U.S. DEPARTMENT OF HOMELAND SECURITY - FEDERAL EMERGENCY MANAGEMENT AGENCY RIVERINE STRUCTURES FORM O.M.B No. 1660-0016 Expires: 12/31/2010 PAPERWORK REDUCTION ACT Public reporting burden for this form is estimated to average 7 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 corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, U.S. Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472, 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. Flooding Source: Note: Fill out one form for each flooding source studied A. GENERAL Complete the appropriate section(s) for each Structure listed below: Channelization complete Section B Bridge/Culvert complete Section C Dam/Basin complete Section D Levee/Floodwall complete Section E Sediment Transport complete Section F (if required) Description Of Structure 1. Name of Structure: Type (check one): 0 Channelization 0 Bridge/Culvert 0 Levee/Floodwall 0 Dam/Basin Location of Structure: Downstream Limit/Cross Section: Upstream Limit/Cross Section: 2. Name of Structure: Type (check one): 0 Channelization 0 Bridge/Culvert 0 Levee/Floodwall 0 Dam/Basin Location of Structure: Downstream Limit/Cross Section: Upstream Limit/Cross Section: 3. Name of Structure: Type (check one) 0 Channelization 0 Bridge/Culvert 0 Levee/Floodwall 0 Dam/Basin Location of Structure: Downstream Limit/Cross Section: Upstream Limit/Cross Section: NOTE: For more structures, attach additional pages as needed. B. CHANNELIZATION Flooding Source: Name of Structure: 1. Accessory Structures The channelization includes (check one): 0 Levees [Attach Section E (Levee/Floodwall)] 0 Drop structures 0 Superelevated sections 0 Transitions in cross sectional geometry 0 Debris basin/detention basin [Attach Section D (Dam/Basin)] 0 Energy dissipator 0 Other (Describe): 2. Drawing Checklist Attach the plans of the channelization certified by a registered professional engineer, as described in the instructions. 3. Hydraulic Considerations The channel was designed to carry (cfs) and/or the -year flood. The design elevation in the channel is based on (check one): 0 Subcritical flow 0 Critical flow 0 Supercritical flow 0 Energy grade line If there is the potential for a hydraulic jump at the following locations, check all that apply and attach an explanation of how the hydraulic jump is controlled without affecting the stability of the channel. 0 Inlet to channel 0 Outlet of channel 0 At Drop Structures 0 At Transitions 0 Other locations (specify): 4. Sediment Transport Considerations Was sediment transport considered? 0 Yes 0 No If Yes, then fill out Section F (Sediment Transport). If No, then attach your explanation for why sediment transport was not considered. C. BRIDGE/CULVERT Flooding Source: Name of Structure: 1. This revision reflects (check one): 0 Bridge/culvert not modeled in the FIS 0 Modified bridge/culvert previously modeled in the FIS 0 Revised analysis of bridge/culvert previously modeled in the FIS 2. Hydraulic model used to analyze the structure (e.g., HEC-2 with special bridge routine, WSPRO, HY8): If different than hydraulic analysis for the flooding source, justify why the hydraulic analysis used for the flooding source could not analyze the structures. Attach justification. 3. Attach plans of the structures certified by a registered professional engineer. The plan detail and information should include the following (check the information that has been provided): 0 Dimensions (height, width, span, radius, length) 0 Erosion Protection 0 Shape (culverts only) 0 Low Chord Elevations - Upstream and Downstream 0 Material 0 Top of Road Elevations - Upstream and Downstream 0 Beveling or Rounding 0 Structure Invert Elevations - Upstream and Downstream 0 Wing Wall Angle 0 Stream Invert Elevations - Upstream and Downstream 0 Skew Angle 0 Cross-Section Locations 0 Distances Between Cross Sections 4. Sediment Transport Considerations Was sediment transport considered? 0 Yes 0 No If yes, then fill out Section F (Sediment Transport). If No, then attach your explanation for why sediment transport was not considered. D. DAM/BASIN Flooding Source: Name of Structure: 1. This request is for (check one): 0 Existing dam 0 New dam 0 Modification of existing dam 2. The dam was designed by (check one): 0 Federal agency 0 State agency 0 Local government agency 0 Private organization Name of the agency or organization: 3. The Dam was permitted as (check one): a. 0 Federal Dam 0 State Dam Provide the permit or identification number (ID) for the dam and the appropriate permitting agency or organization Permit or ID number Permitting Agency or Organization b. 0 Local Government Dam 0 Private Dam Provided related drawings, specification and supporting design information. 4. Does the project involve revised hydrology? 0 Yes 0 No If Yes, complete the Riverine Hydrology & Hydraulics Form (Form 2). Was the dam/basin designed using critical duration storm? 0 Yes, provide supporting documentation with your completed Form 2. 0 No, provide a written explanation and justification for not using the critical duration storm. 5. Does the submittal include debris/sediment yield analysis? 0 Yes 0 No If yes, then fill out Section F (Sediment Transport). If No, then attach your explanation for why debris/sediment analysis was not considered. 6. Does the Base Flood Elevation behind the dam or downstream of the dam change? 0 Yes 0 No If Yes, complete the Riverine Hydrology & Hydraulics Form (Form 2) and complete the table below. Stillwater Elevation Behind the Dam FREQUENCY (% annual chance) FIS REVISED 10-year (10%) 50-year (2%) 100-year (1%) 500-year (0.2%) Normal Pool Elevation 7. Please attach a copy of the formal Operation and Maintenance Plan E. LEVEE/FLOODWALL 1. System Elements a. This Levee/Floodwall analysis is based on (check one): 0 upgrading of an existing levee/floodwall system 0 a newly constructed levee/floodwall system 0 reanalysis of an existing levee/floodwall system b. Levee elements and locations are (check one): 0 earthen embankment, dike, berm, etc. 0 structural floodwall 0 Other (describe): Station to Station to Station to c. Structural Type (check one): 0 monolithic cast-in place reinforced concrete 0 reinforced concrete masonry block 0 sheet piling 0 Other (describe): d. Has this levee/floodwall system been certified by a Federal agency to provide protection from the base flood? 0 Yes 0 No If Yes, by which agency? e. Attach certified drawings containing the following information (indicate drawing sheet numbers): 1. Plan of the levee embankment and floodwall structures. Sheet Numbers: 2. A profile of the levee/floodwall system showing the Base Flood Elevation (BFE), levee and/or wall crest and foundation, and closure locations for the total levee system. Sheet Numbers: 3. A profile of the BFE, closure opening outlet and inlet invert elevations, type and size of opening, and kind of closure. Sheet Numbers: 4. A layout detail for the embankment protection measures. Sheet Numbers: 5. Location, layout, and size and shape of the levee embankment features, foundation treatment, floodwall structure, closure structures, and pump stations. Sheet Numbers: 2. Freeboard a. The minimum freeboard provided above the BFE is: Riverine 3.0 feet or more at the downstream end and throughout 0 Yes 0 No 3.5 feet or more at the upstream end 0 Yes 0 No 4.0 feet within 100 feet upstream of all structures and/or constrictions 0 Yes 0 No Coastal 1.0 foot above the height of the one percent wave associated with the 1%-annual-chance stillwater surge elevation or maximum wave runup (whichever is greater). 0 Yes 0 No 2.0 feet above the 1%-annual-chance stillwater surge elevation 0 Yes 0 No E. LEVEE/FLOODWALL (CONTINUED) 2. Freeboard (continued) Please note, occasionally exceptions are made to the minimum freeboard requirement. If an exception is requested, attach documentation addressing Paragraph 65.10(b)(1)(ii) of the NFIP Regulations. If No is answered to any of the above, please attach an explanation. b. Is there an indication from historical records that ice-jamming can affect the BFE? 0 Yes 0 No If Yes, provide ice-jam analysis profile and evidence that the minimum freeboard discussed above still exists. 3. Closures a. Openings through the levee system (check one): 0 exists 0 does not exist If opening exists, list all closures: Channel Station Left or Right Bank Opening Type Highest Elevation for Opening Invert Type of Closure Device (Extend table on an added sheet as needed and reference) Note: Geotechnical and geologic data In addition to the required detailed analysis reports, data obtained during field and laboratory investigations and used in the design analysis for the following system features should be submitted in a tabulated summary form. (Reference U.S. Army Corps of Engineers [USACE] EM-1110-2-1906 Form 2086.) 4. Embankment Protection a. The maximum levee slope landside is: b. The maximum levee slope floodside is: c. The range of velocities along the levee during the base flood is: (min.) to (max.) d. Embankment material is protected by (describe what kind): e. Riprap Design Parameters (check one): 0 Velocity 0 Tractive stress Attach references Reach Sideslope Flow Depth Velocity Curve or Straight Stone Riprap Depth of Toedown D100 D50 Thickness Sta to Sta to Sta to Sta to Sta to Sta to (Extend table on an added sheet as needed and reference each entry) E. LEVEE/FLOODWALL (CONTINUED) 4. Embankment Protection (continued) f. Is a bedding/filter analysis and design attached? 0 Yes 0 No g. Describe the analysis used for other kinds of protection used (include copies of the design analysis): Attach engineering analysis to support construction plans. 5. Embankment And Foundation Stability a. Identify locations and describe the basis for selection of critical location for analysis: 0 Overall height: Sta. ; height ft. 0 Limiting foundation soil strength: Sta. , depth to strength ? = degrees, c = psf slope: SS = (h) to (v) (Repeat as needed on an added sheet for additional locations) b. Specify the embankment stability analysis methodology used (e.g., circular arc, sliding block, infinite slope, etc.): c. Summary of stability analysis results: Case Loading Conditions Critical Safety Factor Criteria (Min.) I End of construction 1.3 II Sudden drawdown 1.0 III Critical flood stage 1.4 IV Steady seepage at flood stage 1.4 VI Earthquake (Case I) 1.0 (Reference: USACE EM-1110-2-1913 Table 6-1) d. Was a seepage analysis for the embankment performed? 0 Yes 0 No If Yes, describe methodology used: e. Was a seepage analysis for the foundation performed? 0 Yes 0 No f. Were uplift pressures at the embankment landside toe checked? 0 Yes 0 No g. Were seepage exit gradients checked for piping potential? 0 Yes 0 No h. The duration of the base flood hydrograph against the embankment is hours. Attach engineering analysis to support construction plans. E. LEVEE/FLOODWALL (CONTINUED) 6. Floodwall And Foundation Stability a. Describe analysis submittal based on Code (check one): 0 UBC (1988) or 0 Other (specify): b. Stability analysis submitted provides for: 0 Overturning 0 Sliding If not, explain: c. Loading included in the analyses were: 0 Lateral earth @ PA = psf; Pp = psf 0 Surcharge-Slope @ , 0 surface psf 0 Wind @ Pw = psf 0 Seepage (Uplift); 0 Earthquake @ Peq = %g 0 1%-annual-chance significant wave height: ft. 0 1%-annual-chance significant wave period: sec. d. Summary of Stability Analysis Results: Factors of Safety. Itemize for each range in site layout dimension and loading condition limitation for each respective reach. Loading Condition Criteria (Min) Sta To Sta To Overturn Sliding Overturn Sliding Overturn Sliding Dead & Wind 1.5 1.5 Dead & Soil 1.5 1.5 Dead, Soil, Flood, & Impact 1.5 1.5 Dead, Soil, & Seismic 1.3 1.3 (Ref: FEMA 114 Sept 1986; USACE EM 1110-2-2502) (Note: Extend table on an added sheet as needed and reference) e. Foundation bearing strength for each soil type: Bearing Pressure Sustained Load (psf) Short Term Load (psf) Computed design maximum Maximum allowable f. Foundation scour protection 0 is, 0 is not provided. If provided, attach explanation and supporting documentation: Attach engineering analysis to support construction plans. E. LEVEE/FLOODWALL (CONTINUED) 7. Settlement a. Has anticipated potential settlement been determined and incorporated into the specified construction elevations to maintain the established freeboard margin? 0 Yes 0 No b. The computed range of settlement is ft. to ft. c. Settlement of the levee crest is determined to be primarily from : 0 Foundation consolidation 0 Embankment compression 0 Other (Describe): d. Differential settlement of floodwalls 0 has 0 has not been accommodated in the structural design and construction. Attach engineering analysis to support construction plans. 8. Interior Drainage a. Specify size of each interior watershed: Draining to pressure conduit: acres Draining to ponding area: acres b. Relationships Established Ponding elevation vs. storage 0 Yes 0 No Ponding elevation vs. gravity flow 0 Yes 0 No Differential head vs. gravity flow 0 Yes 0 No c. The river flow duration curve is enclosed: 0 Yes 0 No d. Specify the discharge capacity of the head pressure conduit: cfs e. Which flooding conditions were analyzed? * Gravity flow (Interior Watershed) 0 Yes 0 No * Common storm (River Watershed) 0 Yes 0 No * Historical ponding probability 0 Yes 0 No * Coastal wave overtopping 0 Yes 0 No If No for any of the above, attach explanation. f. Interior drainage has been analyzed based on joint probability of interior and exterior flooding and the capacities of pumping and outlet facilities to provide the established level of flood protection. 0 Yes 0 No If No, attach explanation. g. The rate of seepage through the levee system for the base flood is cfs h. The length of levee system used to drive this seepage rate in item g: ft. E. LEVEE/FLOODWALL (CONTINUED) 8. Interior Drainage (continued) i. Will pumping plants be used for interior drainage? 0 Yes 0 No If Yes, include the number of pumping plants: For each pumping plant, list: Plant #1 Plant #2 The number of pumps The ponding storage capacity The maximum pumping rate The maximum pumping head The pumping starting elevation The pumping stopping elevation Is the discharge facility protected? Is there a flood warning plan? How much time is available between warning and flooding? Will the operation be automatic? 0 Yes 0 No If the pumps are electric, are there backup power sources? 0 Yes 0 No (Reference: USACE EM-1110-2-3101, 3102, 3103, 3104, and 3105) Include a copy of supporting documentation of data and analysis. Provide a map showing the flooded area and maximum ponding elevations for all interior watersheds that result in flooding. 9. Other Design Criteria a. The following items have been addressed as stated: Liquefaction 0 is 0 is not a problem Hydrocompaction 0 is 0 is not a problem Heave differential movement due to soils of high shrink/swell 0 is 0 is not a problem b. For each of these problems, state the basic facts and corrective action taken: Attach supporting documentation c. If the levee/floodwall is new or enlarged, will the structure adversely impact flood levels and/or flow velocities floodside of the structure? 0 Yes 0 No Attach supporting documentation d. Sediment Transport Considerations: Was sediment transport considered? 0 Yes 0 No If Yes, then fill out Section F (Sediment Transport). If No, then attach your explanation for why sediment transport was not considered. E. LEVEE/FLOODWALL (CONTINUED) 10. Operational Plan And Criteria a. Are the planned/installed works in full compliance with Part 65.10 of the NFIP Regulations? 0 Yes 0 No b. Does the operation plan incorporate all the provisions for closure devices as required in Paragraph 65.10(c)(1) of the NFIP regulations? 0 Yes 0 No c. Does the operation plan incorporate all the provisions for interior drainage as required in Paragraph 65.10(c)(2) of the NFIP regulations? 0 Yes 0 No If the answer is No to any of the above, please attach supporting documentation. 11. Maintenance Plan a. Are the planned/installed works in full compliance with Part 65.10 of the NFIP Regulations? 0 Yes 0 No If No, please attach supporting documentation. 12. Operations and Maintenance Plan Please attach a copy of the formal Operations and Maintenance Plan for the levee/floodwall. F. SEDIMENT TRANSPORT Flooding Source: Name of Structure: If there is any indication from historical records that sediment transport (including scour and deposition) can affect the Base Flood Elevation (BFE); and/or based on the stream morphology, vegetative cover, development of the watershed and bank conditions, there is a potential for debris and sediment transport (including scour and deposition) to affect the BFEs, then provide the following information along with the supporting documentation: Sediment load associated with the base flood discharge: Volume acre-feet Debris load associated with the base flood discharge: Volume acre-feet Sediment transport rate (percent concentration by volume) Method used to estimate sediment transport: Most sediment transport formulas are intended for a range of hydraulic conditions and sediment sizes; attach a detailed explanation for using the selected method. Method used to estimate scour and/or deposition: Method used to revise hydraulic or hydrologic analysis (model) to account for sediment transport: Please note that bulked flows are used to evaluate the performance of a structure during the base flood; however, FEMA does not map BFEs based on bulked flows. If a sediment analysis has not been performed, an explanation as to why sediment transport (including scour and deposition) will not affect the BFEs or structures must be provided. DHS - FEMA Form 81-89B, DEC 07 Riverine Structures Form MT-2 Form 3 Page 1 of 10