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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
<br /> Federal Emergency Management Agency Expires February 28.2009
<br /> National Flood Insurance Program Important: Read the instructions on pages 1-8.
<br /> SECTION A-PROPERTY INFORMATION For Insurance Company Use
<br /> Al. Building Owner's Name Policy Number
<br /> Tim Carlin
<br /> A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number
<br /> 78 Oak Street
<br /> City Edgerton State WI ZIP Code 53534
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
<br /> Lots 12 & 13, Block 6, Edgerton Beach Park
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential
<br /> A5. Latitude/Longitude:Lat. N 42d52'5" Long W 89d01'16"16" 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 1
<br /> A8. For a building with a crawl space or enclosure(s),provide: A9. For a building with an attached garage,provide:
<br /> a) Square footage of crawl space or enclosures) sq ft a) Square footage of attached garage sq ft
<br /> b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
<br /> enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade
<br /> c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
<br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
<br /> B1.NFIP Community Name&Community Number B2.County Name B3.State
<br /> Dane County 550077 Dane County WI
<br /> B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
<br /> F Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> 55025C085F June, 17 2003 N/A AE 784
<br /> B10. 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 B9: © NGVD 1929 ❑NAVD 1988 El 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: El Construction Drawings* El 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/A1-A30,AR/AH,AR/AO. Complete Items C2.a-g
<br /> below according to the building diagram specified in Item A7.
<br /> Benchmark Utilized Lake Koshkonong Water Surface,8/6/2009 Vertical Datum NGVD 29
<br /> Conversion/Comments No conversion
<br /> Check the measurement used.
<br /> a) Top of bottom floor(including basement,crawl space,or enclosure floor) 788.5 ®feet ❑meters(Puerto Rico only)
<br /> b) Top of the next higher floor N/A •
<br /> © feet El meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) N/A . ID feet ❑meters(Puerto Rico only)
<br /> d) Attached garage(top of slab) N/A ._❑feet El meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the building 788:5 ®feet ❑meters(Puerto Rico only)
<br /> (Describe type of equipment in Comments)
<br /> f) Lowest adjacent(finished)grade(LAG) 786,9 © feet El meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade(HAG) 787..7 © feet ❑meters(Puerto Rico only)
<br /> `t�►lit!ilf?i1/l�
<br /> SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION ,�A\4 c,,C O 1 t ,/:9d,
<br /> This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation "~�, e,.••"°•'•••,<:f ./i��
<br /> information. I certify that the information on this Certificate represents my best efforts to interpret the data available. N,
<br /> I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. ;' • RYAi' D. ��
<br /> El Check here if comments are provided on back of form. & jt`�1 ••�
<br /> Certifier's Name License Number -:- .•
<br /> .- f � MP h N,
<br /> Ryan Quam F-33-.1 t :, . l 1.1`
<br /> e
<br /> Title Company Name f�` •. .r-7:
<br /> Engineer Quam Engineering, LLC O�` • Q•Address 4893 Larson Beach Rd City State ZIP Code 53558 /,f//jI/U1VA�' �\\`
<br /> Mc Farland WI R
<br /> Sign.; : n Date Telephone 1111 111
<br /> •, `mil Lvv‘.....,.. V.j22/Q2t (608) 838-7750
<br /> FEMA F :1-31, February 2006 See reverse side for continuation. Replaces all previous editions
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