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U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood fasurance Program IMPORTANT: Follow the instructions on pages 1-9. OMB No. 1660-0008 I Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION I FOR;INSURANCE, OOMPANY;USE I Al. Building Owner's Name Don & Diane Lehn poncy Numtier: A2. BuildinStreet Address including Apt., Unit, Suite, and/or Bldg- No.) or PO. Route and Box No. Company NAIL Number: 1 138 Pickerel Point Road City Grantsburg State WI ZIP Code 54840 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Part of Gov't Lot 4, Section 21, T.37, R.18, Burnett County, WI PIN 07-034-2-37-18-21-5 05-004-015000 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential (Cabin) A5. Latitude/ Longitude: Lat. 4.5 873938 Long. -92810457 Horizontal Datum: ❑ NAD 1927 [F] NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number q A8. For a building with a crawlspace or enclosure(s): A9, For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 788 sq ft a) Square footage of attached garage sq ft b) Number of permanent flood openings in the crawlspace 0 b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑ Yes N No d) Engineered flood openings? ❑ Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bl. NFIP Community Name & Community Number B2. County Name - B3. State Burnett County 550032 Burnett County N feet I WI B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone ❑ feet ❑ meters Revised Date N feet A0, use base flood depth) 0586 C 08/19/2008 915. 1 AE 910.6 feet 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: [9 AS Profile ❑ FIRM ❑ Community Determined ❑ Other/Source: Bll. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 N NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑ No Designation Date: / / ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* N Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. 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 below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: Trade Bridge vertical Datum: NAVD 88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 N NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 0 Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 914 9 Check the measurement used. - N feet ❑ meters 917 3 N feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters 915. 1 N feet ❑ meters 915. 8 N feet ❑ meters 915. 1 N feet ❑ meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or Imprisonment under 18 U.S. Code, Section 1001. \\\ \ 1 I ( I I t !/7Z, El here if comments are provided on back of form. Were latitude and longitude in Section A provided by a \�,caG O N ❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No FEMA Form 086-0-33 (Revised 7/12) See reverse side for continuation. Replaces all previous editions. - K g • : F CR FEMA Form 086-0-33 (Revised 7/12) See reverse side for continuation. Replaces all previous editions.