Form FEMA Form 086-0-35 FEMA Form 086-0-35 Enviornmental and Historic Preservation Certifications

National Flood Insurance Program

Community Rating System

ENVIRONEMENTAL AND HISTORIC PRESERVATION

CERTIFICATIONS

OMB No. 1660-0022

Expires Sept 30, 2013

Public reporting burden for this form is estimated to average 1.6 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the form. This collection of information is required to obtain a benefit.  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 the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0022) NOTE: Do not send your completed form to this address.

CRS Environmental and

Historic Preservation CERTIFICATIONS

520 (Acquisition and Relocation)

Compliance with Environmental and Historic Preservation Requirements
(see Section 521.b (7) in the CRS Coordinator’s Manual).

In the table below, list each property for which credit is desired under Activity 520, indicate the project date, and check the box that identifies the source of the project funding. Add additional copies of this page (CC-520-1(EHP)) as necessary. Then, complete pages CC-520-2(EHP) and CC-520-3(EHP), as appropriate, based on the project’s funding source.

If any FEMA funding was included in the project, then the source of funding is “FEMA.” FEMA funding includes FEMA Hazard Mitigation Assistance grants (under the Hazard Mitigation Grant Program or the Pre-disaster Mitigation, Flood Mitigation Assistance, Repetitive Flood Claims, or Severe Repetitive Loss programs) and FEMA Public Assistance funds. If no FEMA funding was used but any other federal funds were included (e.g., from the Corps of Engineers), then the funding source is “Other Federal Agency.” If the project was funded only by state, local, and/or private funds, the source is “No Federal Funds.” An NFIP claim payment, including funds provided under Increased Cost of Compliance coverage, is considered “No Federal Funds.”

Note: The self-certification of compliance with environmental and historic preservation requirements incorporated into this certification applies only to projects implemented after the effective date of the 2013 Coordinator’s Manual.

Property Address	Date Project Permitted or Initiated	Source of Project Funding
		FEMA	Other Federal Agency	No Federal Funds

FEMA Form Number 086-0-35B

Property Address	Date Project Permitted or Initiated	Source of Project Funding
		FEMA	Other Federal Agency	No Federal Funds

Acquisition and Relocation Projects

Project Name:
Project or Grant Number:
Project Description (or include as an attachment):
On each row of the table below, initial the box that applies to the project, signifying that the appropriate steps were taken (shaded areas are “not applicable”). Then sign at the end of the certification. More information on these programs can be found in Figure 500-5 of the Coordinator’s Manual.
Federal Funding	No Federal Funding		Certification Statement for Acquisition and Relocation Projects
			All properties marked “FEMA Funded” on CC-520-1(EHP) were included in the above description of the FEMA-funded project.
			State and local requirements: In addition to federal laws, implementing regulations, and executive orders, this project took into consideration the requirements of all state and local environmental and historic preservation laws, ordinances, and permits that apply to this type of project. Communication with the appro­priate state agency and/or local government entity took place before project implementation. Any recommendations made by the agency or office were carried out.
			National Historic Preservation Act: If any acquired or relocated structure affected by this project was 50 years of age or older at the time of the acquisition, communication with the State Historic Preservation Officer or Tribal Historic Preservation Officer (if on tribal land or reservation) took place to determine if the structure was either on or eligible for the National Register of Historic Places (historic property) and to resolve any adverse effect(s) to the historic property.
			Protection of floodplains (E.O. 11988—Floodplain Manage­ment): Consideration was given to the project’s long- and short-term adverse impacts that are associated with the occupance and modification of floodplains, and to avoiding direct and indirect support of floodplain development wherever there was a practicable alternative.
			E.O. 11990—Protection of Wetlands: Consideration was given to the possible loss or degradation of wetlands associated with the construction of this project, as well as to the preservation and enhancement of the natural and beneficial values of wetlands.
			E.O. 12898—Environmental Justice in Minority and Low-income Populations: Consideration was given to possible negative impacts associated with implementation of project on minority and low-income populations, and to avoiding those impacts where practicable.
Federal Funding		No Federal Funding		Certification Statement for Acquisition and Relocation Projects (cont.)
				For projects in areas subject to the Coastal Barrier Resources Act: There was communication with the U.S. Fish and Wildlife Service regarding this project’s potential to jeopardize any ecologically sensitive coastal barrier resources. Any recommendations made by the Service were carried out.
				For projects in coastal communities: There was communication concerning this project with the state’s lead coastal zone management agency regarding the enforcement of the policies of the state’s coastal zone management program in carrying out federally funded or federally authorized construction activities. Any recommendations made by the agency were carried out.
In addition to the above, for projects that also involved the development of a new site on which to place the relocated building(s), continue initialing in the appropriate boxes, below.
				Endangered Species Act: Consideration was given to the protection and preservation of threatened and/or endangered species (including plants and animals and their habitat) whose existence may have been threatened by the construc­tion activities. Communication took place with the U.S. Fish and Wildlife Service (or the National Marine Fisheries Service if the project is in a coastal area) and the applicable state agencies for state-protected species and/or their habitat. Any recommendations made by the Services or state agencies were carried out.
				Archaeological and Historic Preservation Act: The effects of the proposed relocation on archaeological sites were considered.
				Point source and non-point source discharge (Clean Water Act, Section 402): Consideration was given to all permit requirements for municipal point source discharge (sewage treatment plant discharge) as well as non-point discharge (surface runoff) of a pollutant into surface waters. Communication with the Environmental Protection Agency or designated state office took place. Any recommendations made by the agencies were carried out.
				Dredge and fill materials (Clean Water Act, Section 404): Consideration was given to all permit requirements for discharging dredge or fill material into waters of the United States, including wetlands, and communication with the U.S. Army Corps of Engineers took place. Any recommendations made by the Corps were carried out.
				Farmland Protection Policy Act: Considera­tion was given to the protection of prime and unique farmlands in the construction of this project. Communication with the U.S. Depart­ment of Agriculture’s Natural Resources Conservation Service took place. Any recommendations made by the Service were carried out.
I certify that the items initialed above are correct to the best of my knowledge. Name (signed):
Name (printed):
Title:						Date:

Compliance with Environmental and Historic Preservation Requirements
(see Section 531.b(4) in the CRS Coordinator’s Manual).

Note: The self-certification of compliance with environmental and historic preservation requirements incorporated into this certification applies only to projects implemented after the effective date of the 2013 Coordinator’s Manual.

Part A. Retrofitting Projects (TUE, TUD, TUW, TUS)

In the table below, list each retrofitted property for which credit is desired under Activity 530, indicate the type of project, check the box that identifies the source of project funding, and insert the project date. Add additional copies of this page (CC-530-1(EHP)) as needed for the number of properties. Then, complete pages CC-530-2(EHP) and CC-530-3(EHP) as appropriate, based on the project’s funding source.

If any FEMA funding was included in the project, then the source of funding is “FEMA.” FEMA funding includes FEMA Hazard Mitigation Assistance grants (under the Hazard Mitigation Grant Program or the Pre-disaster Mitigation, Flood Mitigation Assistance, Repetitive Flood Claims, or Severe Repetitive Loss programs) or FEMA Public Assistance funds. If no FEMA funding was used but any other federal funds were included (e.g., from the Corps of Engineers), then the funding source is “Other Federal Agency.” If the project was funded only by state, local, and/or private funds, the source is “No Federal Funds.” An NFIP claim payment, including funds provided under Increased Cost of Compliance coverage, is considered “No Federal Funds.”

Property Address for Retrofitted Building	Type of Project	Source of Project Funding			Date Project Permitted or Initiated
	TUE=Elevation TUD=Dry floodproofing TUW=Wet floodproofing TUS=Sewer backup	FEMA Funding	Other Federal Funding	No Federal Funds

[continued on next page]

Part A. Retrofitting Projects (TUE, TUD, TUW, TUS) (cont.):

Project Name:
Project or Grant Number:
Project Description (or include as an attachment):
On each row of the table below, initial the box that applies to the project, signifying that the appropriate steps were taken (shaded areas are “not applicable”). Then sign at the end of the certification. More information on these programs can be found in Figure 500-5 in the CRS Coordinator’s Manual.
Federal Funding	No Federal Funding	Certification Statement for Retrofitting Projects
		All properties marked as “FEMA Funded” on CC-530-EHP-1 were included in the project description of the above FEMA-funded project.
		State and local requirements: In addition to federal laws, implementing regulations, and executive orders, this project took into consideration the requirements of all state and local environmental and historic preservation laws, ordinances, and permits that applied to this type of project. Communication with the appro­priate state agency and/or local government entity took place before project implementation. Any recommendations made by the agency or office were carried out.
		For projects that affected buildings 50 years of age or older (National Historic Preservation Act): If any retrofitted structure affected by this project was 50 years of age or older at the time of the acquisition, communication with the State Historic Preservation Officer or Tribal Historic Preservation Officer (if on tribal land or reservation) took place to determine if the structure was either on or eligible for the National Register of Historic Places (historic property) and to resolve any adverse effect(s) to the historic property.
		Protection of floodplains (E.O. 11988—Floodplain Manage­ment): Consideration was given to the project’s long- and short-term adverse impacts that are associated with the occupance and modification of floodplains, and to avoiding direct and indirect support of floodplain development wherever there was a practicable alternative.
		E.O. 11990—Protection of Wetlands: Consideration was given to the possible loss or degradation of wetlands associated with the construction of this project, as well as to the preservation and enhancement of the natural and beneficial values of wetlands.

[continued on next page]

Federal Funding	No Federal Funding		Certification Statement for Retrofitting Projects (cont.)
			E.O. 12898—Environmental Justice in Minority and Low-income Populations: Consideration was given to the possible negative impacts associated with the implementation of this project on minority and low-income populations, and to avoiding those impacts where practicable.
			For projects in areas subject to the Coastal Barrier Resources Act: There was communication with the U.S. Fish and Wildlife Service regarding this project’s potential to jeopardize any ecologically sensitive coastal barrier resources. Any recommendations made by the Service were carried out.
			For projects in coastal communities: There was communication concerning this project with the state’s lead coastal zone management agency regarding the enforcement of the policies of the state’s coastal zone management program in carrying out federally funded or federally authorized construction activities. Any recommendations made by the agency were carried out.
I certify that the items initialed above are correct to the best of my knowledge
Name (signed):
Name (printed):
Title:				Date:

Part B. Flood Control Projects (TUB, TUC, TUF)

In the table below, list each property for which credit is desired under Activity 530 for flood control projects (TUB, TUC, and TUF), indicate the type of project, check the box that identifies the source of project funding, and insert the project date. Add additional pages (page CC-530-4(EHP) as necessary. Then, complete pages CC-530-5(EHP) through CC-530-11(EHP) as appropriate, based on the project’s funding source.

If any FEMA funding was included in the project, then the source of funding is “FEMA.” FEMA funding includes FEMA Hazard Mitigation Assistance grants (under the Hazard Mitigation Grant Program or the Pre-disaster Mitigation, Flood Mitigation Assistance, Repetitive Flood Claims, or Severe Repetitive Loss programs) or FEMA Public Assistance funds. If no FEMA funding was used but any other federal funds were included (e.g., from the Corps of Engineers), then the funding source is “Other Federal Agency.” If the project was funded only by state, local, and/or private funds, the source is “No Federal Funds.” An NFIP claim payment, including funds provided under Increased Cost of Compliance coverage, is considered “No Federal Funds.”

Note: The self-certification of compliance with environmental and historic preservation requirements incorporated into this certification applies only to projects implemented after the effective date of the 2013 Coordinator’s Manual.

Property Address of Flood Control Project	Type of Project	Source of Project Funding			Date Project Permitted or Initiated
	TUB=Barriers, levees, floodwalls TUC=Bridge or culvert projects, channel modifications, storm drain improvements, diversions TUF=Storage facilities	FEMA Funding	Other Federal Funding	No Federal Funds

TUB—Barriers, Levees, Floodwalls

Project Name:
Project or Grant Number:
Project Description (or include as an attachment):
On each row of the table below, initial the box that applies to the TUB project, signifying that the appropriate steps were taken (shaded areas are “not applicable”). Then sign at the end of the certification. More information on these programs can be found in Figure 500-5 in the CRS Coordinator’s Manual.
Federal Funding	No Federal Funding	Certification Statement for Barriers, Levees, and Floodwalls (TUB)
		All properties marked as “FEMA Funded” on CC-530-EHP-1 were included in the project description of the above FEMA-funded project.
		State and local requirements: In addition to federal laws, implementing regulations, and executive orders, this project took into consideration the requirements of all state and local environmental and historic preservation laws, ordinances, and permits that applied to this particular type of project. Communication with the appro­priate state agency and/or local government entity took place before project implementation. Any recommendations made by the agency or office were carried out.
		For projects that affected buildings 50 years of age or older: (National Historic Preservation Act and Archaeological and Historic Preservation Act): (1) If any structure affected by this project was 50 years of age or older at the time of the project implementation, communication with the State Historic Preservation Officer or Tribal Historic Preservation Officer (if on tribal land or reservation) took place to determine if the structure was either on or eligible for the National Register of Historic Places (historic property) and to resolve any adverse effect(s) to the historic property. (2) The effects of the project on archaeological sites were considered.
		Protection of threatened and endangered species (Endangered Species Act): Consideration was given to the protection and preservation of threatened and/or endangered species (including plants and animals and their habitat) whose existence may have been threatened by the construc­tion activities. Communication took place with the U.S. Fish and Wildlife Service (or the National Marine Fisheries Service if the project is in a coastal area) and the applicable state agencies for state-protected species and/or their habitat. Any recommendations made by the Services or state agencies were carried out.
		Discharge of dredge and fill materials (Clean Water Act, Section 404): Consideration was given to all permit requirements for discharging dredge and fill materials into waters of the United States, including wetlands, and communication with the U.S. Army Corps of Engineers took place. Any recommendations made by the Corps were carried out.

Federal Funding	No Federal Funding		Certification Statement for Barriers, Levees, and Floodwalls (cont.)
			Protection of floodplains (E.O. 11988—Floodplain Manage­ment): Consideration was given to the project’s long- and short-term adverse impacts that are associated with the occupance and modification of floodplains, and to avoiding direct and indirect support of floodplain development wherever there was a practicable alternative.
			E.O. 11990—Protection of Wetlands: Consideration was given to the possible loss or degradation of wetlands associated with the construction of this project, as well as to the preservation and enhancement of the natural and beneficial values of wetlands.
			E.O. 12898—Environmental Justice in Minority and Low-income Populations: Consideration was given to the possible negative impacts associated with the implementation of this project on minority and low-income populations, and to avoiding those impacts where practicable.
			For projects in areas subject to the Coastal Barrier Resources Act: There was communication with the U.S. Fish and Wildlife Service regarding this project’s potential to jeopardize any ecologically sensitive coastal barrier resources. Any recommendations made by the Service were carried out.
			For projects in coastal communities: There was communication concerning this project with the state’s lead Coastal Zone Management agency regarding the enforcement of the policies of the state’s coastal zone management program in carrying out federally funded or federally authorized construction activities. Any recommendations made by the agency were carried out.
I certify that the items initialed above are correct to the best of my knowledge.
Name (signed):
Name (printed):
Title:				Date:

TUC— Bridge or Culvert Projects, Channel Modification, Channel Diversion,
Pump Station Improvements, Storm Drain Improvements, or Other Projects

Project Name:
Project or Grant Number:
Project Description (or include as an attachment):
On each row of the table below, initial the box that applies to the TUC project, signifying that the appropriate steps were taken (shaded areas are “not applicable”). Then sign at the end of the certification. More information on these programs can be found in Figure 500-5 in the CRS Coordinator’s Manual. The creditable projects include Bridge or culvert projects; Channel modification or channel diversion; Pump station improvements; Storm drain improvements; and Other (project not listed in Activity 530, but being considered for CRS credit). Also see the matrix of the various environmental and historical preservation compliance requirements as they relate to these types of projects. It is available at www.CRSresources.org/500.
Federal Funding	No Federal Funding		Certification Statement for Bridge or Culvert Projects, Channel Modification, Channel Diversion, Pump Station Improvements, Storm Drain Improvements, or Other Projects (TUC)
			All properties marked as “FEMA Funded” on CC-530-1(EHP) were included in the project description of the above FEMA-funded project.
For bridge or culvert projects, channel modification, channel diversion, storm drain improvements, pump station improvements, or other projects:
			State and local requirements: In addition to federal laws, implementing regulations, and executive orders, this project took into consideration the requirements of all state and local environmental and historic preservation laws, ordinances, and permits that applied to this type of project. Communication with the appro­priate state agency and/or local government entity took place before project implementation. Any recommendations made by the agency or office were carried out.
			Protection of threatened and endangered species (Endangered Species Act): Consideration was given to the protection and preservation of threatened and/or endangered species (including plants and animals and their habitat) whose existence may have been threatened by the construc­tion activities. Communication took place with the U.S. Fish and Wildlife Service (or the National Marine Fisheries Service if the project is in a coastal area) and the applicable state agencies for state-protected species and/or their habitat. Any recommendations made by the Services or state agencies were carried out.
			Protection of floodplains (E.O. 11988—Floodplain Manage­ment): Consideration was given to the project’s long- and short-term adverse impacts that are associated with the occupance and modification of floodplains, and to avoiding direct and indirect support of floodplain development wherever there was a practicable alternative.
Federal Funding		No Federal Funding		Certification Statement for Bridge or Culvert Projects, Channel Modification, Channel Diversion, Pump Station Improvements, Storm Drain Improvements, or Other Projects (cont.)
Bridge or culvert projects, channel modification, channel diversion, storm drain improvements, pump station improvements, or other projects (cont.)
				E.O. 11990—Protection of Wetlands: Consideration was given to the possible loss or degradation of wetlands associated with the construction of this project, as well as to the preservation and enhancement of the natural and beneficial values of wetlands.
				E.O. 12898—Environmental Justice in Minority and Low-income Populations: Consideration was given to the possible negative impacts associated with the implementation of this project on minority and low-income populations, and to avoiding those impacts where practicable.
				For projects in areas subject to the Coastal Barrier Resources Act: There was communication with the U.S. Fish and Wildlife Service regarding this project’s potential to jeopardize any ecologically sensitive coastal barrier resources. Any recommendations made by the Service were carried out.
				For projects in coastal communities: There was communication concerning this project with the state’s lead coastal zone management agency regarding the enforcement of the policies of the state’s coastal zone management program in carrying out federally funded or federally authorized construction activities. Any recommendations made by the agency were carried out.
In addition to the above, for bridge or culvert projects, storm drain improvements, or other projects:
				For projects that affected structures 50 years of age or older: (National Historic Preservation Act): If any protected structure affected by this project was 50 years of age or older at the time of the project, communication with the State Historical Preservation Officer or Tribal Historical Preservation Officer (if on tribal land or reservation) took place to determine if the structure was either on or eligible for the National Register of Historic Places (historic property) and to resolve any adverse effect(s) to the historic property.
In addition to the above, for bridge or culvert projects, channel modification, channel diversion, storm drain improvements, or other projects:
				Archaeological and Historic Preservation Act: The effects of the project on archaeological sites were considered.
In addition to the above, for bridge or culvert projects, channel modification, channel diversion, and other projects:
				Dredge and fill materials (Clean Water Act, Section 404): Consideration was given to all permit requirements for discharging dredge and fill material into waters of the United States, including wetlands, and communication with the U.S. Army Corps of Engineers took place. Any recommendations made by the Corps were carried out.
				Rivers and Harbors Act, Section 10: Consideration was given to any permits requirements for the project’s impact on navigable waterways. Communication with the U.S. Army Corps of Engineers took place.

Federal Funding	No Federal Funding		Certification Statement for Bridge or Culvert Projects, Channel Modification, Channel Diversion, Pump Station Improvements, Storm Drain Improvements; or Other Projects (cont.)
For bridge or culvert projects, channel modification, channel diversion, and other projects (cont.):
			Fish and Wildlife Coordination Act: Consideration was given to the potential for this project to result in the control or modification of a natural stream or body of water. Communication with the U.S. Fish and Wildlife Service (or National Marine Fisheries Service if the project is in a coastal area) took place. Any recommendations made by the agencies were carried out.
For pump station improvements, storm drain improvements, and other projects:
			Point source and non-point source discharge (Clean Water Act, Section 402): Consideration was given to all permit requirements for municipal point source discharge (sewage treatment plant discharge) as well as non-point discharge (surface runoff) of a pollutant into surface waters. Communication with the Environmental Protection Agency or designated state office took place. Any recommendations made by the agencies were carried out.
For channel modification, channel diversion, and other projects:
			Farmland Protection Policy Act: Considera­tion was given to the protection of prime and unique farmlands in the construction of this project. Communication with the U.S. Depart­ment of Agriculture, Natural Resources Conservation Service took place. Any recommendations made by the Service were carried out.
I certify that the items initialed above are correct to the best of my knowledge.
Name (signed):
Name (printed):
Title:				Date:

TUF—Storage Facilities

Project Name:
Project or Grant Number:
Project Description (or include as an attachment):
On each row of the table below, initial the box that applies to the TUF project, signifying that the appropriate steps were taken (shaded areas are “not applicable”). Then sign at the end of the certification. More information on these programs can be found in Figure 500-5 in the CRS Coordinator’s Manual.
Federal Funding	No Federal Funding	Certification Statement for Storage Facilities (TUF)
		All properties marked as “FEMA Funded” on CC-530-1(EHP) were included in the project description of the above FEMA-funded project.
		State and local requirements: In addition to federal laws, implementing regulations, and executive orders, this project took into consideration the requirements of all state and local environmental and historic preservation laws, ordinances, and permits that applied to this type of project. Communication with the appro­priate state agency and/or local government entity took place before project implementation. Any recommendations made by the agency or office were carried out.
		Archeological and Historic Preservation Act): The effects of the project on archaeological sites were considered.
		Protection of threatened and endangered species (Endangered Species Act): Consideration was given to the protection and preservation of threatened and/or endangered species (including plants and animals and their habitat) whose existence may have been threatened by the construc­tion activities. Communication took place with the U.S. Fish and Wildlife Service (or the National Marine Fisheries Service if the project is in a coastal area) and the applicable state agencies for state-protected species and/or their habitat. Any recommendations made by the Services or state agencies were carried out.
		Point source and non-point source discharge (Clean Water Act, Section 402): Consideration was given to all permit requirements for municipal point source discharge (sewage treatment plant discharge) as well as non-point discharge (surface runoff) of a pollutant into surface waters. Communication with the Environmental Protection Agency or designated state office took place. Any recommendations made by the agencies were carried out.
		Dredge and fill materials (Clean Water Act, Section 404): Consideration was given to all permit requirements for discharging dredge and fill materials into waters of the United States, including wetlands, and communication with the U.S. Army Corps of Engineers took place. Any recommendations made by the Corps were carried out.

Federal Funding	No Federal Funding		Certification Statement for Storage Facilities (cont.)
			Farmland Protection Policy Act: Considera­tion was given to the protection of prime and unique farmlands. Communication with the U.S. Depart­ment of Agriculture’s Natural Resources Conservation Service took place. Any recommendations made by the Service were carried out.
			Protection of floodplains (E.O. 11988-Floodplain Manage­ment): Consideration was given to the project’s long- and short-term adverse impacts that are associated with the occupance and modification of floodplains, and to avoiding direct and indirect support of floodplain development wherever there was a practicable alternative.
			E.O. 11990—Protection of Wetlands: Consideration was given to the possible loss or degradation of wetlands associated with the construction of this project, as well as to the preservation and enhancement of the natural and beneficial values of wetlands.
			E.O. 12898—Environmental Justice in Minority and Low-income Populations: Consideration was given to the possible negative impacts associated with the implementation of this project on minority and low-income populations, and to avoiding those impacts where practicable.
			For projects in areas subject to the Coastal Barrier Resources Act: There was communication with the U.S. Fish and Wildlife Service regarding this project’s potential to jeopardize any ecologically sensitive coastal barrier resources. Any recommendations made by the Service were carried out.
			For projects in coastal communities: There was communication concerning this project with the state’s lead coastal zone management agency regarding the enforcement of the policies of the state’s coastal zone management program in carrying out federally funded or federally authorized construction activities. Any recommendations made by the agency were carried out.
I certify that the items initialed above are correct to the best of my knowledge.
Name (signed):
Name (printed):
Title:				Date:

Activity 530 (Flood Protection)

Retrofitting Documentation for Option 2 Credit

This is an optional certification that may be used for retrofitting projects that are not in a high hazard area and that do not need to be designed or approved by an engineer or architect. Signed elevation certificates are used for buildings retrofitted by elevation (TUE).

One copy of this form can be used for multiple properties that have the same score.

Dry floodproofed buildings (TUD)

This technique was used for property numbers _______________________________________________

___ The project was designed by a licensed engineer or architect and the design accounts for openings and internal drainage, seepage, and underdrainage. (TU = 0.6)

___ The project does not depend on human intervention to close openings, the project protects to a level less than 3 feet over the first floor, the design accounts for internal drainage, seepage, and underdrainage, and the building does not have a basement (i.e., any floor below grade on all sides). (TU = 0.4)

___ There is no documentation of how openings, interior drainage, seepage, or underdrainage are handled. (TU = 0.2)

Wet floodproofed buildings (TUW)

This technique was used for property numbers _______________________________________________

__ The project was designed by a licensed engineer or architect. (TU = 0.5)

__ The project was not designed by a licensed engineer or architect. (TU = 0.3)

__ The furnace, water heater, electrical breaker box, and other utilities are relocated above flood level.
(TU = 0.2)

Buildings protected from sewer or sump backup (TUS)

This technique was used for property numbers _______________________________________________

__ The building is located in the SFHA. (TU = 0.2)

__ The building is located outside of the SFHA and the community has a building code or other regulations that require positive drain sewers or other measures that prevent sewer backup into new buildings. (TU = 0.1)

I certify that the items checked above are correct to the best of my knowledge.

Signature	Date
Name (printed)	Title

540 (Drainage System Maintenance)

Compliance with Environmental and Historic Preservation Requirements
(see Section 541.b(4) in the CRS Coordinator’s Manual).

On each row of the table below, initial to signify that the described steps were (or are) taken. Sign at the end of the certification. More information on these programs can be found in Figure 500-5 in the Coordinator’s Manual.

Note: To receive credit under Activity 540, the self-certification of compliance with environmental and historical preservation requirements incorporated in this certification must be submitted with a CRS application, a modification, or a cycle verification.

All Projects	Certification Statement for Drainage System Maintenance
	State and local requirements: In addition to federal laws, implementing regulations, and executive orders, our drainage maintenance activities take into consideration the applicable requirements of all state and local environmental and historic preservation laws, ordinances, and permits.
	Protection of threatened and endangered species (Endangered Species Act): Consideration is given to the protection and preservation of threatened and/or endangered species (including plants and animals and their habitat) whose existence may be threatened by the maintenance activities. Communication takes place with the U.S. Fish and Wildlife Service (or the National Marine Fisheries Service if activity is in a coastal area) and the applicable state agencies for state-protected species and/or their habitat. Any recommendations made by the federal or state agencies are carried out
	Dredge and fill materials (Clean Water Act, Section 404): Consideration is given to all permit requirements for discharging dredge and fill material into waters of the United States, including wetlands, and communication with the U.S. Army Corps of Engineers takes place. Any recommendations made by the Corps are carried out.
	For all activities that involve heavy equipment and result in the disturbance and release of sediment, such as dredging, channel alteration, bank stabilization, debris removal, and other activities, consideration is given to any permit requirements under the Clean Water Act, Section 404. Communication with the U.S. Army Corps of Engineers takes place. Any recommendations made by the Corps are carried out.
I certify that the items initialed above are correct to the best of my knowledge.
Name (signed):
Name (printed):
Title:			Date:

Community certifications CC-213-0 Edition: 2013