|
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 Richard Ruland 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 /> 83 Beach Avenue
<br /> City Edgerton State WI ZIP Code
<br /> 53534
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
<br /> Lot 1 CSM 6840
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential
<br /> A5. Latitude/Longitude:Lat. Long. 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 8
<br /> A8. For a building with a crawl space or encosure(s),provide: **NOT MEASURED A9. For a building with an attached garage,provide:
<br /> a) Square footage of crawl space or enclosure(s) )4'0 sq ft a) Square footage of attached garage 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 L/ walls within 1.0 foot above adjacent grade
<br /> c) Total net area of flood openings in A8.b 1(25' sq in c) Total net area of flood openings in A9.b 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 County WI
<br /> B4.Map/Panel Number B5.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 /> 55025C085F F June, 17 2003 N/A AE 784
<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 /> C1. 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. **NOTE BUILDING CONSTRUCTION NOT 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 A7.
<br /> Benchmark Utilized Lake Koshkonong Water Surface,8/6/2009 Vertical Datum NGVD 29
<br /> Conversion/Comments No conversion
<br /> Check the measurement used.
<br /> a) Top of bottom floor(including basement,crawl space,or enclosure floor f*NOT MEASUR
<br /> feet ❑meters(Puerto Rico only)
<br /> b) Top of the next higher floor 787:20 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) N/A _❑feet El meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the building **NOT MEASUREI feet ❑meters(Puerto Rico only)
<br /> (Describe type of equipment in Comments)
<br /> f) Lowest adjacent(finished)grade(LAG) 783,29 © feet ❑meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade(HAG) 784,73 © 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 ,,� ,}i€ i f 1;17
<br /> information. I certify that the information on this Certificate represents my best efforts to interpret the data available. �..�`�� n, .t. ;`;;,.,1.,r,r,
<br /> I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. ���., q, �., •••_. :• a ,'
<br /> © Check here if comments are provided on back of form.
<br /> Certifiers Name License Number
<br /> Ryan Quam =°_l; E-J{ji7f5 :v;;,
<br /> Title Company Name ,:. . MADISON •rw?
<br /> Engineer Quam Engineering, LLC �; ;/�,
<br /> Address City State ZIP Code ;/,e3,• WI * -,
<br /> 4893 Larson Beach Rd . .
<br /> Mc Far WI 53558 / ��•y.�• �
<br /> Signature. Qate Telephone Y '••..
<br /> e+�M C� ,ti.,. 2 lC4 Co�(1�)
<br /> (608) 838 7750 �itlS�rl1. ' , �`�
<br /> FEMA Form 8 31, February 2006 See reverse side for continuation. Repl. :II previous editions 5
<br />
|