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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 Paul J.Konopacki,Elizabeth M.Bucaida,Stacey Konopacki,Tom A. Konopacki Policy Number
<br /> A2. Building Street Address(including Apt.,Unit,Suite, and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number
<br /> 358 Lake Shore Dr. _
<br /> City Edgerton State WI ZIP Code 53534
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
<br /> North 4 Lot 10 and all of Lot 11,Block 1,Edgerton Beach Park Tax Parcel No.002/0512-254-2111-1
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential
<br /> A5. Latitude/Longitude:Lat.42.8672 Long.-89.0195 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 enclosure(s) 530 sq ft a) Square footage of attached garage 312 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 2 walls within 1.0 foot above adjacent grade -0-
<br /> c) Total net area of flood openings in A8.b 11 52 sq in c) Total net area of flood openings in A9.b -0- 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 WISCONSIN
<br /> B4.Map/Panel Number 65.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
<br /> Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> 55025CO832 G 1/2/09 1/2/09 A 784.2
<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 ❑Other(Describe)
<br /> B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ElNo
<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' IQ Finished Construction
<br /> 'A new Elevation Certificate will be required when construction of the building is complete.
<br /> C2. Elevations-Zones Al-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 MANHOLE Vertical Datum 783.88
<br /> Conversion/Comments SANITARY DISTRICT MANHOLE AT LAKE SHORE DR.&MAPLE AVE.
<br /> Check the measurement used.
<br /> �rinvc-t_ rLoaL
<br /> a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 783.2 ®feet ❑meters(Puerto Rico only)
<br /> b) Top of the next higher floor 786.5 ®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) 786.5 ®feet ❑meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the building 785.9 ®feet ❑meters(Puerto Rico only)
<br /> (Describe type of equipment in Comments)
<br /> f) Lowest adjacent(finished)grade(LAG) 785.1 ®feet ❑meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade(HAG) 785.2 ®feet ❑meters(Puerto Rico only)
<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
<br /> information. I certify that the information on this Certificate represents my best efforts to interpret the data available. *.yt ss.12:4
<br /> I understand that any f a l s e statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. P.,;P.,; 1
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<br /> El Check here if comments are provided on back of form. 4.? �It;" PLAC! '
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<br /> Certifier's Name Glen L Northrop License Number S-982 7 t ;}N`-' . •'
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<br /> Title Land surveyor Company Name ABEX Survey Company Y ,"
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<br /> Address 101 E.Main St.,P.O.Box 369 City Cambridge State WI ZIP Code 53523 . 4
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<br /> Signature "/� �� Date Telephone (608)423-3331 y,5 ryj "°° , ,..'i fe, �c,
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