Lot 16, Spring Ridge Elevation Certificate.tif U.S, DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY � ram �� OMB No 1660-0008
Natrona! Flood Insurance Program
s Important: Read the instructions on pages 1 -9. Expiration Date July 31 2015
SECTION A- PROPERTY INFORMATION f�tf 3bitPthE ;t(�Af1` Lit
Al Building Owner's Nome ,1[ "RCt41YAND 1iE1Dl 14ORk.11 I 40113be1.+
A2 Building Street Address (including Apt., Unit n .. . . Route o
Suite, and /or Bldg. No or P.O Route and Box No �Z tiiir°stly NAItJ Numb-t
13745 SPRING RIDGE LOOP
City BLAIR State NE ZIP Code 68008
A3 properiy Description (Lot and Biock Numbers, Tax Parcel Number, Legalbescription, etc )
LOT 16, SPRING RIDGE, A SUBDIVISION IN WASHINGTON COUNTY, NEBRASKA
A4 Building Use (e g, Residential, Non - Residential, Addition, Accessory, etc) RESIDENTIAL
A5 Latitude /Longitude: Let 41.48825 Long - 96.16953 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 7
AB For a building with a crawlspace or enclosure(s): A9 For a building with an attached garage:
a) Square footage of crawlspace or enclosures) 1792 sq 11 a) Square footage of attached garage 758 sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 10 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8 b 0 sq in c) Total net area of flood openings in A9 b 0 sq in
d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No
_a
SECT ION B - FLOOD INSURANC RATE MAP (F IRM) INFORMATION
61 NFIP Community Name & Community Number 132. County Name i B3 State
CITY OF BLAIR ETJ 310228 WASHINGTON NE
B4 Map /Panel Number B5 Suffix B6 - FIRM index Date 67 FIRM Panel B8, Flood B9 base Flood Elevation(s) (Zone
3117700285 D 01 -05 -2012 Effective /Revised Date Zone(s) AO, use base flood depth)
01-06-2012 .. __ — m 1178.0
0 . _
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: NEBRASKA DNR DETERMINATION
B11 Indicate elevation datum used for BFE in Item B9: ❑ 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)
C1 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
c', Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, Vi -V30, V (with BFE), AR, ARIA, AR/AE, AR/A1 -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: Vertical Datum: NAVD 1988
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) 1180 7 ® feet ❑ meters
b) Top of the next higher floor 1190,3 0 feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) NA NA ❑ feet ❑ meters
d) Attached garage (top of slab) 1189 0 ® feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 11807 ® feet ❑ meters
(Describe type of equipment and location in Comments)
0 Lowest adjacent (finished) grade next to building (LAG) 1.180 2 ® feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 1189 0 ® feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 1180,4 ® feet ❑ meters
SECTION D - SUR VEYOR, 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 the information on this Certificate represents my best efforts to interpret the data available. ,l 7A ' I l l 3 .
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 'l l
® Check here if attachments licensed land surveyor? ® Yes ❑ No
-- ___— ,..._ ..... . ..... . . _. �' �;
Certifier's Name RICHARD M BROYLES License Number NE RLS # 477
Title REG LAND SURVEYOR Company Name THOMPSON, DREESSEN & DORNER INC,
Address 10836 OLD MILL ROAD City OMAHA State NE ZIP Code 68154 r Uti,
is X
t lr tllwup ' Date 01 -18 -2013 Telephone 402- 330 -8860 i i r0
s a
FEMA Form 0861 See reverse side for continuation. Replaces all previous editions
tt `er�w� va..i�u wrest �.., txrxrax.
IM PORTANT: In th spaces, copy the correspo information from Section A. I `Or tfta == Of��l 11
_
Building Street Address (including Apt, Unit, Suite, and /or Bldg. No.) or P.O: Route and Box No Po'lloy Nurnhar,
13745 SPRING RIDGE LOOP
City BLAIR State NE ZIP Code 68008 l.!ltripv yr RA10 Nufaboc
S ECTION D - SURVEYOR, ENGINEER, OR A RCHITECT CERTIFICATION (CON TINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner
Comments THE BASE FLOOD ELEVATION OF 1178.0 WAS ESTABLISHED BY THE NEBRASKA DEPARTMENT OF NATURAL RESOURCES THE
DETERMINATION IS EFFECTIVE JANUARY 28, 2013, SEE ATTACHED DOCUMENT
I
Signature "' Date 01 -18 -2013
- SECTION E - BUILDING ELEVATION INFORMATION ( SURVEY NOT RE QUIRED) 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, crawispace, or enclosure) is ❑ feet ❑ meters ❑ above or Q 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 f above or ❑ below the HAG
_.....
E3 Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG,
E4 To of platform of machine and /or en
Top p machinery 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 ❑ U nknown The local official must certify this information in Section G.
SECTION F -- PR OPERTY OWNER (_OR OWNER'S R EPRESENTATIVE) 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
Address City State ZIP Code
-
----------
Signature Date Telephone
Comments
Check here if attachments.
SECTION G - CO MMUNITY INFORMATION (OPTIONAL
The local oft5c(a who is aothwl m'd lag low orordinan to a lminister the community's floodplain management can ceroplete Sections A, FX W4), esrgd 4�
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 � 65 Date Permit Issued G6 Date Certificate Of Compliance /Occupancy Issued i
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
09 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
0 86 0.33 (7112) Replaces all previous editions