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HomeMy WebLinkAboutElevation Certificate U.S.dEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATION Al. Building Owner's Name John Brunello A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. 825 Willow Drive City Orono State MN ZIP Code 55331 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) N.235 feet of E.200 feet of Gov't Lot 7,Sec.10,Twp.117,Rge.23. PID#-10-117-23-22-0001 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Res A5. Latitude/Longitude:Lat.44.96326 Long.93.57926 Horizontal Datum: ❑ NAD 1927 ® 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 1 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) sq ft a) Square footage of attached garage 483 sq It b) Number of permanent flood openings in the crawlspace 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 sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ® No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State Orono-270178 Hennepin Minnesota B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 0304 E Effective/Revised Date Zone(s) AO,use base flood depth) Sept.2,2004 A 930.9 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ❑ FIRM ❑ Community Determined ® Other/Source:MN DNR B11. Indicate elevation datum used for BFE in Item 139: ® NGVD 1929 ❑ 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* ® 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,Vi-V30,V(with BFE),AR,AR/A,ARAE,AR/Al-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only,enter meters. Benchmark Utilized:GSID#11336 Vertical Datum: 980.17 Indicate elevation datum used for the elevations in items a)through h)below. ® NGVD 1929 ❑ NAVD 1988 ❑Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a)Top of bottom floor(including basement,crawlspace,or enclosure floor) 933.2 ®feet ❑meters b)Top of the next higher floor 941.5 ®feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) ❑feet ❑meters d)Attached garage(top of slab) 933.2 ®feet ❑meters e) Lowest elevation of machinery or equipment servicing the building ❑feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 932.7 ®feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 940.8 ®feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support 933.4 ®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. /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. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a PLACE ❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No SEAL Certifier's Name David Pemberton License Number 40344 HERE Title Land Surveyor Company Name Sathre-Bergquist,Inc. Address 150 Broadway Ave. City Wayzata State MN ZIP Code 55391 Signature Date 4/16/13 Telephone 952-476-6000 FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions. �r.�•r,.... . ..� .. ....,.�, rays� IMPORTANT:In these spaces,copy the corresponding information from Section A. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. 825 Willow Drive ... =`- City Orono State MN ZIP Code 55331 `A SECTION D—SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments Signature Date SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1—E5.If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C.For Items E1—E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet Elmeters Elabove or E]below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown.The local official must certify this information in Section G. SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name David Pemberton Address 150 Broadway Ave.S. City Wayzata State MN ZIP Code 55391 Signature Date 4/16/2013 Telephone 952-476-6000 Comments ❑Check here if attachments. SECTION G—COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G8—G10.In Puerto Rico only,enter meters. G1.❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The following information(Items G4—G10)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. REVISIONS " SITE ADDRESS 825 Willow Drive South,Orono,Minnesota. NORTH ' • AT�/R Lor00•ajAW DESCRIPTION OF SUBIECT PROPERTY NN041'59•W Rn 2M.04 Z .. y` a 20 10 0 10 20 40 --- a _. The North 233 feet of the East 200 fee of Government Lot 7,Section 10,7 17,Range , T. �-{ - PMIt M Hennepin Cotmy.Minnesota,according w the Government Survey thereof. c" 1 Ran 23 irr iA- VA � _ ) : 1 i SCALE IN FEET \ t \ ! I \ `ice /! m+1 `•' I 7iS - WETLAND .+'� , V/ c) \I nE"�A�` PRESERVE �v: NOTES vim) 1 � This survey does rad purport to show all underground utilises The source ofnfbrtnahon from putts and shakings /'� z will be combined with observed evidence of utilities to develop a view of those underground ut ities However, v •. _,A£.IA�3 \ \ - 1 I •4 licking excavation,the exam location of underground features cannot be accurately,completely and reliably depicted. (� F -� I h 4 1 T Where additional or more detailed information is required the client ss advised thatexcavatim may be necessary. �/ Q • L -1-I- � �t x-r \ �S=;t \) The contractor shall determine the exact location of any and all existing utilities before commencing work The tall W fQJ contractor shall be fully responnble for any and all damages arising out of his failure to exactexactlyocate and prase w 3 rr'u-yrs 'x 1.16 existing utility facilities. } �. A iQ iE7'tw-+.o 1 1 Contxt GOPHER STATE ONE CALL at 1-0540002 for precise onsite location ofmilities prior 3 �. -.___.�-y____- / \ 1 1 •�• \g4�a excavahat. 0 mK 4E7'q- a Ci ` -- t• 'y �6,, ,�1\\ ,.,a 11 1 No site commstrnmt was provided or relied open as to manes ofrecord. 03 f \ t k 1 Thc subjeut propcssy appcan m Ile within Zac X,(coca of rocas outside the 1-percent annual then floodplam. _ LEGEND t I t / / 7 } ..1 area of 1%armual chance sheet lbw flooding where avenge depths are less than I foo,areas of 1%armual chance AIS Denotes Advertising-Informational Sign • I \\ ,./ j ' +, , 1 stream flooding where the contributing drainage mea is leu than I square mile,or areas protected From the 1% 0 AC Denotes Air Conditioning Unit I L _ `/J / annual chance flood by levees.No Base Flood Elevations or depths are shown within this zone.Insurance purchase is Q rn 9FE Denotes Basement Floor Elevation 14E7L/}tp ltifFR fff y / 1 1 riarequiredm these zones and Zone A(Area with a I°.annual chance of flooding and a 26%chance of flooding U / 1 over the fife of a 30-year mortgage.Became detailed analyses me not performed for such areas;no depths or base CB Denotes Catch Basin I e _ _. - ^ { / "**tot.. / 1 Flood elevations are shown within these zanea),per the National Flood In xuar ce Program,Flood Iroumnce Rate CBOX Denotes Curb Box e 1 Map Community Panel Na.27053C(1304E,dated Seplemher 2 2004 as acquired from the Federal Emergency CDL Denotes Building Cohmm /� ,w \ I \ /l _ _ J/ / 1 Management Agency Web Silo. DRS Sy�H � Denotes Building Entrance Elevation / i I ` y ti 1B Demotes Tcle/Caren.Box/Ped J g 1 Ana Information: Gross: 47,000 sq.fl.-1.079 acres yQ. CHH Denotes Conmumeam Handhole / �/ R/W: 11340 sot.R.-0.260 acres H- a / I I 1 -\ `. : Net: 75.660 -0.819 stns CMH Denotes Continuationon Manhole \ t�Wyy 0 Pa I 1 I nl W 1 . CONC Denotes Concrete Surface \ 1 gs t rC7lAlO 6UFFER g 1 8 u) W - i7�U/ 1 � ` � � 'p.��TM Current zoom and setback information: CNP Denotea Corrugated Metal Pipe/Size \ / I 1> „ .1 `Naa�t Nlg i9,�/ V2 DIP Denotes Ductile Iron PipwSize \\t'E7 t- /"'�_1' �3p: it I •` i •,-.. .Z ate 4. ,+ " 1 Zoning:RR-1 B-One Family Ruml Residential `DtV3 DES` lea. Itff}} EB Denotes Elm=Box - \ I / I: \i LV 1 Budding Setbacks.Front Yard-50 feet EHH Dander Electric Handhole I t 1 1 Rem Yard-50 feel IRAN Denotes Electric Transformer _ wiT�'79 I/ 1 \ ' .,., t 1 Side Yard-30 feet EMH Denotes Electric Manhole I I I �\ 1 4E"'a's ` Z Budding Height:2-1/2 Stories-30 feet. EM Denotes Electric Mctcr FH Derides Fire Hookup •"`s /I �/ \ . 9- / / 1 I , 1 'Zoning and Setback information provided by the Planning Depmtinentofthe City of Orono. FH Demotes Flag Pok 1ET 1-6 FES Denotes Flared End Section/Size Survey coordinate and bearing basis:Hennepin County OASV Deriaea Oma Valve .4 % I I �t-- may. .. 1 (JFE Dendee Gunge Floor Elevation [c \� / I \ _ - -- s ` No modifications to this survey i sketch may be performed by any pe �en es federal copyright GM Dennie,Gas Meter - - I / I �---< .. - , W CDL Denotes Gas Vie Light .. .+-. I '1 .\\ Iurnrep�uction anredistribution uout proper commit is Pm ibincl. ci ikons. Ground CP Dentia Gaud Post ' ✓ "'� " r, �I, \ • \1-- ' Benchmark: Water elevation of lake Minnetonka November 20,2012.-927.70 fed DYM Dcndea Guy Wire :.k 1 -� -'irr:�.� \\ ��Y�. g �'•� (Per Mimtehaha Creek Watershed district web site) O HCS Denotes Handicap Parking Sign F I.,'l _�-_+ N ) \ ,• fir' (/� O W HYD Denotes Fire Hydrant LP Denotes Light Poler,Y I _ \ I , /r t 1 w tL u MB Denotes Mailbox DP •r' xar t�a 9\ OPSIN NOUS\$ }� '' \\ / tx , EXISTING HARDCOVER INFORMATION O NDenotes No Parking Sig. L��� I\ \ _ _ • i y s 1 Hwee9Ousge: 2,105 sq.R E.t ¢ M� qAJ Denotes Overhead Utility Line • I ,,}, y •, 1 1 Gravel Driveway: I,I88 sq.tt �t 0. w PKS Denotes Parking Sign - \ ay, r _ �.- \ t 1 Concrete Surfaces 242 sq.ft PIV Denotes Post Indicator Valve - I.. \ `_ \+J i - Q i Duk: 242 sq.It y RCP Denotes Re-enforced Concrete Pipe/Size Stem: 61 w.R. w FMO4 s Roof Dram • ':' R BEE / \ ` \ Toud: 3,838 sq. RD De o e 11 SCG Denotes Sanitary Qeanout ,� *-t - I i' \►� \ - `•afiiy� \ \,,\. I , ` Hmdcover Percentage-Grin Area: 3.838/47.000-8.17°/s •N; �N F+•Y s Sanitary Manhole \ rM \_ _ - 1 e Handover -No A ca: 3.838 35,660-10.76 SMH Denote SV Denotes Septic Vent INEMAW \\ PIL \_ asr•aa .� is s STP Denotes Step Sign a,'\ ^r -r ,� ) \ ,. U i • •.,` STMH Derides Storm Menhok 3 _s• TRS Denotes Traffic Control Sign - - .. 1 •,i ' \ {- i 1 t TL Denotes Traffic LightS •=z^T �. + - - 1 1 l� 1 I j 1 hereby certify thin this strive),plan or report was prepared by me or S ):. • I.. ! • , \ 1 Ice \ under m dircd supervision and that I am a duly Licensed Land Suawyor UGC` Denotes Underground Communication Line •1 under the laws of the State of Munson LIGE Denotes Underground Electric Line 'is� - LIGG Denotes Underground Gas Linin 'i t /y 1� 4I I ,_- 1 Dated this 28th day of November,2012. SAN Denotes Underground Sanitary Sewer ST Detroit"Undergramd Storm Sewer \\ ) `\ `\ \\ SATIIRE-DERGQUIST,INC. DRAWN IJP Denotes Utility Pole \ , \ \ \ 4 T(-7\ I IAP Denotes Utility/Light Pole \ l \ \ \ I+ �M '+ti g 1 DBP TNH Denotes Tap Nd of Hydrant ) \ \ \ \ 1 -._ I 1 s - DATE WMH Dcndcs Water Manhole •++ \ ) �+e.. \--4 \ , 11/2312012 ■ :_ I I g David B.Pemberton,Professional land Surveyor WV Denotes Weer Valve 1 V z • 1 Minneeou Lks enNo.40344 SCALE WET A-1 "nes Wet DelinatioNFkg Identifier • � ---- 1 ',.� ', AS SHOWN Denotes Existing Contain 1 s 1 JOB NO. --<W­Dcnotes Proposed Carrow ' 40995.003 • Dann Found Moniunent-As Denoted \ 1 1 FILE: Oa Dimmer Faced Cam-Iron-Monurnent BNDRY-ALTA.DWG O Denotes In"by 14"Iron Pipe Set and Marked TOWNSHIP-RANGE-SECTION by Liernee No.40344 117-10-23 POL O Dentes"Point an Lire"set - R/W 0 Denotes'Right of Way*limits as HENNEPIN COUNTY Z� ` BOOK:)D« PAGE:Jot `U IZ S SHEET 1 OF ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT:In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number: 825 Willow Drive City Orono State MN ZIP Code 55331 Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View'; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. � t i a a Facing West I i FACING EAST FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number: City State ZIP Code Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. I� 77, - A FACING SOUTH FACING NORTH FEMA Form 086-0-33 (7/12) Replaces all previous editions.