Form FEMA 81-78 FEMA 81-78 Residential Basement Floodproofing Certificate

FEDERAL EMERGENCY MANAGEMENT AGENCY

For use ONLY in communities which have been granted an exception by FEMA to allow the construction of floodproofed residential basements
in Special Flood Hazard Areas.
BUILDING OWNER'S NAME

FOR INSURANCE COMPANY USE
POLICY NUMBER

BUILDING STREET ADDRESS (Including Apt., Unit. Number)
COMPANY NAlC NUMBER

OTHER DESCRIPTION (Lot and Block Numbers, etc.)

1 STATE

CITY

1 ZIP CODE

SECTION I-FLOOD INSURANCE RATE MAP (FIRM) INFORMATION

Provide the following from the FIRM and flood profile (from Flood Insurance Study)
BASE FLOOD ELEVATION (NGVD)
(In A 0 Zones, Use depth)

NAME OF FLOODING SOURCE(S)
AFFECTING BUILDING

SECTION 11-FLOODPROOFING INFORMATION (By a Registered Professional Engineer or Architect)

Floodproofing Design Elevation Information:

II
I

Building is floodproofed to an elevation of
(Elevation datum used must be the same as that on the FIRM)

-

Elevation of the top of the basement floor is

.

feet NGVD.

.

feet NGVD.

(NOTE: Thefloodproofing design elevation must be at least one foot above the Base Flood Elevation (BFE))
SECTION 111-CERTIFICATION (By a Registered Professional Engineer or Architeco

Residential Floodproofed Basement Construction Certification:

I

I certify that based upon development andlor review of structural design specifications, and plans for construction, including consideration of the
depth, velocity, and duration of flooding and the type and permeability of soils at the site, that the design and methods of construction of the
floodproofed basement to be used are in accordance with accepted standards of practice for meeting the following provisions:

I

II

*Basement area, together with attendant utilities and sanitary facilities, is watertight to the floodproofing design elevation with
walls that are impermeable to the passage of water without human intervention; and
*Basement walls and floor are capable of resisting hydrostatic and hydrodynamic loads and the effects of buoyancy resulting
from flooding to the floodproofing design elevation; and have been designed so that minimal damage will occur from floods
that exceed the floodproofing design elevation; and
*Building design, including the floodproofing design elevation, complies with community requirements.

I

I 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 1001.
LICENSE NUMBER(or affix Seal)

CERTIFIER'S NAME

1

COMPANY NAME

I CITY

I
I

SIGNATURE

I

1
I

STATE

1 ZIP
I

DATE

Copies of this certificate must be given to: 1) the community official: 2) the insurance agent: and 3) the building owner.

FEMA Form 81-78, MAY 04

PREVIOUS EDITION OBSOLETE

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