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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No.1660-0008 Federal Emergency Management Agency Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION 'j,a X27. t, ' Al. Building Owner's Name Elizabeth Dudzik • 77r r .1-- A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. 396 Lake Shore Drive City Edgerton State WI ZIP Code 53534 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 5 and S 1/2 of Lot 6,Block 2,Edgerton Beach Park;Parcel No.0512-254-2305-7 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential A5. Latitude/Longitude:Lat. N 42d52'09" Long. W-89d01'06" Horizontal Datum: ❑NAD 1927 © NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 2 A8. For a building with a crawlspace or endosure(s): 1 134 A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No.of permanent flood openings in the crawlspace or 0 b) No.of permanent flood openings in the attached garage endosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑Yes ❑No d) Engineered flood openings? ❑Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 81.NFIP Community Name&Community Number 82.County Name B3.State Dane County 550077 Dane County • WI B4.Map/Panel Number 85.Suffix 86.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 55025C0832G G Date Effective/Revised Date Zone(s) AO,use base flood depth) June 17,2003 January 2,2009 AE 784 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89. ❑FIS Profile ©FIRM Community Determined ❑Other(Describe) B11. Indicate elevation datum used for BFE In Item B9: ❑ NGVD 1929 ®NAVD 1988 ❑Other(Describe) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes © No Designation Date ❑CBRS ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑Construction Drawings' ❑ Building Under Construction* © Finished Construction "A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A.AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized Lake Koshkonong Water Surface 777.29,8/6/08 Vertical Datum NGVD29 Conversion/Comments A conversion of-0.20 feet was applied in converting from NGVD29 to NAVD88 'Elevations a-h are NAVD88 surveyed 10/7/10 Check the measurement used. a) Top of bottom floor(including basement(awispatd)or enclosure floor) 783,0 Ri feet A meters(Puerto Rico only) b) Top of the next higher floor 788.3 feet meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) N/A _❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) N/A _❑feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 785.3 N feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 785.1_21 feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 785.7 ®feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including 785.4 © feet ❑meters(Puerto Rico only) structural support SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION .011 I 1 ///, � This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation ```Vs C U N c f/, information. I certify that the information on this Certificate represents my best efforts to interpret the data available. N N. ••• /1 I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. ,, �� ©Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a�•A. AA F IF. ••- f licensed land surveyor? ales © No FAL �{ .- CertifiersName License Number t Aaron Falkosky E-40083 --Ll E- 1,F Title Project Engineer Company Name Quam Engineering, •LLC .- MADISON '1.0 �'. •• Address 4893 Larson Beach Road City McFarland State WI ZIP Code 53558c(\' p" /. Signature Date Telephone �/ ra/7/fib 608-838-7750 /1)5/01V 1 •AV-1C- FEMA Form 81-31,Mar 09 See reverse side for continuation. Replacfes (Oiravious editions