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• U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No.1660-0008 Expires February 28.2009 Federal Emergency Management Agency National Flood Insurance Program Important: Read the instructions on pages 1-8. SECTION A-PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name Policy Number Salvatore Gloria A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number 79 Beach Avenue City Edgerton State WI ZIP Code 53534 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Highwood Estates let Addition Block 1, lot 9 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential A5. Latitude/Longitude:Lat. Long. Horizontal Datum: ❑NAD 1927 © NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood Insurance. A7. Building Diagram Number 8 A8. For a building with a crawl space or enclosure(s),provide: A9. For a building with an attached garage,provide: a) Square footage of crawl space or endosure(s) 800 sq ft a) Square footage of attached garage sq ft b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade 0 *See Comments walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 0 *See Comments sq in c) Total net area of flood openings in A9.b sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.Sat Dane County 550077 Dane County WI B4.Map/Panel Number B5.Suffix 86.FIRM Index B7.FIRM Panel 88.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revlsed Data Zone(s) AO,use base flood depth) 55025C0832G G June 17,2003 Jan 2, 2009 AE 784 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89. ❑FIS Profile ©FIRM ❑Community Determined ❑Other(Describe) B11. Indicate elevation datum used for BFE In Item B9: ❑ NGVD 1929 ©NAVD 1988 ❑Other(Describe) B12. Is the building located In a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes © No Designation Date ❑CBRS ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑Construction Drawings' © Building Under Construction* ❑ Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. **NOTE BUILDING CONSTRUCTION NOT COMPLETE 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 below according to the building diagram specified In Item A7. Benchmark Utilized Lake Koshkonong Water Surface,8/6/2009 Vertical Datum NGVD 29 Conversion/Comments Lake Koshkononct Water Suf ace of 777.28(NGVD 29) = 777.05(NAVD 88) Check the measurement used. *Elevations a-g are NAVD 88 datum Gravel Crawl Space EI=782.97 a) Top of bottom floor(including basement,crawl space,or enclosure floor) ©feet ❑meters(Puerto Rico only) b) Top of the next higher floor 786.97 © feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) N/A . ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) N/A . ❑feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building **NOT MEA,SURi©D feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent(finished)grade(LAG) 782.99 Q feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) 784,3i 9 feet ❑meters(Puerto Rico only) 1t�f:+r SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION `.0\%t �� y/ff!l�. This certification Is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation ‘` �,:'�;...:AV ',. information. I certify that the Information on this Certificate represents my best efforts to interpret the data available. `. • •`••�V" I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. .. © Check here if comments are provided on back of form. ;Z::*:: FOAM • • Csb31Z�5 CeRifreRyan Quam License 3 � 5 Number . �0{v, �• ` Title Ryan Company Name Quam Engineering, LLC i� •�. W) �: Engineer Address City State ZIP Code �/ts(•�•'•.vAn is16-• 4893 Larson Beach Rd Mc Far land State Telephone WI 53558 /��'Q��,` �� Signature. 0 spate aa9 (608) 838-7750 FEMA Form -31,February 2006 See reverse side for continuation. Replaces all previous editions 2d ObSTL926:01 2S11-828(809) Ti `JNId33NIJN3 Ndf1n:NQilJ dLT:2T 6002-9T-Zldti