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| # FEDERAL EMERGENCY MANAGEMENT AGENCY                  | ***O.M.B.   |
|                                                        | No.         |
| ## ALLUVIAL FAN FLOODING FORM                          | 3           |
|                                                        | 067-0148*** |
|                                                        |             |
|                                                        | ***Expires  |
|                                                        | September   |
|                                                        | 30, 2005*** |
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| # PAPERWORK REDUCTION ACT                                             |
|                                                                       |
| Public reporting burden for this form is estimated to average 1 hour  |
| per response. The burden estimate includes the time for reviewing     |
| instructions, searching existing data sources, gathering and          |
| maintaining the needed data, and completing, reviewing, and           |
| submitting the form. You are not required to respond to this          |
| collection of information unless a valid OMB control number appears   |
| in the upper right corner of this form. Send comments regarding the   |
| accuracy of the burden estimate and any suggestions for reducing this |
| burden to: Information Collections Management, Federal Emergency      |
| Management Agency, 500 C Street, SW, Washington DC 20472, Paperwork   |
| Reduction Project (3067-0148). 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.**    |
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| Flooding Source:                                                      |
|                                                                       |
| **Note:** Fill out one form for each flooding source studied          |
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**A. THREE-STAGE ANALYSIS (Based on FEMA Guidelines dated February 23,
2000)**

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| 1\. [Stage 1 Analysis]{.underline}                                    |
|                                                                       |
| a\. The landform is composed of (check one) alluvial debris flow      |
| deposits.                                                             |
|                                                                       |
| ##                                                                    |
|                                                                       |
| ## Source of data used                                                |
|  to determine composition, morphology, and location of the landform:  |
|                                                                       |
| ##                                                                    |
|                                                                       |
| c\. Is there an NRCS soils survey and soil survey map available? Yes  |
| No                                                                    |
|                                                                       |
| If Yes, please include a copy of the map and any pertinent sections   |
| of the soil survey                                                    |
|                                                                       |
| 2.  [Stage 2 Analysis]{.underline}                                    |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| a.  The alluvial fan exhibits active inactive a combination of active |
|     and inactive alluvial fan flooding.                               |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| b.  Approximate age of inactive fan surfaces (thousands of years):    |
|           yrs.                                                        |
|                                                                       |
| c.  Is there an opportunity for avulsions that could lead channels or |
|     sheetfloods across the older fan surfaces?                        |
|                                                                       |
| > Yes No                                                              |
|                                                                       |
| d.  Is there evidence of headcutting that could lead to stream        |
|     piracy? Yes No                                                    |
|                                                                       |
| e.  Is there geomorphic evidence of past avulsions during the         |
|     Holocene epoch? Yes No                                            |
|                                                                       |
| f\. The fan exhibits the following types of flooding (check one):     |
|                                                                       |
| > Flooding along stable channels                                      |
| >                                                                     |
| > Sheetflow                                                           |
| >                                                                     |
| > Debris flow                                                         |
| >                                                                     |
| > Unstable flow path flooding                                         |
|                                                                       |
| 3\. [Stage 3 Analysis]{.underline}                                    |
|                                                                       |
| The boundaries of the 1%-annual-chance floodplain have been           |
| determined using (check one):                                         |
|                                                                       |
| > Risk-Based Analysis                                                 |
|                                                                       |
| FEMA FAN program (if discharge at the apex is different than that     |
| given in the effective FIS, then attach MT-2, Form 2 along with a     |
| plot of the flood frequency curve on log-normal probability paper and |
| include the drainage area above the hydrographic apex, and the mean,  |
| standard deviation, and skew coefficient of the curve)                |
|                                                                       |
| Sheetflow Methods                                                     |
|                                                                       |
| Hydraulic Analytical Methods                                          |
|                                                                       |
| Geomorphic Data, Post-Flood Hazard Verification, and Historical       |
| Information                                                           |
|                                                                       |
| Composite Methods                                                     |
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B. STRUCTURAL FLOOD CONTROL MEASURES

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| 1.  The following structural flood control measures are proposed or   |
|     built (check one):                                                |
|                                                                       |
| Channelization Levee/Floodwall Dam Sedimentation Basin                |
|                                                                       |
| 2\. Do the constructed or proposed structural measures affect flood   |
| hazards (including velocity, scour, and sediment deposition) on other |
| areas of the fan? Yes No                                              |
|                                                                       |
| 3\. Attach completed Form 3 (Riverine Structures Form).               |
|                                                                       |
| 4\. Sediment Transport Considerations:                                |
|                                                                       |
| Was sediment transport considered? Yes No If Yes, then fill out Form  |
| 3, Section F (Sediment Transport).                                    |
|                                                                       |
| If No, then attach your explanation for why sediment transport was    |
| not considered.                                                       |
|                                                                       |
| 5\. Please attach a copy of the formal Operations and Maintenance     |
| Plan.                                                                 |
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C. MAPPING REQUIREMENTS

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| Attach a certified topographic work map showing the following:        |
|                                                                       |
| \- The boundaries of the alluvial fan including: toe, topographic and |
| hydrologic apexes, and lateral boundaries                             |
|                                                                       |
| \- The delineation of the active and inactive portions of the fan as  |
| determined by the Stage 2 analysis                                    |
|                                                                       |
| \- The revised 1%-annual-chance floodplain boundaries, as determined  |
| by the Stage 3 Analysis, that tie into the effective                  |
|                                                                       |
| floodplain boundaries                                                 |
|                                                                       |
| \- The correct alignment of all structural features                   |
|                                                                       |
| \- The map scale                                                      |
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