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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 >' >`::::
<br /> Al. Building Owners Name Eddy Rosengren
<br /> and/or Bldg.No. or P.O.Route and Box No. # ! 0`: t ! ::::: >;»'`
<br /> A2. Building Street Address(including Apt.,Unit,Suite,and/ g )
<br /> 83 Main St. ......................................................
<br /> City Edgerton State WI ZIP Code 53534
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
<br /> Lots 1,2&3,Block 1,Hickory Hills Estate,Section 25,T6N,R12E,Tn of Albion,Dane Co.,WI PIN 002/0512-254-5501-3
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
<br /> A5. Latitude/Longitude:Lat.42.865635 Long.-89.020012 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 2
<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) 131K sq ft a) Square footage of attached garage 0 sq ft
<br /> b) No.of 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 1 within 1.0 foot above adjacent grade 0
<br /> c) Total net area of flood openings in A8.b 576 sq in c) Total net area of flood openings in A9.b 0 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 B2.County Name 83.State
<br /> Dane Co.550077 Dane Co WI
<br /> B4.Map/Panel Number B5.Suffix B6.FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s)(Zone
<br /> 0832 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> 1-2-09 1-2-09 AE
<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 69: ❑ 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 /> Cl. 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.
<br /> Benchmark Utilized Manhole Rim Vertical Datum 783.85
<br /> Conversion/Comments Benchmark datum 783.88 NGVD29 Datum converted to 783.65 Der FEMA VERTCON:elevations below are NGVD88.
<br /> Check the measurement used.
<br /> CRAWLSPACE FLOOR 71
<br /> 15 LOOSE GRAVEL ; SEE COMMENT SEcOU D
<br /> a) (op of bottom floor(including basement,crawispace,or enclosure floor)781.4 0 feet ❑meters(Puerto Rico only)
<br /> b) Top of the next higher floor 788.7 0 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) ❑feet ❑meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the building ❑feet ❑meters(Puerto Rico only)
<br /> (Describe type of equipment and location in Comments)
<br /> f) Lowest adjacent(finished)grade next to building(LAG) 784.4 0 feet ❑meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade next to building(HAG) 7m.$ 0 feet ❑meters(Puerto Rico only)
<br /> h) Lowest adjacent grade at lowest elevation of deck or stairs,including Z$4. co feet ❑meters(Puerto Rico only)
<br /> structural support
<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 t�b,13�f.Cttt�
<br /> information. I certify that the information on this Certificate represents my best efforts to interpret the data avaiable.I ,SOS r- •I,�f�
<br /> understand that any false statement may be punishable by fine or Imprisonment under 18 U.S.Code,Seddon 1001.❑ �,,•P' S C A�, �#0�
<br /> Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a vo �. °o
<br /> licensed land surveyor? ❑ Yes 0 No o•' PLACE; °..
<br /> G LEbtAL
<br /> Certifiers Name Glen L.Northrop License Number S-982 w I NGRT
<br /> j,- ; .•
<br /> MADISON, i
<br /> �► WISCONSIN °
<br /> Address P.O.Box 369 City Cambridge State WI ZIP Code 53523 ,7 y4 0.'
<br /> Sgna 7‘; ..„.----./ 5-7-- Date Telephone (608)423-3331 d®o�/�+•''"»•••••-0,-...-1*�,
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