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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE <br /> FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 <br /> Vaiiurra/Rood brrrrrarice Pr.,,'r,un Important: Read the instructions on pages 1-9. Expiration Date:July 31,2015 <br /> SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE <br /> Al. Building Owner's Name Timothy&Lori Plan Policy <br /> A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number: <br /> 7666 Entrance Road <br /> City Webster State WI ZIP Code 54893 <br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) <br /> Village of Yellow Lake Assessor's Plat Lot 22,Block 1 <br /> A4, Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc)Residential <br /> A5. Latitude/longitude:Lat.45d 55m 52.5s Long.92d 22m 36.1s Horizontal Datum: 0 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 9 <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) 628 sq ft a) Square footage of attached garage 632 sq ft <br /> b) Number of permanent flood openings in the crawispace b) Number of permanent flood openings in the attached garage <br /> or enclosure(s)within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade Q <br /> c) Total net area of flood openings in A8.b NA sq in c) Total net area of flood openings in A9.b NA sq in <br /> d) Engineered flood openings? 0 Yes ® No d) Engineered flood openings? 0 Yes ® No <br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION <br /> 81.NFIP Community Name&Community Number B2.County Name B3.State <br /> Burnett County 550032 Burnett WI <br /> ------ <br /> 84.Map/Panel Number I 85.Suffix ! B6.FIRM Index Date B7.FIRM Panel B8.Flood 89.Base Flood Elevation(s)(Zone <br /> 55013CO242 C 8/19/2008 Effective/Revised Date Zone(s) AO,use base flood depth) <br /> 8/19/2008 AE 933 <br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. <br /> ❑ FIS Profile ® FIRM 0 Community Determined 0 OtheriSource:_ <br /> • B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ® NAVD 1988 0 Other/Source: <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 ❑ OPA <br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) <br /> C1. Building elevations are based on: ❑ Construction Drawings' 0 Building Under Construction' ® Finished Construction <br /> 'A new Elevation Certificate will be required when construction 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-h <br /> below according to the building diagram specified in Item A7 In Puerto Rico onty,enter meters. <br /> Benchmark Utilized:N.G.S.DN5314 Elev.=935.8 Vertical Datum: NAVD 1988 <br /> Indicate elevation datum used for the elevations in items a)through h)below. ❑NGVD 1929 El NAVD 1988 D Other/Source: <br /> Datum used for building elevations must be the same as that used for the BFE. <br /> Check the measurement used. <br /> a)Top of bottom floor(including basement,crawlspace,or enclosure floor) 931.0 ®feet 0 meters <br /> b)Top of the next higher floor 935.4 ®feet 0 meters <br /> c)Bottom of the lowest horizontal structural member(V Zones only) NA. ®feet 0 meters <br /> d)Attached garage(top of slab) 932.3 ®feet (2 meters <br /> e)Lowest elevation of machinery or equipment servicing the building 931.5 I8 feet ❑meters <br /> (Describe type of equipment and location in Comments) <br /> f) Lowest adjacent(finished)grade next to building(LAG) 931 5 IS feet ❑motors <br /> g)Highest adjacent(finished)grade next to building(HAG) 932.2 ®feet 0 meters <br /> h)Lowest adjacent grade at lowest elevation of deck or stairs.including structural support Y31.4 ®feet ❑meters <br /> ' SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION <br /> • <br /> This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation owes M�+r/r <br /> 1 information.I certify that the information on this Certificate represents my best efforts to interpret the data available. ,,t•v � v�v'i4 <br /> I I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001, 4 <br /> toCheck here if comments are provided on back of form. Were latitude and longitude in Section A provided by a <br /> ❑ Check here if attachments. licensed land surveyor? ® Yes CI No > BRIAN K. <br /> Certifiers Name Brian K.Wodele WODELE s <br /> License Number S-2945 - <br /> Title Land Surveyor Company Name Johnson&Scofield,Inc. a ABASH <br /> Address 507 Vermillion Street CityHastings WABASHA, e <br /> 9 State MN ZIP Code 55033 MN O <br /> Signature s 64/" Date 9/19/2013 Telephone 651-438-0000 e + ' ` <br /> 'tea�urnNnlanNNOq��0 FEMA Form 086-0-33(7/12) See reverse side for continuation Replaces all previous editions <br />