HomeMy WebLinkAboutIDOT-Gary and Hollie Ritter - B&R Oil Corop-11/14/2016Page 1 of 6
Number: 201700003067
Recorded: 8/15/2016 at 3:35:49.130 PM
Fee Amount: $32.00.
Revenue Tax:
Sandie L. Smith, RECORDER
Black Hawk County, Iowa
Return to and Prepared by Katie Johnson, Right of Way Office, Iowa Department of Transportation,
800 Lincoln Way, Ames, IA 50010, 515-239-1216
Foran 634028 (01-14)
�lowAooT
Office of Right of Way
www.iowadot.gov
800 Lincoln Way, Ames, lowa 50010
Phone: 515-239-1135 FAX: 515-239-1247
PURCHASE AGREEMENT
Parcel Number: 51 County: Black Hawk
Project Number: NHSX-63-6(70)--3H-07 Route Number: 63
. B and R Oil Corp. -1/2 Interest; and
Seller: Gary C. Ritter and Hollie Ritter, his wife - 1/2 Interest p
THIS AGREEMENT entered into this 8 ikt day of Affrip57 _
by and between, Seller and the Iowa Department of Transportatiaf, acting for the State of Iowa, Buyer.
la. The Seller agrees to sell and furnish to the Buyer a conveyance document, on forms) furnished by the
Buyer, and the Buyer agrees to buy the following real estate, hereinafter referred to as the premises, in
parts of the following: Lot 5, Block 11, in the Original Plat on the West side of the Cedar River, In the City of
Waterloo, in the County of Black Hawk, State of Iowa, -and more particularly described on page 6, Including
the following buildings, improvements and other property:
All land, trees, shrubs, landscaping and surfacing attached to the premises sought and described herein
2. The Buyer agrees to pay, and the Seller agrees to grant, the right of possession, convey title and surrender
physical possessioq of the premises as shown on or before the dates listed below:
Paymehf Amount` " , : ('Agreed-Perfdrmande ": i ` Date[of PLeffonnance'
jOn conveyance of title 7 •
I
IOn surrender of possession
$3,000.00 !On possession and conveyance I 90 days after Buyer approval
$3,000.00 [Total Lump Sum Amount J
I
Breakdown ',`Ac/Sq Ft.
[Land by fee title 0 I !Fence 0 hods woven
Underlying fee title 0 ' Fence t 0 [rods barbed
(Permanent easement to
[the City of Waterloo to 1
construct & maintain a
(retaining wall _.._.._74 In ft.
DISTRIBUTION: TWO COPIES RETURNED TO BUYER (IOWA DOT) ONE COPY RETAINED BY SELLER.
51, NHSX-63-6(70)--3H-07
Page 1 of 6
File Number: 2017-00003067 Seq: 1
'Page 2 of
3. Possession of the premises is the essence of thls agreement and the Buyer may enter and assume -full use
and enjoyment of the premises per the terms of this agreement. The Seller grants the Buyer the immediate
right to enter the premises for the purpose of gathering survey and soil data. The Seller may surrender
possession of the premises, building, Improvement, or any part thereof, prior to the time that he/she has
agreed to do so, and agrees to give the Buyer 10 days notice of the Seller's Intention to surrender
possession by calling the Buyer at 1-866-282-5809.
4. The Seller warrants that there are no tenants on the premises holding under lease, except:
Craig Lindsey, 100 Commercial St., Waterlod, IA 50701
5. This agreement shall apply to and bind the legal successors in interest of the Seiler, and the Seller agrees
to pay all liens and assessments against the premises, including all taxes and•special assessments payable
until surrender of possession, as required by the Iowa Code section 427.2 and agrees to warrant good and -
sufficient title.
6. The Buyer may include mortgagees, lien holders, encumbrances, and taxing authorities as payees on
warrants issued In payment of this agreement. -In addition to the total lump -sum payment amount, the Buyer
agrees to pay $150.00 for the cost of adding title documents required by this transaction to the Seller's
abstract of title. If requested to do so, the Seller will deliver to the Iowa Department of Transportation, Office
of Right of Way, 800 Lincoln Way, Ames, IA 50010, an abstract of title to the premises. The Buyer agrees to
pay the cost of abstract continuation. The Seller agrees to provide the documents as may be required by
Iowa Land Title Standards to convey merchantable title to the Buyer. The Seller also agrees to obtain court
approval of this agreement, if requested by the Buyer, in the event title to the premises becomes an asset of
any estate, trust, conservatorship or guardianship. The Buyer agrees to pay court approval costs and all
other costs necessary to transfer the premises to the Buyer, except attorney fees. Claims for such transfer
costs shall be paid in amounts supported by paid receipts or signed Invoices.
7. The Buyer agrees that any agricultural drain tiles that are located within the premises that are damaged or
require relocation by highway construction shall be repaired or relocated at no expense to the Seller. Where
the Buyer specifically agrees to construct and maintain fence, the fence shall be constructed and maintained
for vehicle access control purposes at no expense to the Seller. The Buyer has the right of entry upon the
Seller's remaining property along the right-of-way line, if necessary, for the purpose of connecting the drain
tile, and constructing and maintaining the fence. The Seller may pasture against the fence at his/her own
risk. The Buyer will not be liable for fencing private property or maintaining it to restrain livestock.
8. If the Seller holds title to the premises in joint tenancy with full rights of survivorship and not as tenants In
common at the time of this agreement, the Buyer will pay any remaining proceeds to the survivor of that joint
tenancy, and will accept title solely from that survivor, provided the joint tenancy has not been destroyed by
operation of law or acts of the Seller.
9. These premises are' being acquired for public purposes. This transfer is exempt from the requirements for
the filing of a "Declaration of Value' In accordance with Iowa Code section 428A.1.
10. The premises also Includes all estates, rights, title, and interests, Including all easements, and all advertising •
devices and the right to erect such devices as are located thereon. The Seller consents to any change of
grade of the highway and accepts payment under this agreement for any and all damages arising from
those changes. The Seller acknowledges full settlement and payment from the Buyer for all claims per the
terms of this agreement, and discharges the Buyer from liability because of this agreement and the
construction of the public Improvement project.
11. The Seiler states and warrants that, to the best of the Seller's knowledge, there Is no burial site, well, solid
waste disposal site, private sewage disposal systems, hazardous substance or underground storage tank
on the premises, except: Old gas station may contain old underground storage tank(s).
12. This written agreement constitutes the entire agreement between Buyer and Seller and there Is no
agreement to do or not to do any act or deed except as specifically provided for herein.
13. Buyer hereby gives notice of Seller's five-year right to renegotiate construction or maintenance damages not
apparent at the time of the signing of this agreement as required by the Code of Iowa, Section 68.52.
14. The Sellers grant to the Buyer temporary easements for the purpose of saw cutting and constructing
entrances, The Right -of -Way Design Plot Plan, attached as a page 5 of this agreement, graphically
illustrates the proposed temporary easement area being granted. The temporary easement shall terminate
on completion of this highway project.
15. Buyer agrees to construct a Type "B" entrance at Sta. 307+17, mainline, East side; and a Type "8" entrance
at Sta. 1309+03, side road Commercial Street, South side.
It is understood and agreed that the entrances at Sta. 307+74, mainline, East side; and the entrance at Sta.
1308+90, side road Commercial Street, South side; and all other entrances located within the construction
limits of this highway project that are not listed or allowed in this agreement will be eliminated,
16. It Is understood and agreed that the illegal 'Can -Am' sign, located in the City ROW and overhanging the State
ROW, shall be removed by the Owner before possession is given. If said sign Is not removed before
possession is given, the Buyer shall remove the sign, as needed, for the project's construction.
51, NHSX-63-6(70)-3H-07
Page 2 of 6
File Number: 2017-00003067 Seri: 2
'Page 3 of 6
Seller's signature and claimant's certification: Upon due approval and execution by the Buyer, the
undersigned sellers/claimants certify the total lump -sum payment amount shown here is Just and unpaid.
B and R 011 Corp.
BY: X /f . X
G. 'fitter, Secretary
100 Commercial St.
Waterloo, IA 50701
This section to be completed by a
SELLER'S ACKNOWLEDGEMENT
STATE OF Iowa }
COUNTY OF /2/t1'',/r 141/4) }
SS:
On this an -c• day of
A.D.2016
before me, the undersigned, a notary public in and for said state,
personally appeared Gary Ritter
Notary Public.
CAPACITY. -CI MMED BYSIGNER:
❑ INDIVIDUAL
® CORPORATE
Title(s) of CorporateOfficer(s);
Secretary
LEI to me personally known; or
El proved to me on the basis of satisfactory evidence to be the person
(s) whose name(s) Is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/
their authorized capacity°es), and that by his/her/their signature(s)
on the instrument the person(s), or the entity upon behalf of which
the person(s) acted, executed the instrument.
KM.Lan -
.ea -- —T
(Sign in ink)
Wkin` �z'Z C izr rrz— (Print/type name)
Notary Public in and for the $tate of Iowa !'
My commission expires /— 0 — oI9
(NOTARIAL SEAL)
EI OM IONNO161342l
:A=
on 8
JANUAR , e
61, NHSX-63-6(70)-3H-07
fl Corporate Seal is affixed
® No Corporate Seal procured
0 Limited Partnership
0 General Partnership
0 ATTORNEY-IN-FACT
EXECUTOR(s) or TRUSTEE(s)
GUARDIAN(s) or
CONSERVATOR(s)
Other:
SIGNER IS REPRESENTING:
List name(s) of endty(ies) or person(s)
B and R 011 Corp.
Page 3 of 6
File Number: 2017-00003067 Seq: 3
Page d of 6
Seller's signature and claimant's certification: Upon due approval and execution by the Buyer, the
undersigned sellers/claimants certify the total lump -sum payment amount shown here Is just and unpaid.
Xice' X fj�Z
��-uT/7fit✓
G§ Ritter
Hol Ritter G .
1924 Kamilla Ct.
Waterloo, IA 50701
This section to be completed by a Notary Public.
SELLER'S ACKNOWLEDGEMENT
CAPACITYGI:AIMED BY:SIGNER:
STATE OF Iowa }
COUNTY OF , 2d,b fK/ } ss:
On this adz day of JwLt- A.D. 2016
before me, the undersigned, a notary public in and for said state, personally
appeared Gary C. Ritter and Hollis Ritter
to me personally known; or
❑ proved to me on the basis of satisfactory evidence to be the person
(s) whose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same In his/her/
their authorized capacity(ies), and that by his/her/their signature(s)
on the instrument the person(s), or the entity upon behalf of which
the person(s) acted, executed the instrument.
t..._> !' i (Sign in ink)
1'I
n HOZ/6- y � 94-(Print/type name)
Notary Public in and for the State of/ Iowa
My commission exp res
® INDIVIDUAL
❑ CORPORATE
TItle(s) of Corporate Offlcer(s):
U Corporate Seal is affixed
❑ No Corporate Seal procured
❑ Limited Partnership
❑ General Partnership "
❑ ATTORNEY-IN-FACT
0 EXECUTOR(s) or TRUSTEE(s)
❑ GUARDIAN(s) or
CONSERVATOR(s)
❑ Other:
aeenReoersustnm(s) or ry(is) or person(s)
BUYER'S APPROVAL
Recommended
(Sign in
(Printed Name):
Approved by
(Sign in
(Printed Name):
by ���/
Ink): X t�fiC.vas
.F/0(//24., or
(Date)
Project Agent
Scott Henning
ink): X clyn/ / (Date) AUG 0 8 16
Right of ay Director
Martin J. ankey /
BUYER'S' ACKNOWLEDGEMENT
STATE
COUNTY
On
personally
Buyer
minutes,
hereon,
(NOTARIAL
OF IOWA , }
OF STORY } ss:u^,
this 24' day of /4 , lli( 2016 , before me, the undersigned,
appeared ROW Director,
and who did say that the instrument
and said right of way director
to be the voluntary act and deed
Martin 5. Sankey known to me to be aRight of Way Director of the
was signed on behalf of the Buyer by its authority duly recorded in its
acknowledged the execution of the instrument, whose signature appears
of the Buyer, and by it voluntarily executed.
'
IXs_ t„
.�'q,
a 1
rows.
VALERIE E. GOETHALS
COMMISSION NO. 10573
Mfi COMMISSION EXPIRES
JUNE 5, 2018
SEAL) otary Public in one- the State of Iowa
51, NHSX-63-6(70)-3H-07
Page 4of6
File Number: 2017-00003067 Seq: 4
Page 5 O\ 6
OWNER: GARY C. RITTER
0106NIW94av\ enoa
IOWA DEPARTMENT OF TRANSPORTATION l'IM15eeHaubifermi. ha#IN\41069010.
PROJECT DEVELOPMENT
PLOT PLAN
PARCEL NO.: 51
B AND R OIL CORP.
SECTION: 26 T 89 N -R 13 W
SCALE -111=50'
. City of Waterloo
Orlg!nal Plat Waterloo --Block 11
W.D. OR EASEMENT LINE:
ACCESS LOCATION POINT:
PROPERTY LINE:
LEGEND
�• s
(
Y� 0IARY EASEMENT TO
CU CONSTRUCT ENTRANCE
1,281 SQ.FT.
COUNTY: BLACKHAWK
C
PROJECT N0• NHSX-63-6(70)- -3H-07
File Number: 2017-00003067 Seq: 5
Payo6o'6 '
EOMGM-011
6-15
COUNTY
IOWA DEPARTMENT OF TRANSPORTATION
ACQUISITION PLAT
EXHIBIT "A"
BLACK HAWK
PROJECT NO.
SECTION
NNSX-63-6(701--3H-01
26
TOWNSHIP 89 N
STATE CONTROL NO.
PARCEL NO.
RANGE
Piqa
&a IOWADOT
51
13.W
ROW - FEE AC EASE 74 S0. FT. AC. EXCESS - FEE
ACOUIREO ACCESS RIGHTS FROM STA. TO STA. MAIN LINE
ACOUIREO ACCESS RIGHTS FROM STA. TO STA. SIDE ROAD
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File Number: 2017-00003067 Seq: 6
FLOOD PLAIN DEVELOPMENT PERMIT
WATERLOO, IOWA
In accordance to the provisions of the Waterloo Zoning Ordinance No. 5079, as amended, approval
of this Flood Plain Development Permit is required for all construction improvements and
development located within the boundaries of the Floodway, Floodway Fringe, General Flood Plain
and Shallow Flooding Overlay Districts,
1. APPLICATION INFORMATION
a. Applicant's Name: Hydrite Chemical Co.
Address: 114N. Main St Cottage Grove WI 53527
Telephone No.: 608-839-8126
b. Status of Applicant (owner, contract owner, agent, etc.): Owner
c. Property owner's name, address and telephone number (if different from above):
2. PROJECT LOCATION
a. General location ofproperty/project: WCP&N Drive and Airline Highway
b. Legal description of property: Parcel "C" as shown on Plat of Survey recorded as
Document 2014.007998: and Parcel "D" as shown on Plat of Survey recorded as
Document 2017-002391 :in the NW 1/4 of Section 10-89-13
c. Stream: No. 13
d. 100 Year Flood Elevation (mean sea level) 862.5
e. Elevation (mean sea level) of the lowest floor (including basement) of building or of
the level to which a building or structure is to be lloodproofed' 864.9
f. Zoning Classification'
M-2, Heavy industrial
3. PROJECT DESCRIPTION
a, Anticipated dates. of constivction:
Initiation Nov. 15, 2016
Completion November, 2017
b. Estimated costs of improvements and, if applicable, the market value of the
building prior to the improvements'
c. Describe the use or occupancy for which the proposed work is intended:
Production facility for
d, Brief description of project and methods used for floodproofing• Building is slab -
on -grade production facility With adjacent outdoor storage tanks.
Certification: It is required that a professional engineer or land surveyor (registered
in the State of Iowa) must certify that the finished fill, building floor elevations,
floodproofing, or other flood protection measures were accomplished and comply
with the provisions of this ordinance, Said certification shall be affixed to the plans
and/or specifications of the proposed development.
Signature of Certifying Engineer or Surveyor: - 6.41.4 (,.r.e //�� ,,,__
Date of Certification: Nov. 3, 2016 (Por pro1Sosd conditions)
I (we) hereby certify that this application and all the above described information are true
and corr et o to be, t of my (our) knowledge.
ignature of Applicant
City of Waterloo
11 I 7/Q of
Date
Date
Approve By Hydrlte Legal Dept
Dy:_, 0- /l 7- ;20 /�
DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
ELEVATION CERTIFICATE
IMPORTANT: FOLLOW THE INSTRUCTIONS ON PAGES 9-16
OMB Control Number. 16000008
Expiration: 11/38/2018
Copy all pages of this Elevation Certificate and all enrichments for (1) community official, (2) 'neurone agent/company. and (3) building owner.
SECTION A -PROPERTY INFORMATION
FORM INSURANCE COMPANY USE
A1. Building Owner's Name
Hydrile Chemical Co.
Policy Number.
A2. Building Street Address (including Apt., Unit, Suite, and/or BIdg. No.) or P.O. Route and
Box No.
Company NAIC
Number:
City Waterloo State Iowa
Zip Code 5070
A3. Properly Description
Black Hawk County Parcel
A4. Building Use (e.g., Residential,
A5. Lalilude/Longilude:
A6. Attach al least 2 photographs
A7. Building Diagram Number
A8 For a building with a
a) Square footage of
b) Number of permanent
crawlspace or enclosure(s)
above adjacent grade
c) Total net area of food
d) Engineered flood
(Lot and Block
8913-10-126-007
Non
La1.42.54145
of the
1A
Numbers. Tax Parcel Number, Legal Description,
-Residential, Addition, Accessory, etc) Non•Residential
Long. -92.36849 Horizontal Datum:
etc.)
("NAD 1927
insurance.
with an attached
footage of attached garage
of permanent good openings
garage within
grade
area of flood openings
good openings?
(.'NAD 1983
garage:
sq fl
building it the Cedificate Is being used to obtain good
aawlspace
aawlspace
good openings
within
openings
openings?
or endosure(s): A9. For a building
or endosure(s) sq 6 a) Square
in the b) Number
1.0 foot in the attached
above adjacent
1.0 fool
in A6.b sq in c) Total net
In A9.b sq In
r Yes IT No d) Engineered
r Yes a-, No
SECTION 8 -FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community N me& Community Number
Waterloo 190025
82. County Name
Black Hawk
B3. Stale
Iowa
84. Map/Panel Number
0186
85. Sulfa
F
88. FIRM Index Cale
87. FIRM Panel Effective/
Revised Dale
July 18.2011
88. Flood Zone(s)
AE
89. Base Flood Elevation(s)
(Zone AO, use base good
depth
862.5
810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item
RFIS Profile CFIRM (-Community Determined (-Other/Source:
811. Indicate elevation datum used for BFE in Item 89: (-NOVO 1929 67 NAVD 1988 ('Other/Source:
812. Is the building located In a Coastal Barrier Resources System (CBRS) area or Otherwise Protected
Designation Date: n/a ('CBRS COPA
89:
Area (OPA)? r Yes (•• No
SECTION C • BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1 Building elevations are based on:
C2. Elevations - Zones Al - A30, AE,
Complete Items C2.a -h below according
' A new Elevation Certificate will be required
Benchmark Utilized:
Indicate elevation datum used for the
C Other/Source:
Datum used for building elevations must
a) Top of bottom floor(induding basement,
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural
d) Attached garage flop of slab)
e) Lowest elevation of machinery or equipment
Desabet sof
( type equipment and location
0 Lowest adjacent (finished) grade next
g) Highest adjacent (finished) grade next
h) Lowest adjacent grade at lowest elevation
structural support
CO -Construction Drawings' C Building Under Construction' C
AH, A (with BFE), VE, VI - V30, V (with BFE), AR, ARIA. AR/AE, AR/A1 -
to the building diagram specified In Item A7. In Puerto Rico only. enter
when construction of the building is complete.
Vertical Datum:
elevations in items a) through h) below. CNGVD 1929 (e' NAVD 1988
Finished ConslNction
A30, AR/AH, AR/A0.
meters.
Check the measurement used.
( feet r meters
(2' feet C meters
Cleet C meters
(.'feel Cmelers
deet Cmelers
afeet (- meters
(.'feel r meters
('feel Cmelers
be the same as That used for
aawlspace, or enclosure
member (V Zones only)
servicing the building
M Comments)
to building (LAG)
to building (HAG)
of deck or stairs, including
the BFE.
floor) 884.90_
-
880.90__
884.90_
cc.AA o,,..., ee5 n '1171451
Pane '1 of IF
ELEVATION CERTIFICATE
OMB Control Number: 1660-0008
Expiralion: 11(302010
SECTION D • SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by land surveyor, engineer, or architect authorized by
that the lnfomation an Ods Certificate represents my hest efforts to Interpret Ilia data available. I understand
poareliaele by ono or Imprisonment under III U.S. Code, Socaan Wet
Were latitude and longitude In Section A
E Check here if attachments. provided by alicensed land surveyor?
(. 'Yes ('No
law to certify elevation information. I codify
that any false statement may be
at gURVEy' 111
zo
/Q.'Wenaeii J. '• j
Lupkes j
�I :`, t 2088 .i j
i
11 4'''' -
1 film 'ow e
Cedifier's Name
Wendell J. Lupkes
License Number
12086
Title
Professional Land Surveyor
Company Name
VJ Engineering
Address -
1501 Technology Parkway
City
Cedar Falls
Stale
IA
Zip Code
50613
Signature
/.4-!),
Q
A- 1 a ‘A—
Dale
/ /- .3 - tin
Telephone
+1 (3 9) 266.5829
r
Copy both sides of this 6 eevaiion Certificate for ( ) community official, (2 insurance agent/company, and (3) building owner.
Comments (including type
Lowest Adjacent grade I
of equipment and location , per C2(e), If applicable)"
al truck docks on north end of building
Signature
Date
SECTION E -BUILDING
ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones A0 and A (Wil
Sections A, B,end C. For
E1. Provide elevation ink
highest adjacent grade
a) Top of bottom foo
orenclosure) Is
b) Top of bottom Boo
or enclosure) Is
E2. For Building Diagram
higher floor (elevation C2
E3. Attached garage (lop
E4. Top of platform of m
servicing the building Is
65, Zone AO only: If ho fld
management ordinanco7l
out BFE), complete Items
Items E1 -E4, use natural
ovation for the following
(HAG) and the lowest
(including basement, crawlspace,
(Including basement cravdspaco'
6 -9 with permanent flood
bin Bre diagrams) of the
of stab) is
chinery and /or equipment
depth number is available,
ryes r No (Unknown.
El -E5. 111110 Certificate is Intended
grade. if available. Check the
andcheck the appropriate boxes
adjacent grade (LAG),
.
to support
measurement used.
to show whether
(' (eelC meters
('Icer rmelers
A ((ems 8 and/or
r feel r
a LOMA or LOMR-F request. complete
In Puerto Rico only. enter meters.
the elevation Is above or below the
❑ above or ■below the HAG.
❑above or ❑below the LAG.
9 (see pages 8 -9 of Instructions), the next
meters ❑ above or ❑ below the HAG.
0 above or ❑ below the HAG.
❑ above or • below the HAG:
openings provided
building Is
In Section
-
r feet C meters
r (eel C meters
elevated In accordance
certify this information
Is the top of the bottom Poor
The local official must
with the community's floodplain
In Section 0.
ISECTION
F -PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or ot'(ner's
community -Issued BFE)
eu(heezed representative who completes Sections A, B, and E for Zone A (without a FEMA•issuod or
r Zone AO must sign here. The statements in Sections A, e, and E ere correct to the best of my knowledge.
Property Owner or Owner's
Authorized Representative's Name:
AddressLv N,
s
Pc.f-y(Cic stud . City arooLeie id, Slate to' ZIP Code 530:is
Signature \LPDate
^ Telephone ? f,a -1C( —1 L+G o
I r''.7/ !fa
•� F
Comments
❑ Check here If. attachments.
CCAAA
00
'11(7 1c,
Pana d of 1 F
OMB Control Number: 10640008
Expiration: 118012018
SECTION G. -COMMUNITY INFORMATION (OPTIONAL)
The local official who Is authorized by law or ordinance to administer the community's Iloodpluln management ordinance can complete Sections
A, B, C (or E), and G of This Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used In Items G8 -
610. In Puerto Rico only, enter meters.
G1. [] The information in Section C was taken from other documentation Thal has been signed and sealed by a licensed surveyor, engineer,
or architect who Is aulhodzed by law to certify elevation information. (Indicate the source and date of the elevation data in the
Comments area below.)
02.❑ A community official completed Section E for a building located in Zone A (without a FEMAdssued or community -issued BFE) or Zone
AO.
03. [] The following information (Items G4 -G10) is provided for community floodplain management purposes.
G4. Permit Number
05, Date Permit Issued
G6. Date Certificate of Compliance/Occupancy Issued
G7. This permit has been issued for, r New Construction
G8. Elevation of as -built lowest floor (including basement)
of the building:
G9. BFE or (In Zone AO) depth of flooding at the
site:
010. Community's design flood elevation:rfeel
r Substantial Improvement
_- (-feel rmelers Datum
building
r feel r- Datum
meters
rmeters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
fl Check here if attachments.
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PAVING/GRADING PLAN
Walorlo°, Iowa
VJ Engineering
1501 Technology Parkway
Cedar Falls, Iowa — 319-266-5829
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Page 1 of 1
EXHIBIT "A"
The West 67 feet of the East 100 feet of the North 5
acres of the South 10 acres of the Northwest '% of the
Southeast Quarter of Section 36, Township 89 North,
Range 13 West, City of Waterloo, Iowa. And also, the
East 67 feet of Lots 1 and 2 of Sunkist Addition, City
of Waterloo, Iowa.
File Number: 2015-00008550 Seq: 2