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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 1: rCd`7 -,-Kr -,•7tu` 1. •:I
<br /> Al. Building Owner's Name L_PI , ,.- , :�
<br /> Michael Disantis , _ `"J
<br /> A2. Building Street Address(induding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. ! , k /I`ve�;(� r "__J
<br /> 69 Beach Avenue " 1
<br /> City Edgerton State WI ZIP Code 53534
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
<br /> 051236100018,051236100125,051236196005
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential
<br /> A5. Latitude/Longitude:tat Long. 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 8
<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 sq ft
<br /> b) No.of permanent flood openings In the crawlspace or b) No.of permanent flood openings in the attached garage
<br /> endosure(s)within 1.0 foot above adjacent grade 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 /> d) Engineered flood openings? ❑Yes ❑No d) Engineered flood openings? ❑Yes ❑No
<br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
<br /> 81.NFIP Community Name&Community Number B2.County Name B3.State WI
<br /> Dane County 550077 Dane County
<br /> 84.Map/Panel Number 85.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
<br /> 55025C0832G G Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> 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 B9.
<br /> ❑FIS Profile ©FIRM Community Determined ❑Other(Describe)
<br /> 811. Indicate elevation datum used for BFE In Item B9: ❑ 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' ❑ 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-h
<br /> below according to the building diagram specified in Item A7. Use the same datum as the BFE. NGVD29
<br /> Benchmark Utilized Lake Koshkonong Water Surface 777.29,8/6/09 Vertical Datum
<br /> Conversion/Comments A conversion of-0.20 feet was applied in converting from NGVD29 to NAVD88
<br /> *Elevations a-h are NAVD88 surveyed 5/13/09 Check the measurement used.
<br /> a) Top of bottom floor(induding basement,crawlspace,or enclosure floor) Not Measured feet meters(Puerto Rico only)
<br /> b) Top of the next higher floor 787,1 feet meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) N/A _❑feet ❑meters(Puerto Rico only)
<br /> d) Attached garage(top of slab) N/A . ❑feet ❑meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the building Not Measured❑feet 0 meters(Puerto Rico only)
<br /> (Describe type of equipment and location In Comments)
<br /> f) Lowest adjacent(finished)grade next to building(LAG) 782:8 ®feet ❑meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade next to building(HAG) 784:0_®feet ❑meters(Puerto Rico only)
<br /> h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A _❑feet ❑meters(Puerto Rico only)
<br /> structural support oil Wait
<br /> SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION N•I ",
<br /> This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation >% , •''• ��'4/1:0
<br /> Information. l certify that the information on this Certificate represents my best efforts to interpret the data available. 0
<br /> I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. .�^►.:•• ✓
<br /> AARON F.
<br /> IN Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a. FAL. f��KY ✓-
<br /> licensed land surveyor? Dyes ❑No .-� E-.0 a-
<br /> Certifiers Name License Number E-40083
<br /> Aaron Falkosky MA; •N i
<br /> Tr" opy
<br /> Project Engineer Company Name Quam Engineering,LLC r AN\, WI '�s
<br /> C State ZIP Code i�s '• ._0•;,..\k..7∎
<br /> Address 4893 Larson Beach Road itY McFarland WI 53558 .,-S�ONA\- ```
<br /> Signature d 1 /e / Date s /4./. D cf Telephone 608-838-7750 ./1/1 I i 11,
<br /> FEMA Form 81-•31,MMaar✓09 See reverse side for continuation. Replaces all previous editions
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