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U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
Federal Emergency Management Agency
National Flood Insurance Program Important: Read the instructions on pages 1-8.
OMS No. 1660-0008
EXDires Februarv 28. 2009
SECTION A - PROPERTY INFORMATION For Insurance Company Use:
A 1. Building Owner's Name Jeff & Heather Pederson Policy Number
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Nurnber
15363 Red Oaks Road SE
City Prior Lake
State. MN ZIP Code 55372
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lots 38 and 39, RED OAKS, Scott County, Minnesota
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RES
A5. Latitude/Longitude: Lat. 44.726 Long. -93.424 Horizontal Datum: D NAD 1927 181 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 I
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
A9. For a building with an attached garage, provide:
a) Square footage of attached garage 1065 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 _ sq in
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name B3. State
Prior Lake 270432 Scott MN
_ sqft
sqin
~I~~ [~ ~ Z007
By --:::;:::::::::c::::-.:::-.:--~=.:::.
84. MaplPanel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
270432 0004 C 11-19-1997 11-19-1997 AE 909
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
o FIS Profile 181 FIRM 0 Community Determined 0 Other (Describe)
B11. Indicate elevation datum used for BFE in Item B9: 181 NGVD 1929 D NAVD 1988 D Other (Describe)
B12. Is the bUilding located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? DYes I8INo
Designation Date _ D CBRS DOPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
b)
c)
d)
e)
Building elevations are based on: D Construction Drawings* D Building Under Construction*
*A new Elevation Certificate will be required when construction of the building is complete.
Elevations - Zones A 1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARiA, ARlAE, ARIA 1-A30, ARlAH, ARlAO. Complete Items C2.a-g
below according to the building diagram specified in Item A7.
Benchmark Utilized AC7590 Vertical Datum NAVD 1988
Conversion/Comments Converted to NGVD 1929 usina Vertcon 2.1 software from NGS website
Check the measurement used.
908.~ ~ feet b meters (Puerto Rico only) .
lllL.~ IgJ feet D meters (Puerto Rico only)
_ _ 0 feet 0 meters (Puerto Rico only)
mlL.IDL- ~ feet D meters (Puerto Rico only)
_ _ 0 feet D meters (Puerto Rico only)
181 Finished Construction
C1.
C2.
a) Top of bottom floor (including basement, crawl space, or enclosure floor).
Top of the next higher floor
Bottom of the lowest horizontal structural member (V Zones only)
Attached garage (top of slab)
Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment in Comments)
Lowest adjacent (finished) grade (LAG)
Highest adjacent (finished) grade (HAG)
,OOL.mL-
~.mL-
~ feet
lia feet
D meters (Puerto Rico only)
D meters (Puerto Rico only)
f)
g)
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. I certify that tha 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 he~mments are p ided on back of form.
V~ W.
Certifier's Name David G. Rapp License Number 22044
City Kenyon
State MN ZIP Code 55946
telephone 507-789-5366
Title President
Company Name Rapp Land Surveying, Inc.
Signature
Date 12-5-2007
IMPORTANT: In these spaces, copy the corresponding infonnation 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
15363 Red Oaks Road SE .
City Prior Lake State MN ZIP Code 55372 Company NAIC Number
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
s~"2~~ ~
Date 12-5-2007
o Check here if attachments
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.
E 1. Provide elevation information for the following and check the appropriate boxes to show whett-.er tt-.e elevation is above or below the highest adjacent
grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement, crawl space, or enclosure) is _'_ 0 feet 0 meters 0 above or 0 below the HAG.
b) Top of bottom floor (including basement, crawl space, or enclosure) is _'_ 0 feet 0 meters 0 above or 0 below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 of Instrudions), the next higher floor
(elevation C2.b in the diagrams) of the building is _'_ 0 feet 0 meters 0 above or 0 below the HAG.
E3. Attached garage (top of slab) is _'_ 0 feet 0 meters 0 above or 0 below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is _'_ 0 feet 0 meters 0 above or 0 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? 0 Yes 0 No 0 Unknown. The local official must certify this information in Sedion G.
SECTION F - PROPERTY OWNER (OR OWNExS ~L... '"':...~_. - .
- --," ---
Tn",; ;::~r;~,,=rty '}w~~e, '}f '}wner's authmiz.ed representative who (;ompletes Sections A, B, and E for Zone A (without a FEMA-issued or commlJnity-issued BFE)
"..,.____...:.............__~_ __r-_..__~_ ::......"-_-=__-"........________..._...._._._ aoa____
i IH.ii-t'Oii..J' .-"'h'Hi:j:i":; vi ~j"i'l!rGt';:; ",""'iiii.iiirill&::..i:i"u i ..oGjiIHJ..:H:firc.u.c..iirG u. ,,;';P:F"<!~J
" -"_t__ __
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vitj
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Signature
Date
Telephone
i."Oti1tTISOiS
o Check here if attachments
" SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by !a'll or ardln;::;::: :: :::-:-:'<:::' ::~: : - , ,
and G of this Elevation Certificate. Complete ~e applj{'~blH iAAml",'1 :.r...l "'~m", to<!li;;.li C5,,,,"'~: j;.,.,.""..,.":"."":.,,,,,' ..:..,..
G1. 0 The infonnation in Section C was taken from other documentation that has been signed and sealed by a licensed $1.lrveYOf, en!Ji~f, Of arc.l'lnet:~ w"')
is s!Jthorized by law to certify elevation infonnation. (Indicate the source and date of the elevation data in the Comments area below.)
G2. 0 A community official completed Section E for a building located in Zone A (without a FEMA-issued Of community-issued BFE) or Zone AO.
G3. 0 The following infonnation (Items G4.-G9.) is provided for community floodplain management purposes: ,
; ";;4. !-';;;rrmt N!,lm!::i;;;r l (;5. Date Permit Issued
G6. Date Certificate Of Compliance/OcCupancy Issued
Gi. ihi~ (J~lfllil hC;t~ Ut;tt:11 i~:>w;::u rul. 0 Nt:w CUfl~hul.iiiulI
o Suu:)h:;llliiGli irflfJIOVt;t"I~lIl
Ga. Elevation of as-built lowest floor (including basement) of the building: _'_ _0 feet 0 meters (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: . _'_ 0 feet 0 meters (PR) Datum
Local Official's Name
Title
Community Name
Telephone
Signature
Date
Comments
o Check here if attachments