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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 For Insurance Company Use:
<br /> Al. Building Owner's Name Linda Salustro 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 /> 357 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 /> Lots 16&17,Block 10,Edgerton Beach Park;Tax Parcel 002/0512-254-2677-8
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
<br /> A5. Latitude/Longitude:Lat.42.8673 Long.-89.0200 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) 880 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 /> enclosure(s)within 1.0 foot above adjacent grade 5 within 1.0 foot above adjacent grade
<br /> c) Total net area of flood openings in A8.b 1004 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 /> B1. NFIP Community Name&Community Number B2.County Name B3.State
<br /> Dane County 550077 Dane WI
<br /> B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
<br /> 55025C0832 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> January 2,2009 January 2,2009 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 ® 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` 0 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/Al-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 RimVertical Datum 783.68
<br /> Conversion/Comments NAVD'88
<br /> 4eravel
<br /> Check the measurement used.
<br /> a) Top of bottom floor(including basement,crawlspace,or enclosure floor-6&* 0 feet ❑meters(Puerto Rico only)
<br /> b) Top of the next higher floor 788.4 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
<br /> ❑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) 785.2 0 feet ❑meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade next to building(HAG) 785.5 0 feet ❑meters(Puerto Rico only)
<br /> h) Lowest adjacent grade at lowest elevation of deck or stairs,including ❑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 aiWatt.G;7l,,,
<br /> information. /certify that the information on this Certificate represents my best efforts to interpret the data available.! ,q4�`c F O �'.3dj
<br /> understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001.❑ ,->,�\.1 N.......,,1,..)I S
<br /> Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a a t;,';... ''� �/ ''fir
<br /> licensed land surveyor? ❑ Yes ❑ No GLEN L. •
<br /> a .NORTHROP
<br /> C
<br /> st
<br /> ertifier's Name Glen L.Northrop License Number 982-S o �
<br /> e 5, ` S-962
<br /> Title Registered Land Surveyor Company Name ABEX Survey Company ` MADISON, t�,
<br /> WISCONSIN / R`'
<br /> Address P.O.Box 369 City Cambridge State WI ZIP Code 53523 ,•„I%
<br /> � t.„ {%g•
<br /> Signature , /:i/ � Date q Telephone (608)423-3331 ����.t <J•~�""""!"��f•N:o .`L��
<br /> //'/ %/ /�'!�7-Cd/C, X01.410 V a� �t'���.ttt�`.a
<br /> IgeStlta Sae
<br /> FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions
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