevation during a flood with a 1% annual probability of being equaled or exceeded in any given year, If a structure is located on one of the BFE contour lines, use the elevation associated with the line For structures between two contour lines, use the higher value. Please note that contours are referenced to NAVD 1986. Elevations of unlabeled contours continue in a consistent pattern, and may be estimated from labeled contours nearby, Elevations In areas with an effective detailed study are for reference only: the official elevation should be determined from the published profile, This determination may be used for floodplain management or permitting. For design of developments within the floodplain, the Nebraska Department of Natural Resources (NDNR) recommends that a professional engineer perform a site - specific analysis. NDNR provides floodplain information from best available data to other units of government based on authority from Nebraska state statutes. The BFEs shown on this map are valid only for the dates listed above and may be superseded at any time If better data becomes available it12- 47.91x.., Legend Vebraskp BFE- -NAVD 19 Sections Effective Flood Zone Approximate Dam Flood Pool q yg 999f^Si O �d f,. , i : �tq- 1711E i Use and Limitations The Base Flood Elevation (BFE) is defined as the calculated water surface elevation during a flood with a 1% annual probability of being equaled or exceeded in any given year, If a structure is located on one of the BFE contour lines, use the elevation associated with the line For structures between two contour lines, use the higher value. Please note that contours are referenced to NAVD 1986. Elevations of unlabeled contours continue in a consistent pattern, and may be estimated from labeled contours nearby, Elevations In areas with an effective detailed study are for reference only: the official elevation should be determined from the published profile, This determination may be used for floodplain management or permitting. For design of developments within the floodplain, the Nebraska Department of Natural Resources (NDNR) recommends that a professional engineer perform a site - specific analysis. NDNR provides floodplain information from best available data to other units of government based on authority from Nebraska state statutes. The BFEs shown on this map are valid only for the dates listed above and may be superseded at any time If better data becomes available it12- 47.91x.., Legend Vebraskp BFE- -NAVD 19 Sections Effective Flood Zone Approximate Dam Flood Pool 1,000 500 0 1,000 2,000 This BFE was determined by: „+� p •' j'', {// �„ ! -r� d 4 Digitallysigned by Katie Rmgland, PE,CFM DN <n =Kane Rmgland PE.CFM, o- Nebraska Depnmmtof Natural Resowces, ou=noodplain Management } ff V. emai _Katie,Ringlandgnebnska,gov, c =U5 {! Date 2013 02 04 045130 06'00 Katie Ringland, PE., CFM (402) 471 -2094, Katie. Ringiand @nebraska,gov Nebraska Dept. Natural Res., A, O. Box 94676, Lincoln, NE 685D9