It says "not to scale", which in the world of mapping means very specifically that the scale is inconsistent. An exaggerated vertical scale would not include the disclaimer for "not to scale" and is very common, as I already said. It's common for maps showing vertical reliefs like profiles or cross sections to have a horizontal scale of something like 1:20 while the vertical dimension has a scale of 1:5 or 1:10, which would still be considered "to scale". If you still can't fit everything on a single sheet, you can add a break line or a jog to indicate a discontinuity, but the map would still be "to scale". This map is "not to scale" because it says so, so the only real information we should be able to glean from it are the connections between things; size, angles, and lengths as are meaningless because that's what "not to scale" is specifically warning us about.