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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No.1660-0008
<br /> Federal Emergency Management Agency Expires March 31,2012
<br /> National Flood Insurance Program Important: Read the instructions on pages 1-9.
<br /> SECTION A-PROPERTY INFORMATION
<br /> Building Owners Name Elizabeth Dudzik
<br /> A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No.
<br /> 396 Lake Shore Drive 1
<br /> City Edgerton State WI ZIP Code 53534
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
<br /> Lot 5 and S 1/2 of Lot 6,Block 2,Edgerton Beach Park;Parcel No.0512-254-2305-7
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential
<br /> A5. Latitude/Longitude:Lat. N 42d52'09" Long. W 89d01'06" Horizontal Datum: ❑NAD 1927 © NAD 1983
<br /> A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
<br /> A7. Building Diagram Number 2
<br /> A8. For a building with a crawlspace or enclosure(s): 1,134 A9. For a building with an attached garage:
<br /> a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq ft
<br /> b) No.of permanent flood openings in the crawlspace or 7 b) No.of permanent flood openings in the attached garage
<br /> enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade
<br /> c) Total net area of flood openings in A8.b 1,756 sq in c) Total net area of flood openings in A9.b sq in
<br /> d) Engineered flood openings? ❑Yes ®No d) Engineered flood openings? ❑Yes ❑ No
<br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
<br /> B1.NFIP Community Name&Community Number 82.County Name 83.State
<br /> Dane County 550077 Dane County WI
<br /> 84.Map/Panel Number B5.Suffix 86.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
<br /> 55025C0832G G Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> June 17,2003 January 2,2009 AE 784
<br /> 810. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
<br /> ❑FIS Profile ©FIRM Community Determined ❑Other(Describe)
<br /> B11. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 IN NAVD 1988 ❑Other(Describe)
<br /> B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes © No
<br /> Designation Date ❑CBRS ❑OPA
<br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
<br /> Cl. Building elevations are based on: ❑Construction Drawings* ❑ Building Under Construction` i3 Finished Construction
<br /> •A new Elevation Certificate will be required when construction of the building is complete.
<br /> C2. Elevations-Zones A1-A30,AE,AH,A(with BEE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete items C2.a-h
<br /> below according to the building diagram specified in Item A7. Use the same datum as the BFE.
<br /> Benchmark Utilized Lake Koshkonong Water Surface 777.29,8/6/08 Vertical Datum NGVD29
<br /> Conversion/Comments A conversion of-0.20 feet was applied in converting from NGVD29 to NAVD88
<br /> 'Elevations a-h are NAVD88 surveyed 10/7/10;crawispace is gravel Check the measurement used.
<br /> a) Top of bottom floor(including basement crawlspace or enclosure floor) 783,0 GI feet ❑meters(Puerto Rico only)
<br /> b) Top of the next higher floor 788.3 © feet ❑meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) N/A _❑feet ❑meters(Puerto Rico only)
<br /> d) Attached garage(top of slab) NIA _❑feet ❑meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the building 785.3121 feet ❑meters(Puerto Rico only)
<br /> (Describe type of equipment and location in Comments)
<br /> f) Lowest adjacent(finished)grade next to building(LAG) 785.0___IN feet ❑meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade next to building(HAG) 785.7 [XI feet ❑meters(Puerto Rico only)
<br /> h) Lowest adjacent grade at lowest elevation of deck or stairs,including 785.4 ©feet ❑meters(Puerto Rico only)
<br /> structural support
<br /> SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION x 11;-1 t1 1 l/ //
<br /> This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation \�1` , 4 ✓d","
<br /> information. /certify that the information on this Certificate represents my best efforts to interpret the data available. •• 1r✓ •
<br /> I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. ....s. .
<br /> :"s :'1J
<br /> ©Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a /��+"f "j r
<br /> �E•_�7,C
<br /> licensed land surveyor? ❑Yes © No =ALK l`(
<br /> Certifier's Name Aaron Falkosky License Number E-40083 � I' IM r" E' :11J7-
<br /> Title Company Name .• MAD'1 O N
<br /> Project Engineer Quam Engineering,LLC M".>•4\_,4:\\- WI
<br /> Address 4604 Siggelkow Road,Suite A City McFarland State WI ZIP Code 53558 ,-,c‘--..,..., . , :,�t���
<br /> Signature Date j. S 1 Telephone 608-838-7750 Z7/` !���i.
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<br /> FEMA Farm :1-31,Mar 09 See reverse side for continuation. Replaces all previous editions
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