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<br /> U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OM6 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. Budding Owner's Name Linda Salustro
<br /> 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 Cow 53534
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
<br /> Lots 16&17, Block 4, Edgerton Beach Park
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential
<br /> A5. Latitude/Longitude,Lat N 42d52'02.5" Long. W 89d01'12.3" Hat•ontal Datum: ❑NAD 1927 ©NAD 1983
<br /> A6. Attach at least 2 photographs of the budding if the Certificate is being used to obtain flood insurance.
<br /> A7. Budding Diagram Number 8
<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 erdoskre(s) sq ft a) Square footage of attached garage sq It
<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 walls 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 /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
<br /> ' BI.NFIP Community Name&Community Number B2.County Name B3.S�
<br /> Dane County 550077 Dane County
<br /> B4.Map/Panel Number I B5.Suffbc B6.ARM index 87.FIRM Panel B8.Flood 89.Base Flood Elevation(s)(Zone
<br /> F Data Effective/Revtsed Date Zone(s) AO,use base flood depth)
<br /> 55025C085F June, 17 2003 N/A AE 784 SEE COMMENTS
<br /> 1 _
<br /> 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 139.
<br /> El FIS Profile ®FIRM 0 Community Determined ❑Other(Describe)
<br /> B11. Indicate elevation datum used for BFE in Item 69: 0 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)? 0 Yes ® No
<br /> Designation Date 0 CBRS 0 OPA
<br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
<br /> C1. Budding elevations are based on: ❑Construction Drawings* ❑Building Under Construction* ®Finished Construction
<br /> 'A new Elevation Certllkate will be required when ccestruction 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-g
<br /> below according to the building diagram specified in Item AT
<br /> Benchmark UtHlzed SEE COMMENTS Vertical Datrn NGVD 29
<br /> Convey No conversion
<br /> Check the measurement used.
<br /> a) Top of bottom floor(Including basement,crawl space,or enclosure floor) 784:6 ®,'feet ❑meters(Puerto Rico only)
<br /> IA
<br /> b) Top of the next higher floor 785.2 feet ❑meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) 0 . CI feet ❑meters(Puerto Rico only)
<br /> d) Attached garage(top of stab) 0 . [1 feet ❑meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the budding 783:6 ®feet El meters(Puerto Rico only)
<br /> (Describe type of equipment in Comments)
<br /> f) Lowest adjacent(finished)grade(LAG) 783,.§____E feet 0 meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade(HAG) 784. 7 D feet 0 meters(Puerto Rico only)
<br /> SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION �►tlillll+r
<br /> This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation \��`` C 0N.Sit/i,/�
<br /> information. I certify that the information on this Certificate represents my best efforts to interpret the data available. \\\�% ........ .Sl ��
<br /> I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001_ ``�% ��•.' ��''/•
<br /> ®Check here if comments are provided on bade of form. ,k:• P LAIR D. '`,* i
<br /> ��JAM•Certifier's Name License Number _ r 3715 :IY,
<br /> Ryan pram ISON, l
<br /> Title Company Name Q
<br /> Engineer Gluon Engineering, LLC WI ∎
<br /> Address 4893 Larson Beach Rd City State ZIP Code '�/ -t�•' (���,`�\
<br /> Mc Far land WI 53558 V,�i••7�r...=.• •w'
<br /> Sngnatu `] 9��{_ Tel one (608) 838 7750 ///`/'/(�O+�Pi�1t,\\\````
<br /> I11
<br /> FEMA Form 1 1,February 2006 See reverse side for continuation. Replaces all previous editions
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