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REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT
Please read the filing instructions on the reverse side BEFORE completing this form.
PART I - TO BE COMPLETED BY TRANSFEROR
(Please Type or Print Legibly)
TRANSFEROR Name William C. Knapp Revocable Trust Social Security No.
(or Federal I.D. No.) 42-6426333
Address 300 Walnut, Suite 185 Des Moines Iowa 50309
Number and Street or RR City,Town or P.O. State Zip
Bloomington Heights Social Security No.
TRANSFEREE Name _ ghts Plat 4 L—�
(or Federal I.D. No.)
Address 1�
Number and Street or RR City,Town or P.O. State Zip
kddress of Property Transfered Ames Iowa 50010
Number and Street or RR City,Town or P.O. State Zip
.egal Description of Property See Exhibit A attached hereto
1. Wells (check one)
� There are no known wells situated on this property.
❑ There is a well or wells situated on this property. The type(s), location(s) and legal status are stated below.
2. Solid Waste Disposal (check one)
There is no known solid waste disposal site on this property.
❑ There is a solid waste disposal site on this property, but no notice has been received from the Department
of Natural Resources that the site is deemed to be potentially hazardous.
❑ There is a solid waste disposal site on this property which has been deemed to be potentially hazardous
by the Department of Natural Resources. The location(s) of the site(s) is stated below.
3. Hazardous Wastes (check one)
�b There is no known hazardous waste on this property.
❑ There is hazardous waste on this property and it is being managed in accordance with Department of
Natural Resources rules.
4. Underground Storage Tanks (check one)
There are no known underground storage tanks on this property. (Note exclusions such as small farm
and residential motor fuel tanks, most heating oil tanks, cisterns and septic tanks, in instructions.)
❑ There is an underground storage tank or tanks on this property. The type(s), size(s) and any known
substance(s) contained are described below.
Information, if any, required by statements checked above:
s
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Attachment for Additional Information? Y / N If so, number of pages
I HEREBY DECLARE THAT THE INFOR ATION CONTAINED IN PART I OF THIS STATEMENT IS TRUE
AND CORRECT.
Signature: Telephone Number: ( I� z��-�Od 0
--- (Transf ror or Agent)—
----------------- --------------------------------------------------
Q PART II - TO BE COMPLETED BY RECORDER
Date of Instrument -` '�� C y Book/I.D.[� Page/I.D. 1U426
Date of Recording - l q/ City Township —ffilne
Deed ❑
Contract ❑ County
DNR form (JUL 89) FILE WITH RECORDER 502-0960
(See Instructions, #5)
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EXHIBIT A
LEGAL DESCRIPTION
A replat of outlot "C", Bloomington Heights Plat 3, an
Official plat, City of Ames, Story County, Iowa, that is also described as
follows:
Beginning at the Northwest (NW) Corner of Section Twenty-
seven (27) , Township Eighty-four (84) North, Range Twenty-four (24) West of
the 5th P.M. , Iowa; thence S 89*02.50" E, One Thousand Three Hundred Nine
and Two Tenths (1,309.2) Feet along the North line of said Section Twenty-
seven (27) to the Northwest (NW) Corner of Stone Brooke Subdivision Fourth
Addition, an official plat; thence S00°2213311W, One Thousand One Hundred
and Fifty-three Hundredths (1,100.53) Feet along the West line of said
Stone Brooke Subdivision Fourth Addition, an official plat; thence N
89°37'27" W, Two Hundred Twelve and Fifty-seven Hundredths (212.57) Feet to
a point; thence S 56000,00" W, Two Hundred Sixty-nine and Fifty-nine
Hundredths (269.59) Feet to a point; thence S 27*00,00" W, Three Hundred
Twenty-three and Seven Tenths (323.7) Feet to a point; thence S 20*24,35"
W, One Hundred Sixteen and Thirty-six Hundredths (116.36) Feet to a point;
thence S 00*22,33" W, One Hundred Eighty-four (184) Feet to a point; thence
N 89*37127" W, Three Hundred Ten (310) Feet to a point; thence S 00*22.33"
W, One Hundred Thirty-five (135) Feet to a point; thence S 89*37,27" t,
Fifty and Four Hundredths (50.04) Feet to a point; thence S 00022,33" W,
One Hundred Twenty-five and Thirteen Hundredths (125.13) Feet to a point;
thence S 89*04,19" W, Four Hundred Thirty-four and Seventy-seven Hundredths
(434.77) Feet to a point on the West line of said Section Twenty-seven
(27) ; thence N 00*31127" E, Two Thousand One Hundred Eighteen and Sixty-six
Hundredths (2,118.66) Feet along said West line to the point of beginning
and containing Forty-nine and Thirty-two Hundredths (49.32) Acres, more or
less, From Root of Title.