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<br />FEDERAL EMERGENCY MANAGEMENT AGENCY <br />RIVERINE STRUCTURES FORM <br /> <br />a.M.B. No. 3067-0148 <br />Expires September 30,1005 <br /> <br />PAPERWORK REDUCTION ACT <br /> <br />Public reporting burden for this form is estimated to average 7 hours per response. The burden estimate includes the time for reviewing instructions, <br />searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not <br />required to respond to this collection of information unless a valid OMB control number appears in the upper right comer of this form. Send <br />comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, <br />Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472, Paperwork Reduction Project (3067-0148). Submission of the <br />form is required to obtain or retain benefits under the National Flood Insurance Program. Please do not send your completed survey to the <br />above address. <br /> <br />Flooding Source: CACHE LA POUDRE RIVER <br />Note: Fill out one form for each flooding source studied <br /> <br />A. GENERAL <br /> <br />Complete the appropriate section(s) for each Structure listed below: <br /> <br />Channelization................complete Section B <br />Bridge/Culvert.................complete Section C <br />Dam ...............................complete Section D <br />Levee/Floodwall.............complete Section E <br />Sediment Transport........complete Section F (if required) <br /> <br />Descriotion Of Structure <br /> <br />1. Name of Structure: Harmony Road Bridge (replacement of existing bridge) <br /> <br />Type (check one): <br /> <br />D Channelization <br /> <br />IZI Bridge/Culvert <br /> <br />D Levee/Floodwall <br /> <br />DDam <br /> <br />Location of Structure: Harmony Road at the Cache la Poudre River, Timnath, Larimer County, Colorado <br /> <br />Downstream Limit/Cross Section: 183656 <br /> <br />Upstream Limit/Cross Section: 183850 <br /> <br />2. Name of Structure: <br /> <br />Type (check one): <br /> <br />D Channelization <br /> <br />D Bridge/Culvert <br /> <br />D Levee/Floodwall <br /> <br />DDam <br /> <br />Location of Structure: <br /> <br />Downstream Limit/Cross Section: <br /> <br />Upstream Limit/Cross Section: <br /> <br />3. Name of Structure: <br /> <br />Type (check one) <br /> <br />D Channelization <br /> <br />D Bridge/Culvert <br /> <br />D Levee/Floodwall <br /> <br />DDam <br /> <br />Location of Structure: <br /> <br />Downstream Limit/Cross Section: <br /> <br />Upstream Limit/Cross Section: <br /> <br />NOTE: For more structures, attach additional pages as needed. <br /> <br />FEMA Form 81,89B, SEP 02 <br /> <br />Riverine Structures Form <br /> <br />MT,2 Form 3 Page 1 of 10 <br />