722 DrennenU.S, DEPARTMENT OF HOMELAND SECURITY OMB No. 1ss0-000B
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
SECTION A - PROPERTY INFORMATION
FOR INSURANCE COMPANY USE '.
Al Building Owner's Name
Policy Number:
BAXTER PROPERTIES INC
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
an Company
p y N AIC Number:
722 DRENNEN
City State ZIP Code
Van Buren Arkansas 72956
A3. Property Description (Lot and Block Numbers, Tax ParcelNumber, Legal Description, etc.)
700-00771-000; LOT 73 ORIGINAL TOWN VAN BUREN
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Let, 35'26'01.68" Long.-94°20'58.31" _ 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,
AT Building Diagram Number 1A
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) sq IT
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade
c) Total net area of flood openings in AB.b sq in
d) Engineered flood openings? ❑ Yes ❑ No
Ag. For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? Yes D No
SECTION a - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1, NFIP Community Name & Community Number
B2. County Name
B3. State
VAN BUREN, 050053
CRAWFORD
Arkansas
B4. Map/Panel
B5. Suffix
86. FIRM Index
87. FIRM Panel
B8. Flood Zone(s)
B9. Base Flood Elevation(s)
Number
Date
Effective/
(Zone AO, use Base
Revised Date
Flood Depth)
05033CO390J
J
12/03/2010
12/03/2010
AE
410,00
810. Indicate the source of the Base Flood Elevation (BEE) data or base flood depth entered in Item B9:
❑ FIS Profile- Q FIRM ❑ Community Determined Q Other/Source: SCALED FROM FIRM & QUAD SHEET
B11, Indicate elevation datum used for BEE in Item B9: ❑ NGVD 1929 Z NAVD 1988 El Other/Source:
B12, Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes E] No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
!' t
OMB No. 1660-0008
Expiration Date: November 30, 2018
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:
722 DRENNEN
City State ZIP Code
Company NAIC Number
Van Buren Arkansas 72956
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY
REQUIRED)
01. Building elevations are based on; ❑ Construction Drawings' ❑ Building Under Construction* U 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, V1—V30, V (with BFE), AR, ARIA, AR/AE, AWA1—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: UAFS Vertical Datum: NAD 1983
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 x❑ NAVD 1988 ❑ OtherlSource:
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) 411 . 00
feet ❑meters
b) Top of the next higher floor N/A.
❑x feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A.
0 feet ❑ meters
d) Attached garage (top of slab) N/A.
Z feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building N/A. _
0 feet ❑ meters
(Describe type of equipment and location in Comments)
- -
f) Lowest adjacent (finished) grade next to building (LAG) 406, 83
n feet ❑meters
g) Highest adjacent (finished) grade next to building (HAG) 407,50EXI
feet [] meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A,
Z feet ❑ meters
structural support
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 the information on this Certificate represents my best efforts to interpret the data available. l understand that any false
statement may be punishable byline or imprisonment under 18 t/.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ❑ Yes ❑ No
❑ Check here if attachments.
Certifier's Name License Number
RICKY W. HILL 1443
srrRfi
E� •.
INe `r•.
Title
PLS
QF `�
"a ' Qe4s F
Company Name
SATTERFIELD LAND SURVEYORS, PA
Address
1928 HWY 71 NORTH;siPQ-
°;rACiLANb''4
City State ZIP Code
ALMA Arkansas 72921
Sig r ore Date Telephone
�N J 09/07/2017 (479) 632-3565
Elev
Copy all page of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenticompany, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
FEMA Form 066-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6
OMB No.
1660-0008
Expiration
Date:
November
30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Sldg. No.) or P,O, Route and Box No.
Policy Number:
722 DRENNEN
City State ZIP Code Company NA Number
Van Buren Arkansas 72956
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 Et—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 F 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 1-2 of Instructions),
the next higher floor (elevation C2.b in
the diagrams) of the building is i ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4, Top of platform of machinery and/or equipment
servicing the building is ❑feet ❑ meters ❑ above or ❑ below the HAG.
E5. ZoneADonly: 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 or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑ Check here If attachments.
FEMA Form 086-0.33 (7/15) Replaces all previous editions. Form Page 3 of 6
OMB No.
1660-0008
Expiration
Date:
November
30, 2018
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:
722 DRENNEN
City State ZIP Code Company NAIC Number
Van Buren Arkansas 72956
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 Itom(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)
❑ feet
of the building: ❑ 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 (including type of equipment and location, per C2(e), if applicable)
❑ Check here if attachments.
FEMA Form 086-0-33 (7/1 S) Replaces all previous editions. Form Page 4 of 6