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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.