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U1.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 Al. Building Owners Name Martin J.Duellman 41 A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No. or P.O.Route and Box No. 1 9 C 9 P 9� ) 342 Lake Shore Dr. yr City Edgerton State WI ZIP Code 53534 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 3 and N 1/2 Lot 2,Blk 2 Edgerton Beach Park,Section 25,T6N,R12E,Tn of Albion,Dane Co.,WI PIN 002/0512-254-2023-8 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Let.42.866135 Long.-89.020178 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 enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 1056 sq ft a) Square footage of attached garage 497 sq ft b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade 5 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 455 sq in c) Total net area of flood openings in A9.b Q sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State Dane Co.550077 Dane Co WI B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 0832 G Date Effective/Revised Date Zone(s) AO,use base flood depth) 1-2-09 1-2-09 A 784.0 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ❑ FIRM ® Community Determined ❑ Other(Describe) 811. 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) Cl. 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/Al-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 Manhole Rim Vertical Datum 783.65 1 Conversion/Comments Benchmark datum 783.88 NGVD29 Datum converted to 783.65 per FEMA VERTCON;elevations below are NGVD88. ^' '- ° -----7 .A, heck the measurement used. C11-1\---) VCL a� C4tqu��fJcE - dl� a) Top of bottom floor(including basement,crawlspace,or enclosure fl 783.2 0 feet ❑meters(Puerto Rico only) G1yet.' � 1oov' b) Top of the next higher floor 7 .Q 0 feet ❑meters(Puerto Rico only) ✓ f Cl 11O" `DQ c) Bottom of the lowest horizontal structural member(V Zones only) ❑feet ❑meters(Puerto Rico only) )20/w 1 d) Attached garage(top of slab) 786.0 ®feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building ❑feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) t) Lowest adjacent(finished)grade next to building(LAG) 785.9 0 feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 786.1 0 feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including 785.9 ®feet ❑meters(Puerto Rico only) structural support SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION o%%itt"•rtf� This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation �� of information. /certify that the information on this Certificate represents my best efforts to interpret the data available.! I�`��`��G ON / understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.0 �e .-• .,, /� �.* Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a 414. r• '`* i licensed land surveyor? ❑ Yes 0 No a a* GLEN:L. NORT14ROP Certifier's Name Glen L.Northrop License Number S-982 0='4z F MADISON, Title Surveyor Company Name ABEX Survey Company i°',.` e WISCONSIN • Address P.O.Box 369 City Cambridge State WI ZIP Code 53523 10 • •• 0• Signature /ire / Date /' /-2Z-VOTelephone (608)423-3331 aAPOf f8f�`u Re �AO