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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 /> Al. Building Owner's Name Judith Mozerka
<br /> A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. r x ,
<br /> 370 Lake Shore Drive :
<br /> City Edgerton State WI ZIP Code
<br /> 53534
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
<br /> North 1/2 of Lot 16 and Lot 17,Edgerton Beach Park
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential
<br /> A5. Latitude/Longitude:Lat N42d52'05" Long, W89d01'10" Horizontal Datum: ❑NAD 1927 ©NAD 1983
<br /> AS. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
<br /> A7. Building Diagram Number 9
<br /> A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
<br /> a) Square footage of crawlspace or enclosure(s) Not Measured sq ft a) Square footage of attached garage Not Measured sq ft
<br /> b) No.of permanent flood openings in the crawlspace or , b) No.of permanent flood
<br /> openings in the attached garage
<br /> enclosure(s)within 1.0 foot above adjacent grade 2 within 1.0 foot above adjacent grade
<br /> c) Total net area of flood openings in A8.b 256 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 /> -
<br /> 84.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
<br /> G Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> 55025C0832G June 17,2003 January 2,2009 AE 784
<br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89.
<br /> ❑FIS Profile ®FIRM Community Determined ❑Other(Describe)
<br /> B11. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 ©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 /> C1. Building elevations are based on: ❑Construction Drawings* 0 Building Under Construction* ©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 BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/Al-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,8/6/2008 Vertical Datum NGVD 29
<br /> Conversion/Comments Lake Koshkonong Water Surface of 777.28(NGVD 29)=777.08(NAVD 88)
<br /> **Elevations a-g are NAVD 88 datu Check the measurement used.
<br /> a) Top of bottom floor(including basemen cxawlspar enclosure floor} Not Measured feet ❑Mars(Puerto Rico only)
<br /> b) Top of the next higher floor 787,5 X feet ❑meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) ._❑feet ❑meters(Puerto Rico only)
<br /> d) Attached garage(top of slab) 785.3 n feet ❑meters(Puerto Rico only)
<br /> a) Lowest elevation of machinery or equipment servicing the building 787.3 ©feet ❑meters(Puerto Rico only)
<br /> (Describe type of equipment and location in Comments)
<br /> f) Lowest adjacent(finished)grade next to building(LAG) 784.8 (^I feet ❑meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade next to building(HAG) 786.0 (k]feet ❑meters(Puerto Rico only)
<br /> h) Lowest adjacent grade at lowest elevation of deck or stairs,including 783.6 ®feet ❑meters(Puerto RIR 9n}y1 r `
<br /> structural support 1 /
<br /> SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION,��,\5�',� �i/A.1,-
<br /> This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevaIio " `,.,
<br /> information. I certify the!the Information on this Certificate represents my best efforts to interpret the data available. "._
<br /> i understand that any false statement may be punishable by fine or Imprisonment under 18 U.S.Code,Section 1001..` r• AARON F. ---
<br /> [23 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided bra FA L Kktis
<br /> licensed land surveyor? Lives ®No --q; E-4 '�-
<br /> Certifier's Name Aaron Falkosky License Number 40083 MADW4• ' r C,{/:
<br /> Title Project Engineer Company Name Quam Engineering,LLC ! .10 W : ��'`
<br /> Address 4893 Larson Beach Road City McFarland State WI ZIP Code 53558'fis .....
<br /> �'N\
<br /> Signature JJ Date Telephone l�N AV- \'
<br /> Grc--' y 7/' ,6 608-838-7750
<br /> FEMA Form 81-31,Mar 09 See reverse side for continuation. Replaces all previous editions
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