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EPARTMENTOF HOMELAND SECURITY ELEVATIO•
<br /> N CERTIFICATE OMB No. 1660-0008
<br /> Federal Emergency Management Agency
<br /> National Flood Insurance Program Important: Read the instructions on pages 1-9. Expires March 31,2012
<br /> SECTION A-PROPERTY INFORMATION For Insurance
<br /> Al. Building Owner's Name Daniel Meyer Company Use:
<br /> Policy Number
<br /> A2. Building Street Address(including ',f_ `'''
<br /> 390 ( g Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. company NAIC Number
<br /> A2. Lake Building Street
<br /> Dr.
<br /> City Edgerton State WI ZIP Code 53534
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number, I Description,etc.)
<br /> Lots 1 and 2,Block 2,Edgerton Beach Park;PIN 002/0512-2542261-0;N N/ 25,T5N,R12E,Town of Albion,Dane Co.,WI
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
<br /> A5. Latitude/Longitude:Lat.42.86883 Long.-89.018421 Horizontal Datum: ® fy7-/a N" //;�2��d��
<br /> A6. Attach at least 2 photographs of the building if the Certificate is being used to❑obtainDlfl�ood insurance.1983
<br /> A7. Building Diagram Number Q �� -/f�/�
<br /> A8. For a building with a crawlspace or enclosure(s):
<br /> a) Square footage of crawlspace or enclosure(s) 1115 A9. For a building with an attached garage:
<br /> b) No.of sq ft a) Square footage of attached garage sq ft
<br /> permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage
<br /> enclosure(s)within 1.0 foot above adjacent grade $
<br /> c) Total net area o.flood openings in A8.b "i`hir. 1.,,;�,,,above adjacent grade
<br /> d) Total net area
<br /> flood openings? ❑ Yes 259Z sq in C) Total net area of flood openings in A9.b _ sq in
<br /> 0 No d) Engineered flood openings? ❑ Yes
<br /> ❑ No
<br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
<br /> B1. NFIP Community Name 8 Community Number l B2.County Name
<br /> Dane County 550077 I Dane ( WI State
<br /> I I
<br /> B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel
<br /> 55025C0832 G Date B8. Flood B9.Base Flood Elevation(s)(Zone
<br /> Effective/Revised Date Zop@(s) AO,use h)
<br /> January 02,2009 January 02,2009 A� 784 2
<br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
<br /> ❑ FIS Profile X FIRM )Community Determined ❑ Other(Describe) r- 7 0 II.d
<br /> B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 0 NAVD 1988
<br /> ❑ Other(Describe)
<br /> B12. Is the building located in aeoastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes 0 NO
<br /> Designation Date CO22ge77041 ❑ CBRS ❑ OPA
<br /> Co2a.YeTtov
<br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
<br /> Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction*
<br /> 'A new Elevation Certificate will be required when construction of the building is complete. ® Finished Construction
<br /> C2. Elevations-Zones Al-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
<br /> below according to the building diagram specified in Item A7. Use the same datum as the BFE.
<br /> Benchmark Utilized Manhole Rim Vertical Datum 780.26
<br /> Conversion/Comments
<br /> Check the measurement used.
<br /> a) Top of bottom floor(including basement,crawlspace,or enclosure floor)z22.2 0 feet
<br /> b) Top of the next higher floor ❑meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) za§$ ❑feet 0 meters(Puerto Rico only)
<br /> d) Attached garage(top of slab) ❑feet ❑meters(Puerto Rico only)
<br /> e) ❑feet ❑meters(Puerto Rico only)
<br /> Lowest elevation of machinery or equipment servicing the building ❑feet
<br /> (Describe type of equipment and location in Comments) ❑meters(Puerto Rico only)
<br /> f) Lowest adjacent(finished)grade next to building(LAG) if8.2 0 feet
<br /> g) Highest adjacent(finished)grade next to building(HAG) 7 ❑meters(Puerto Rico only)
<br /> 4.$ 0 0 meters(Puerto Rico only)
<br /> h) Lowest adjacent grade at lowest elevation of deck or stairs,including 0 feet
<br /> structural support ❑meters(Puerto Rico only)
<br /> SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
<br /> This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation p1� •..g
<br /> information. I certify that the information on this Certificate represents my best efforts to interpret the data available.! ```.,t C O jv �,`�4,
<br /> understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.® �ti �%5••••••'•"�•..S/^-pie
<br /> Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a o� �`"r� `'"Y •�"
<br /> licensed land surveyor? ❑ Yes 0 No ;' GLEN L. do
<br /> Certifier's Name Glen L.Northrop License Number S-982 ° NORT HROP\
<br /> ti . S9r;2
<br /> Title Surveyor Company Name ABEX.Survey Company �� MADISON, I 11:1
<br /> ".1;1,.,....t• WISCONSIN O
<br /> Address P.O.Bo 369 City Cambridge State WI '�' o
<br /> ZIP Code 53523 a i' $
<br /> /bate �/� Telephone (608)423-3331 �c �••S ;e�
<br /> / "-- ems ICJ/ p0, o
<br /> •'i*aetU R'-
<br /> FEMA Form 81-31, Mar 09 See reverse side for continuation.
<br /> Replaces all previous editions
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