HomeMy WebLinkAboutCertificate of Elevation
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Expires February 28, 2009
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
Important Read the instructions on pages 1-8.
SECTION A - PROPERTY INFORMATION
.. For InSUfClooeComp,my Use:
A 1. Building Owner's Name
Martin Rybak
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
14364 Rutgers Street Northeast
City Prior Lake State MN ZIP Code 55372
COlTlpiinyN,l\19 Number'
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PID: 25-930098-0
A4. Building Use (e.g., Residential. Non-Residential, Addition, Accessory, etc.) Residentia!
AS. Latitude/Longitude: Lat. 44-44-33.56 Long. @3-23-24.2Q Horizontal Datum: 0 NAD 1927 I:2l 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 crawl space or enclosure(s), provide A9. For a building with an attached garage. provide:
a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage ~ sq ft
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
enclosure(s) walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade Q
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b Q sq in
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
r 81. NFIP Community Name 8. Community Number 82. County Name IBM3N. State
Prior Lake MN 270432 Scott I M
84. Map/Panel Number B~;:"'Su'ffix-' B6. FIRM Index B7. FIRM Panel 88. Flood....Si:r..8ase Flood Elevation(s) (Zone
Date Effective/Revised Date Zone(s) AO. use base flood depth)
2704320002 C November 19.1997 November 19,1997 AE 909
810, Indicate the source of the Base Flood Elevation (BFE) data or base Oood depth entered in Item B9.
o FIS Profile I:2l FIRM 0 Community Determined 0 Other (Describe)
811, Indicate elevation datum used for 8FE in Item 89: I:2l NGVD 1929 0 NAVD 1988 0 Other (Describe)
812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date 0 CBRS DOPA
DYes
I:2lNo
SECTION C . BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
t21 Finished Construction
Building elevations are based on: 0 Construction Drawings. 0 Building Under Construction'
. A new Elevation Certificate will be required when construction of the building is complete,
Elevations-Zones A1-A30, AE. AH, A (with BFE), VE, V1-V30, V (With BFE), AR. ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO.
below according to the bUilding diagram specified in Item A7.
Benchmark Utilized TNH=909,1 E! Vertical Datum NGVD:1.Q4Q
Conversion/Comments
C1.
C2.
a)
Top of bottom floor (including basement, crawl space, or enclosure floorl-
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 in Comments)
f) Lowest adjacent (finished) grade (LAG)
g) Highest adjacent (finished) grade (HAG)
Complete Items C2.a-g
~7 to
v,"J 0
{Uj'l-'2-
~ 1 Check the measurement used.
910.55 I:2l feet 0 meters (Puerto Rico only)
9~.1.Q!?' I:2l feet 0 meters (Puerto Rico only)
t:liA.Q I:2l feet 0 meters (Puerto Rico only)
91Q.Q? I:2l feet 0 meters (Puerto Rico only)
l1.1Q.i& I:2l feet 0 meters (Puerto Rico only)
909.~
~.Q
I:2l feet 0 meters (Puerto Rico only)
t21 feet 0 meters (Puerto Rico only)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signedandsealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. / certify that the infonnation on this Cerlificate represents my best efftJrts to Interpret the data available.
I understand that any false statement may be punishable by tine or imprisonment under 18 U.S. Code, Section 1001.
o Check here if comments are provided on back of form.
Certifier's Name Jeffrey D, Lindgren
Title VP
License Number 14376
Address 2005 Pin Oak Drive
City Eagan
Company Name Hedlund Engineering Services, Inc.
State MN ZIP Cod" 55122m
Date 6/18/08
FEMA Form 81-31, February 2006
Telephone 651-203-6615
See reverse side for continuation.
Replaces all previous editions
U,S, DEPARTMENT OF HOMELAND SECURITY - FEDERAL EMERGENCY MANAGEMENT AGENCY
COMMUNITY ACKNOWLEDGMENT FORM
O,M.B. NO. 1660-001S
E;q1iru D_btl1' 31. Z010
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1.38 hours per response. The burden estimate Includes the time for reviewing instructions,
searching existing data sourcas, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required
to respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding
tho accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, U,S. Depertment of
Homeland Security, Federal Emergency Management Agency, 500 CStreet, SW, WaShington DC 20472, Paperwork Reduction Project (1660-0015).
Submission of the form is required to obtain or retain benefits under the National Flood Insurance Program. Please do not send your completed
survey to the above address.
-'
This form must be completed for requests involving the existing or proposed placement of nil (complete Section A) OR to provide acknOWledgment of
this request to remove a property from the SFHA which was previously located Within the regulatory nOOdWllY (complete Section 8).
This form must be completed and signed by the official responsible for floodplain management in the community. The six digit NFIP community
number and the subject property address must appear in the spaces provided below. Incomplete submissions may result In processing delays.
Community Number: :2 70 1.f3~ Property Name or Address: Ill- 36 'f /(v..t:.!Jer S S "tn:e't: /liE
A. REOUESTS INVOLVING THE PLACEMENT OF FILL
As the community official responsible for floodplain management. I hereby acknowledge that we have received and reviewed this Letter of Map Revision
Based on Fill (LOMR-F) or Conditional LOMR.F reqUeSt. Based upon the community's review, we find the completed or proposed project meets or is
designed to meet all of the community floodplain management requirements, inclUding the requirement that no fill be placed in the regulatory floodway,
and that all necessary Federal, State, and local permits have been, or in the case of a Conditional LOMR-F, will be obtained. In addition, we have
determined that the land and any existing or proposed structures to be removed from the SFHA are or Will be reasonably safe from flooding as defined in
44CFR 65.2(c), and that we have available upon request by DHS-FEMA, all analyses and documentation used to make this determination. For LOMR-F
requests, we understand that this request Is being forwarded to DHS-FEMA for a possible map revision. For LOMR-F or Conditional LOMR-F requests
that have the potential to impact an endangered species, documentation Will be submitted to show that we have complied with Sectlcns 9 and 10 of the
Endangered Species Act (ESA). Section 9 of the ESA prohibits anyone from "taking" or harming an endangered species. If an action might harm an
endangered species, a permit Is required from U,S. Fish and Wildlife Service or National Marine Fisheries Service under Section 10 of the ESA. For
actions authorized, funded, or being carried out by Federal or State agencies:'documentatlon from the agency shoWing its compliance with Section
7(a)(2) olthe ESA Will be submitted.
Community Comments:
Community Official's Name and Title: (Plesse Print or Type)! c../J. M ...... L LJ'I.
e. IT ...~ e.f~' Q"rJlle...
Commun ity Name; Comm~y ~ia~'s Si nature:?Uired)
C,'ty crF Prio,.. Lr;..ke ~..
B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY:
As the community official responsible for floodplain management, I hereby acknowledge that we have received and reviewed this
request for a LOMA, We understand that this request is being fOlWarded to DHS-FEMA to determine if this property has been
inadvertently included in the regUlatory f1oodway. We acknowledge that no fill on this property has been or will be placed within the
designated regulatory f1oodway. We find that the completed or proposed project meets or is designed to meet all of the community
floodplain management requirements.
Telephone No.:
'S~-"''''7 - '81(1
Date:
/0-;;" -Og
Community Comments:
Community Official's Name and Title: (Plesse Print or Type)
Telephone No.:
Community Name:
Community Official's Signature (required):
Date:
DHS " FEMA Form 81-87B, OEe 07
Community Acknowledgment Form
MT-1 Form 3 Page 17 of 1
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APPROXIMATE SCALE
o
500 FEET
NAT/OHAl ROOD . INSURANCE PRtl&RAM
FIRM
flOOD INSURANCE RATE MAP
CITY OF
PRIOR LAKE,
MINNESOTA
soon COUNTY
PAREl Z OF 4
tSEl! tvSAP INDEX, "CA PA~'ELS NOT PRIN'fEDJ
COMMUNITY - PANEL NUMBER
270432 0002 C
MAP REVISED:
NOVEMBER 19. 1991
I
Federal Emergency M..........__.Dl AIIClJCY I
. --------_._----_._--~
Thls is an official copy of a portion of the- abOw refereneed flood map. It
wm; extracted using F..fvIiT On-Unt'.!. This map does nat refteot, changes:
or amendments which may !ta\ole been made sUbsequent to the date on the
title block. For the latest prOduct information about Nationaf Rood Insurance
Program !load /'napa cheek the FEMA Flood Map Store at WWN.mse.fe.rna.gov
For a building with an attached garage, provide:
a) Square footage of attached garage 592 sq ft
b) No. of permanent flood openings in the attached garage
walls within 1.0 foot above adjacent grade Q
c) Total net area of flood openings in A9.b Q
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-8.
SECTION A - PROPERTY INFORMATION
A 1. Building Owner's Name
Martin Rybak
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
14364 Rutgers Street Northeast
City Prior Lake State MN ZIP Code 55372
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PID: 25-930098-0
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residentia!
A5. Latitude/Longitude: La!. ~~ AA 33.512 Long. 93-23-24.20
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 crawl space or enclosure(s), provide
a) Square footage of crawl space or enclosure(s)
b) No. of permanent flood openings in the crawl space or
enclosure(s) walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b
Horizontal Datum:
A9.
sq ft
sqin
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
OMS No. 1660-0008
Expires Februarv 28, 2009
...f~rlN>4~@~RPrrl~~YlJS~:..'''.'.. ..
o NAD 1927 ~ NAD 1983
sqin
B1. NFIP Community Name & Community Number
Prior Lake MN 270432
B2. County Name
Scott
B3. State
MN
B4. Map/Panel Number
B5. Suffix
B6. FIRM Index
Date
November 19,1997
B7. FIRM Panel
Effective/Revised Date
November 19,1997
B8. Flood
Zone(s)
AE
270432 0002
C
B 1 O. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
o FIS Profile I:8l FIRM 0 Community Determined 0 Other (Describe)
B11. Indicate elevation datum used for BFE in Item B9: I:8l NGVD 1929 0 NAVD 1988 0 Other (Describe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date 0 CBRS DOPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
909
DYes
~No
C 1. Building elevations are based on: 0 Construction Drawings' 0 Building Under Construction' ~ Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones A 1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A 1-A30, AR/AH, AR/AO. Complete Items C2.a-g
below according to the building diagram specified in Item A7.
Benchmark Utilized TNH=909.18 Vertical Datum NGVD-1929
Conversion/Comments
Check the measurement used.
a) Top of bottom floor (including basement, crawl space, or enclosure f100rL
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 in Comments)
f) Lowest adjacent (finished) grade (LAG)
g) Highest adjacent (finiShed) grade (HAG)
910.1
921.1
N/A.Q
910..2
910.1
I:8l feet 0 meters (Puerto Rico only)
I:2l feet 0 meters (Puerto Rico only)
I:2l feet 0 meters (Puerto Rico only)
I:2l feet 0 meters (Puerto Rico only)
I:8l feet 0 meters (Puerto Rico only)
909.~
910.Q
I:2l feet 0 meters (Puerto Rico only)
I:8l feet 0 meters (Puerto Rico only)
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.
o Check here if comments are provided on back of form.
Certifier's Name Jeffrey D. Lindgren
License Number 14376
Title VP
.___., _...on'h_... ____'..,__ ..__ ._..
Company Name Hedlund Engineering Services, Inc.
Address 2005 Pin Oak Drive
-- .---- --
City Eagan
State MN ZIP Code 55122
Si9",1~1J. 4
Date 9/23/08
Telephone 651-203-6615
~ .
FEMA Form 81-31, February 2006
See reverse side for continuation.
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Replaces all previous editions
Grading
As
Built
SURVEY FOR : Mark Halvorson
DESCRIBED AS :AII that part of Goverment Lot 3. Section 3D, Township 115, Range 21, described as follows: Beginning at a point on the
west line of "Boudin's Manor", whichpoint is 17.0 feet north and 30,0 feet westof the northwestcorner of Lot No. 56 of said" Boudin's Manor";
thence southwest at right angle to the said west line of Boudin's Manor a distance of 235,0 feet; thence southwest at an angle of 1 03.56 feet a
distance of 85.0 feet; thence northeast at an angle of 74 degrees 23 minutes a distance of 255.6 feet to the west line of said "Boudin's Manor";
thence northwest along said west line of Boudin's Manor a distance of 75.0 feet to the point of beginning.
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LOT SQ. FOOTAGE == 15,792
LOT COVERAGE 3,811
IMPERVIOUS COVERAGE 24%
"
OCT 1
Z008 I
~j
PROPOSED ELEVA~ONS
1
~ 0
Top of Foundation
Garage Floor
Basement Floor
Aprox. Sewer Service
Proposed Elev.
Existing Elev,
Drainage Directions
Denotes Offset Stake =
= 910,7
= 910.2
= 910,7
= N/A
= ( )
~
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BE~<;HMARK,
-"... ~-
MIN. SETBACK REQUIREMENTS
=
....
SCALE: 1 inch = .30 feet
Front -
Rear
House Side
Garage Side
=
DATE
I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION
OF THE BOUNDARIES OF THE ABOVE DESCRIBED PROPERTY AS SURVEYED
BY ME OR UNDER MY DIRECT SUPERVISION AND DOES NOT PURPORT TO
SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN.
() J~ __ D. j, . O. -'
/JEtfdlEY (d. LINDGREN, LAND Q:;URVEYOR
MINNESOTA LICENSE NUMBER 14.376
JOB NO:
HEDLUND
07R-063
BOOK: PAGE:
PLANNING ENGINEERING SURVEYING
2005 Pin Oak Drive
Eagan, MN 55122
Phone: (651) 405-6600
Fax : (651) 405-6606
'1 / 30/ DB
CAD FILE:
Misc 07